Alfirevic Z, Neilson J P
Department of Obstetrics and Gynaecology, University of Liverpool, UK.
Curr Opin Obstet Gynecol. 1996 Apr;8(2):114-8.
Searches for clinical applications of Doppler ultrasound in fetomaternal medicine continue. Currently, there are three main areas of interest: Doppler velocimetry of the umbilical artery, uterine artery and the fetal circulation (cerebral and venous blood flow studies). Evidence from randomized trials suggests that if women with suspected intra-uterine growth retardation or pre-eclampsia are offered Doppler studies of the umbilical artery, a clinically important reduction in perinatal mortality may be expected. On the other hand, screening of low-risk women either by umbilical artery Doppler or uterine artery Doppler is unlikely to be cost-effective. The study of other fetal vessels provides a fascinating insight into vascular changes that occur in fetal compromise, but it is not known whether the use of these tests will actually reduce perinatal mortality and morbidity. None of the Doppler indices used so far, including the middle-cerebral artery to umbilical artery ratio, has been able to match the performance characteristics of umbilical artery Doppler. Until clear evidence emerges on its benefit or otherwise, comprehensive fetal assessment by Doppler ultrasound should be used for research purposes only and results of these tests should not be used to guide clinical practice.
对多普勒超声在母胎医学中的临床应用的探索仍在继续。目前，主要有三个感兴趣的领域：脐动脉、子宫动脉的多普勒测速以及胎儿循环（脑和静脉血流研究）。随机试验的证据表明，如果对疑似宫内生长受限或先兆子痫的妇女进行脐动脉多普勒检查，围产期死亡率有望在临床上得到显著降低。另一方面，通过脐动脉多普勒或子宫动脉多普勒对低风险妇女进行筛查不太可能具有成本效益。对其他胎儿血管的研究为胎儿窘迫时发生的血管变化提供了有趣的见解，但尚不清楚使用这些检查是否真的会降低围产期死亡率和发病率。到目前为止所使用的多普勒指标，包括大脑中动脉与脐动脉比值，都无法与脐动脉多普勒的性能特征相匹配。在有明确证据证明其有益或无益之前，多普勒超声的综合胎儿评估仅应用于研究目的，这些检查结果不应被用于指导临床实践。
