Harrington K, Carpenter R G, Nguyen M, Campbell S
Department of Obstetrics and Gynaecology, King's College School of Medicine and Dentistry, London, UK.
Ultrasound Obstet Gynecol. 1995 Jul;6(1):19-28. doi: 10.1046/j.1469-0705.1995.06010019.x.
The aim of this study was to compare changes in Doppler ultrasound studies of the fetal circulation in normal pregnancies with a group of pregnancies complicated by proteinuric pregnancy-induced hypertension (PPIH), delivery of a small-for-gestational-age (SGA) baby, or both. A total of 167 uncomplicated pregnancies with a term delivery of an appropriately grown baby (AGA) were used to define the normal range. Altogether, 123 high-risk pregnancies with a known outcome constituted the study group. A color duplex ultrasound machine was used to perform biometry and fetal Doppler studies. Measurements obtained from the fetal circulation included the umbilical artery (UA) pulsatility index (PI), the middle cerebral artery (MCA) PI and time-averaged velocity (TAV), the thoracic aorta (AO) PI and TAV. In addition, the ratio between the MCA PI and UA PI, the MCA PI and the AO PI, and the product of the MCA PI and AO TAV were used in the analysis. A total of 105 pregnancies had a complicated outcome. They were divided into three categories: PPIH only (pregnancies complicated by PPIH with the delivery of an AGA fetus, n = 17), SGA only (delivery of an SGA baby, with no evidence of PPIH, n = 55), and PPIH + SGA (pregnancies complicated by pre-eclampsia and delivery of an SGA baby, n = 37). The PPIH + SGA group represented true clinical intrauterine growth retardation. Cross-sectional reference ranges were created using the observations from the normal group. z-scores (standard deviation from the mean of the normal range) of the last observations made before delivery were calculated for each of the vessel velocimetry measurements and ratios. The statistical significance of z-score values was calculated using analysis of variance. The MCA and UA PI values showed the greatest deviation for any single-vessel parameter. The ratios of fetal Doppler indices (MCA/UA PI ratio, MCA/AO PI ratio and the MCA PI/AO TAV index) demonstrated greater deviation from normal than any individual vessel. The UA PI z-score for PPIH+SGA delivering < 34 weeks gestation (2.92) was significantly greater than the z-score for PPIH+SGA delivering > or = 34 weeks (1.20, p < 0.05). Fetal Doppler indices, in particular ratios that include measurements obtained from the cerebral circulation, help in the recognition of the small fetus that is growth-retarded. At term, evidence of fetal hemodynamic redistribution may exist in the presence of a normal umbilical artery PI. Fetal Doppler indices provide information that is not readily obtained from more conventional tests of fetal well-being.(ABSTRACT TRUNCATED AT 400 WORDS)
本研究的目的是比较正常妊娠与一组并发蛋白尿性妊娠高血压（PPIH）、分娩小于胎龄儿（SGA）或两者皆有的妊娠中胎儿循环的多普勒超声研究变化。总共167例足月分娩正常生长胎儿（AGA）的未并发妊娠用于定义正常范围。总共123例已知结局的高危妊娠构成研究组。使用彩色双功超声仪进行生物测量和胎儿多普勒研究。从胎儿循环获得的测量值包括脐动脉（UA）搏动指数（PI）、大脑中动脉（MCA）PI和时间平均速度（TAV）、胸主动脉（AO）PI和TAV。此外，MCA PI与UA PI的比值、MCA PI与AO PI的比值以及MCA PI与AO TAV的乘积用于分析。共有105例妊娠结局复杂。它们分为三类：仅PPIH（并发PPIH且分娩AGA胎儿的妊娠，n = 17）、仅SGA（分娩SGA婴儿，无PPIH证据，n = 55）和PPIH + SGA（并发子痫前期且分娩SGA婴儿的妊娠，n = 37）。PPIH + SGA组代表真正的临床宫内生长受限。使用正常组的观察结果创建横断面参考范围。为每个血管测速测量值和比值计算分娩前最后一次观察的z分数（与正常范围平均值的标准差）。使用方差分析计算z分数值的统计学显著性。MCA和UA PI值在任何单个血管参数中显示出最大偏差。胎儿多普勒指数的比值（MCA/UA PI比值、MCA/AO PI比值和MCA PI/AO TAV指数）显示出比任何单个血管更大的偏离正常。妊娠<34周分娩的PPIH + SGA的UA PI z分数（2.92）显著大于妊娠≥34周分娩的PPIH + SGA的z分数（1.20，p < 0.05）。胎儿多普勒指数，特别是包括从脑循环获得测量值的比值，有助于识别生长受限的小胎儿。足月时，在脐动脉PI正常的情况下可能存在胎儿血流动力学重新分布的证据。胎儿多普勒指数提供了从更传统的胎儿健康测试中不易获得的信息。（摘要截短至400字）
