Guerra F, Puga O, Isla A, Retamal C, Montero A, Campos G, Aguilar R
Instituto y Servicio de Obstetricia y Ginecología, Hospital Regional, Universidad Austral de Chile, Facultad de Medicina, Valdivia.
Rev Chil Obstet Ginecol. 1995;60(2):101-7.
We show our experience in the diagnostic and management of 19 pregnancies with absent or reverse diastolic blood flow velocity (ARFV) in the umbilical artery. The presence of ARFV was a rare condition (2.2% of the high risk patients), and it was associated with a poor prognosis shown by the high percentage of fetuses SGD (small for gestational age) (63.2%), malformations and hydrops fetalis (26%) and asphyxiated fetuses, giving a final perinatal mortality rate of 36.8%. In 8 cases (42.1%) the termination or pregnancy was delayed for at least 48 hours, allowing in some cases the administration of corticosteroid. There were significant differences when comparing the groups of survivors and non survivors in relation to the gestational age at the moment of delivery (33.1 +/- 3.4 vs 28.6 +/- 3.8 weeks), malformations (8.3 vs 57.1%) and C-section (91.7 vs 42.9%). Finally, we conclude that the presence of ARFV in the umbilical artery is associated with a critical fetal condition and termination of pregnancy should be considered. In this decision the gestational age and fetal and maternal well being ought to be taken into account when choosing the best moment and route of delivery.
我们展示了对19例脐动脉舒张末期血流速度缺失或反向（ARFV）的妊娠进行诊断和管理的经验。ARFV的存在是一种罕见情况（占高危患者的2.2%），并且与不良预后相关，表现为胎儿生长受限（SGD，小于胎龄儿）的高比例（63.2%）、畸形和胎儿水肿（26%）以及胎儿窒息，最终围产儿死亡率为36.8%。在8例（42.1%）中，终止妊娠或分娩被推迟至少48小时，在某些情况下允许使用皮质类固醇。比较存活组和非存活组时，在分娩时的胎龄（33.1±3.4对28.6±3.8周）、畸形（8.3%对57.1%）和剖宫产（91.7%对42.9%）方面存在显著差异。最后，我们得出结论，脐动脉中ARFV的存在与胎儿危急状况相关，应考虑终止妊娠。在做出这一决定时，选择最佳分娩时机和途径时应考虑胎龄以及胎儿和母亲的健康状况。
