Behrens O, Wedeking-Schöhl H, Goeschen K
Frauenklinik der Medizinischen Hochschule Hannover.
Geburtshilfe Frauenheilkd. 1996 Jun;56(6):272-7. doi: 10.1055/s-2007-1023025.
Absent (absent-EDF) or reversed (RF) end-diastolic flow in Doppler velocimetry in the umbilical artery and fetal aorta indicates highly disturbed fetoplacental perfusion, which often occurs early in pregnancy. Perinatal mortality and morbidity is very high. In this situation it is not clear how long pregnancy can be continued to achieve better conditions for the preterm fetus. This study was performed to investigate the value of fetal heart rate recordings (FHR) in patients with absent EDF or RF as a parameter to determine the optimum time of delivery. 25 pregnancies with absent (n = 21) or reversed end-diastolic velocity (n = 4) were analysed. Gestational age was between 24 and 34 weeks. 17 children showed compensatory dilatation of the middle cerebral artery (68%). 15 (60%) were growth retarded, 8 of them below the 3% percentile, while 3 had normal weight. Maximum time interval until delivery was 18 days, median was 2 days. Five children died before, 2 during delivery. As none died after delivery, perinatal mortality was 28%. 4 of the survivers (22%) showed arterial acidosis. Only three children had completely normal fetal heart rate recordings on the day of diagnosis of absent EDF or RF. All others showed at least suspicious FHR (according to Hammacher), 8 of them (32%) even pathological FHR, including all children who died later. Early suspicious changes in FHR were the reduction in frequency and amplitude of oscillation, while decelerations occurred later. Additional unfavourable parameters in FHR were roundings of the oscillatory inversions as well as missing reactivity to fetal movements. Fetal heart rate monitoring is a reliable tool for determination of the optimum time of delivery in children with absent EDF or RF. The decision has to be made in relation to the gestational age. If possible, the fetus should be born before FHR becomes pathological. In this manner perinatal mortality and morbidity should be kept at a low level even in high-risk patients with absent EDF or RF.
脐动脉和胎儿主动脉多普勒测速中舒张末期血流缺失（EDF缺失）或反向（RF）表明胎儿胎盘灌注严重紊乱，这在妊娠早期经常发生。围产期死亡率和发病率非常高。在这种情况下，尚不清楚妊娠可以持续多长时间以便为早产胎儿创造更好的条件。本研究旨在调查EDF缺失或RF患者的胎儿心率记录（FHR）作为确定最佳分娩时间参数的价值。分析了25例舒张末期血流缺失（n = 21）或反向（n = 4）的妊娠病例。孕周在24至34周之间。17例患儿出现大脑中动脉代偿性扩张（68%）。15例（60%）生长受限，其中8例低于第3百分位数，而3例体重正常。直至分娩的最长时间间隔为18天，中位数为2天。5例患儿在分娩前死亡，2例在分娩过程中死亡。由于分娩后无死亡病例，围产期死亡率为28%。4例存活者（22%）出现动脉酸中毒。在诊断EDF缺失或RF当天，只有3例患儿的胎儿心率记录完全正常。所有其他患儿至少显示可疑的FHR（根据哈马赫尔标准），其中8例（32%）甚至为病理性FHR，包括所有后来死亡的患儿。FHR早期可疑变化为振荡频率和幅度降低，而减速出现较晚。FHR的其他不利参数为振荡反转变圆以及对胎动缺乏反应性。胎儿心率监测是确定EDF缺失或RF患儿最佳分娩时间的可靠工具。必须根据孕周做出决定。如果可能，胎儿应在FHR变为病理性之前出生。通过这种方式，即使在EDF缺失或RF的高危患者中，围产期死亡率和发病率也应保持在较低水平。
