Reece E A, Hagay Z, Moroder W, DeGennaro N, Homko C, Wiznitzer A
Department of Obstetrics, Gynecology, and Reproductive Sciences, Temple University School of Medicine, Philadelphia, Pennsylvania 19140, USA.
J Ultrasound Med. 1996 Jun;15(6):437-40. doi: 10.7863/jum.1996.15.6.437.
At present, the role of Doppler velocimetry in monitoring fetal well-being in diabetic pregnancies is controversial. The present study was conducted to determine if fetal aortic velocity waveforms were correlated with fetal outcome in pregnancies complicated by diabetes mellitus. Fetal aortic blood flow was prospectively assessed in 30 pregnant women with insulin-dependent diabetes mellitus. Systolic-diastolic ratios were obtained at 2 week intervals between 18 and 38 weeks of gestation. They were analyzed according to several fetal outcome variables. Infants with presumed fetal distress during labor and neonates with respiratory abnormalities (respiratory distress syndrome, persistent fetal circulation, or transient tachypnea of the newborn) showed statistically significant elevations of aortic Doppler indices (P < 0.031 and < 0.011, respectively). However, these correlations lacked clinical relevance. The infants demonstrated no evidence of fetal distress at birth since Apgar scores were > 7 at 5 min in all but one neonate. No relationship was found between the mean third trimester fetal aortic systolic-diastolic ratios and perinatal death, preterm deliveries, birth weight, Apgar scores at 1 and 5 min, and neonatal metabolic abnormalities. These data demonstrate a poor correlation between fetal aortic Doppler waveform analysis and fetal outcome. Therefore, fetal aortic Doppler velocimetry cannot be used as a means of assessing impending fetal compromise in offspring of diabetic mothers.
目前，多普勒测速法在监测糖尿病孕妇胎儿健康状况方面的作用存在争议。本研究旨在确定胎儿主动脉速度波形与糖尿病合并妊娠的胎儿结局是否相关。对30例胰岛素依赖型糖尿病孕妇进行前瞻性胎儿主动脉血流评估。在妊娠18至38周期间，每隔2周获取收缩期与舒张期比值。根据几个胎儿结局变量进行分析。分娩时疑似胎儿窘迫的婴儿和有呼吸异常（呼吸窘迫综合征、持续性胎儿循环或新生儿短暂性呼吸急促）的新生儿，其主动脉多普勒指数有统计学意义的升高（分别为P < 0.031和< 0.011）。然而，这些相关性缺乏临床意义。由于除一名新生儿外，所有新生儿5分钟时阿氏评分均>7，故出生时婴儿无胎儿窘迫迹象。未发现孕晚期胎儿主动脉平均收缩期与舒张期比值与围产期死亡、早产、出生体重、1分钟和5分钟时的阿氏评分以及新生儿代谢异常之间存在关联。这些数据表明胎儿主动脉多普勒波形分析与胎儿结局之间相关性较差。因此，胎儿主动脉多普勒测速法不能用作评估糖尿病母亲后代即将出现的胎儿窘迫的手段。
