Caruso A, De Carolis S, Ferrazzani S, Valesini G, Caforio L, Mancuso S
Department of Obstetrics and Gynecology, Catholic University, Rome, Italy.
Obstet Gynecol. 1993 Dec;82(6):970-7.
To determine whether uterine artery velocimetry is a useful tool for identifying pregnancies with antiphospholipid syndrome at risk for adverse outcome.
Twenty-four women with antiphospholipid syndrome, who had experienced 56 fetal losses in 63 previous pregnancies (88.9%), were treated with prednisone (40 mg/day) and aspirin (100 mg/day) during 28 pregnancies. Color Doppler ultrasound was performed at 18-24 weeks' gestation to investigate the resistance index of the uterine arteries.
Treated women delivered 23 live infants in the 28 pregnancies (82.1%). Three infants weighed less than the tenth percentile (13%). Five pregnancies were complicated by preeclampsia and ten by nonproteinuric gestational hypertension. Positive results for all three assays for antiphospholipid antibodies (anticardiolipin antibodies, lupus anti-coagulant, VDRL) at conception identified pregnancies destined to have poor fetal outcome and a significantly lower birth weight compared to pregnancies not having all three assays positive. An abnormal resistance index of the uterine arteries predicted pregnancies with poor fetal outcome in terms of week of delivery, birth weight, and birth percentile, as well as four of five cases of preeclampsia.
Three assays positive for antiphospholipid antibodies at conception and an abnormal resistance index of the uterine arteries at 18-24 weeks' gestation predicted pregnancies at major risk for obstetric complications. Future studies should determine whether treatment can be modulated based on the Doppler findings.
确定子宫动脉血流速度测定是否为识别有不良结局风险的抗磷脂综合征妊娠的有用工具。
24例抗磷脂综合征女性，既往63次妊娠中有56次胎儿丢失（88.9%），在28次妊娠期间接受泼尼松（40mg/天）和阿司匹林（100mg/天）治疗。在妊娠18 - 24周时进行彩色多普勒超声检查，以研究子宫动脉的阻力指数。
接受治疗的女性在28次妊娠中分娩了23名活婴（82.1%）。3名婴儿体重低于第十百分位数（13%）。5次妊娠并发子痫前期，10次并发非蛋白尿性妊娠高血压。妊娠时抗磷脂抗体的所有三项检测（抗心磷脂抗体、狼疮抗凝物、VDRL）结果均为阳性，表明这些妊娠的胎儿结局较差，且与三项检测结果均为阴性的妊娠相比，出生体重显著更低。子宫动脉阻力指数异常可预测胎儿结局不良的妊娠，包括分娩孕周、出生体重和出生百分位数，以及五例子痫前期中的四例。
妊娠时抗磷脂抗体三项检测结果均为阳性，以及妊娠18 - 24周时子宫动脉阻力指数异常，可预测产科并发症风险较高的妊娠。未来研究应确定是否可根据多普勒检查结果调整治疗方案。
