[子宫和胎儿血流搏动指数的标准曲线及其在宫内生长受限临床管理中的功效。与胎儿血气分析的比较]

[The standard curves of pulsatility index from uterine and fetal blood flow, and their efficacy in clinical management of intrauterine growth retardation. A comparison with fetal blood gas analysis].

作者信息

Iwasaki T

机构信息

Department of Obstetrics and Gynecology, Nippon Medical School, Japan.

出版信息

Nihon Ika Daigaku Zasshi. 1996 Oct;63(5):327-42. doi: 10.1272/jnms1923.63.327.

DOI:10.1272/jnms1923.63.327

PMID:8937119

Abstract

Pulsed Doppler ultrasonography was used to asses the pulsatility index (PI) on flow velocity waveforms in uterine, umbilical and fetal middle cerebral arteries from a total of 659 pregnancies and the standard curves of each PI in relation with the gestational age were obtained from a total of 472 normal pregnancies. Cordocentesis was performed on 20 patients (centesis group) of PIH (pregnancy-induced hypertension) complicated with intrauterine growth retardation (IUGR) and fetal blood from the umbilical vein was sampled for blood gas analysis. Fetuses in the centesis group were acidemic (pH < 7.25) in 10 cases (50%), hypercapnemic (pCO2 > or = 50 mmHg) in 8 cases (40%), and hypoxemic (pO2 < 20 mmHg) in 6 cases (30%). In 13 cases (65%) in the centesis group, PI of the uterine artery (UTPI) was higher than +1.5 SD (standard division) of the standard curve (high UTPI), in 9 cases (45%) PI of the umbilical artery (UAPI) was higher than +1.5 SD of the standard curve (high UAPI), and in 10 cases (50%) PI of the middle cerebral artery (MCAPI) was lower than -1.5 SD of the standard curve (low MCAPI). All acidemic fetuses (100%) had high UTPI, 9 (90%) had high UAPI, and 8 (80%) had low MCAPI. All hypercapnemic fetuses had high UTPI, high UAPI and low MCAPI. All hypoxemic fetuses had high UTPI, high UAPI and low MCAPI. In the centesis group, the sensitivity, specificity, positive predictive value and negative predictive value of high UTPI to fetal acidosis was 100%, 70%, 76.9% and 100%, respectively. The sensitivity and the specificity of high UAPI and low MCAPI to fetal acidosis was 80% and 100%, respectively. The positive predictive value was 100% and negative predictive value was 83.3%. From this study, we conclude that measurement of uterine and fetal blood flow waveforms by pulsed Doppler ultrasonography is useful to assess fetal well-being in IUGR caused by hypertension during pregnancy.

摘要

采用脉冲多普勒超声检查评估了659例妊娠子宫、脐及胎儿大脑中动脉血流速度波形的搏动指数（PI），并从472例正常妊娠中获得了各PI与孕周相关的标准曲线。对20例妊娠高血压综合征（PIH）合并宫内生长受限（IUGR）的患者（穿刺组）进行了脐血穿刺，采集脐静脉血进行血气分析。穿刺组胎儿中，10例（50%）为酸血症（pH<7.25），8例（40%）为高碳酸血症（pCO2≥50 mmHg），6例（30%）为低氧血症（pO2<20 mmHg）。穿刺组中，13例（65%）子宫动脉PI（UTPI）高于标准曲线的+1.5标准差（SD）（高UTPI），9例（45%）脐动脉PI（UAPI）高于标准曲线的+1.5 SD（高UAPI），10例（50%）大脑中动脉PI（MCAPI）低于标准曲线的-1.5 SD（低MCAPI）。所有酸血症胎儿（100%）均有高UTPI，9例（90%）有高UAPI，8例（80%）有低MCAPI。所有高碳酸血症胎儿均有高UTPI、高UAPI和低MCAPI。所有低氧血症胎儿均有高UTPI、高UAPI和低MCAPI。穿刺组中，高UTPI对胎儿酸中毒的敏感性、特异性、阳性预测值和阴性预测值分别为100%、70%、76.9%和100%。高UAPI和低MCAPI对胎儿酸中毒的敏感性和特异性分别为80%和100%。阳性预测值为100%，阴性预测值为83.3%。从本研究中，我们得出结论，采用脉冲多普勒超声检查测量子宫和胎儿血流波形有助于评估妊娠期高血压所致IUGR胎儿的健康状况。