Ochi H
Department of Obstetrics and Gynecology, Ehime University, School of Medicine.
Nihon Sanka Fujinka Gakkai Zasshi. 1993 Jul;45(7):643-9.
The present study was conducted to elucidate circulation dynamics in uteroplacental and fetal circulation in 130 normal pregnancies and in 40 patients with pregnancy-induced hypertension (PIH). A sector and pulsed Doppler system was employed to measure the uterine artery pulsatility index (UtA-PI), umbilical artery pulsatility index (UAPI), fetal middle cerebral artery pulsatility index (MCPI) and fetal descending aorta peak velocity (AoPV). Furthermore, peak velocity during early diastolic (E) and atrial contraction (A) periods through the mitral (M) and tricuspid (T) valves was measured to determine their ratios (M-E/A and T-E/A). Twelve of the 40 PIH women had UtA-PIs of 95% or higher in normal pregnant women. Ten of the 12 fetuses in women with high UtA-PIs had high UAPIs, 5 of whom demonstrated an MCPI decrease. Two of them represented an increase in M-E/A and a decrease in T-E/A and AoPV, and the prognosis was poor. Only 2 of the PIH women with normal UtA-PIs had high UAPIs. The fact that both M-E/A and T-E/A were inversely correlated with MCPI and UAPI, respectively, suggests that these parameters could be used as indexes demonstrating cardiac afterload in fetuses. UtA-PI measurement in combination with fetal circulation indexes could predict fetal and neonatal well-being.
本研究旨在阐明130例正常妊娠和40例妊娠高血压综合征(PIH)患者的子宫胎盘循环及胎儿循环的血流动力学情况。采用扇形脉冲多普勒系统测量子宫动脉搏动指数(UtA-PI)、脐动脉搏动指数(UAPI)、胎儿大脑中动脉搏动指数(MCPI)及胎儿降主动脉峰值流速(AoPV)。此外,还测量了通过二尖瓣(M)和三尖瓣(T)瓣膜的舒张早期(E)和心房收缩期(A)的峰值流速,以确定它们的比值(M-E/A和T-E/A)。40例PIH患者中有12例的UtA-PI在正常孕妇的95%或更高。UtA-PI高的女性所怀的12例胎儿中有10例UAPI高,其中5例MCPI降低。其中2例表现为M-E/A升高、T-E/A和AoPV降低,预后较差。UtA-PI正常的PIH患者中只有2例UAPI高。M-E/A和T-E/A分别与MCPI和UAPI呈负相关,这一事实表明这些参数可作为显示胎儿心脏后负荷的指标。联合测量UtA-PI和胎儿循环指标可预测胎儿及新生儿的健康状况。