Guzman E R, Vintzileos A, Benito C, Houlihan C, Waldron R, Egan S
Department of Obstetrics, Gynecology and Reproductive Sciences, UMDNJ-Robert Wood Johnson Medical School, St. Peter's Medical Center, New Brunswick 08903-0591, USA.
J Matern Fetal Med. 1996 Nov-Dec;5(6):299-304. doi: 10.1002/(SICI)1520-6661(199611/12)5:6<299::AID-MFM1>3.0.CO;2-K.
The objective of this study was to determine the effects of removal of amniotic fluid in cases of symptomatic severe polyhydramnios on Doppler waveform indices of the uterine and umbilical arteries and flow velocities of the uterine arteries. Nine women underwent therapeutic amniocentesis during ten pregnancies for symptomatic polyhydramnios due to Beckwith-Wiedemann Syndrome (n = 1), esophageal atresia (n = 2), chorioangioma (n = 1), twin-twin transfusion syndrome (n = 3), a presumed autosomal recessive syndrome (n = 2), and an unbalanced double translocation (n = 1; partial dup 3q and partial del 9p syndrome). An average of 2.78 +/- 0.9 (range 1-4) 1 of fluid were removed at each procedure between the gestational ages of 18 and 34 weeks (mean of 28 weeks). The systolic/diastolic (S/D) ratio, pulsitility index (PI), and resistance index (RI) of the uterine and umbilical arteries were obtained before and after the procedure using color and pulsed Doppler. After angle correction, the peak systolic velocity (PSV) and mean velocity (MV) in centimeters/second (cm/s) of the uterine arteries were also determined. The presence or absence of a uterine artery waveform notch was determined. Dominant uterine arteries were defined as those with lower impedance indices or higher flow velocities. Statistical analysis was performed with the Wilcoxon signed-rank test. Significance was set at P < 0.05. There was a significant increase in the median value of the uterine artery MV (43.8 vs. 81.1 cm/s, P = 0.005) and PSV (74.2 vs. 125.5 cm/s, P = 0.007) after amniocentesis. The uterine S/D (3.0 vs. 1.84, P = 0.007), PI (1.12 vs. 0.68, P = 0.008), and RI (0.60 vs. 0.45, P = 0.005) impedance indices significantly decreased following amniocentesis. When uterine arteries were categorized as dominant vs. nondominant, there were greater improvements in impedance indices and flow velocities in the nondominant uterine arteries. There were three cases of unilateral and one case of bilateral early diastolic notches of the uterine artery waveforms which either resolved (n = 4) or improved (n = 1). There was no effect on the umbilical artery impedance indices. Therapeutic amniocentesis significantly improved uterine artery impedance indices and resulted in improved flow velocities, while there was no effect on umbilical artery waveform indices. The procedure resulted in the disappearance or improvement of the uterine waveform notch. Our findings suggest that in cases of severe polyhydramnios abnormal uterine artery velocimetry may not be due to lack of trophoblastic invasion of the spiral arteries but to increased intrauterine pressure secondary to polyhydramnios.
本研究的目的是确定在有症状的严重羊水过多病例中，抽取羊水对子宫和脐动脉的多普勒波形指数以及子宫动脉血流速度的影响。9名女性在10次妊娠期间因有症状的羊水过多接受了治疗性羊膜腔穿刺术，病因包括贝克威思-维德曼综合征（1例）、食管闭锁（2例）、绒毛膜血管瘤（1例）、双胎输血综合征（3例）、一种推测的常染色体隐性综合征（2例）以及一种不平衡的双易位（1例；3q部分重复和9p部分缺失综合征）。在妊娠18至34周（平均28周）期间，每次操作平均抽取2.78±0.9（范围1 - 4）升羊水。在操作前后，使用彩色和脉冲多普勒获取子宫和脐动脉的收缩/舒张（S/D）比值、搏动指数（PI）和阻力指数（RI）。经过角度校正后，还测定了子宫动脉的峰值收缩速度（PSV）和平均速度（MV），单位为厘米/秒（cm/s）。确定子宫动脉波形切迹的有无。优势子宫动脉定义为阻抗指数较低或血流速度较高的动脉。采用Wilcoxon符号秩检验进行统计分析。显著性设定为P < 0.05。羊膜腔穿刺术后，子宫动脉MV的中位数显著增加（43.8 vs. 81.1 cm/s，P = 0.005），PSV也显著增加（74.2 vs. 125.5 cm/s，P = 0.007）。羊膜腔穿刺术后子宫的S/D（3.0 vs. 1.84，P = 0.007）、PI（1.12 vs. 0.68，P = 0.008）和RI（0.60 vs. 0.45，P = 0.005）阻抗指数显著降低。当将子宫动脉分为优势和非优势时，非优势子宫动脉的阻抗指数和血流速度改善更大。子宫动脉波形有3例单侧和1例双侧早期舒张期切迹，其中4例切迹消失，1例改善。对脐动脉阻抗指数没有影响。治疗性羊膜腔穿刺术显著改善了子宫动脉阻抗指数并提高了血流速度，而对脐动脉波形指数没有影响。该操作导致子宫波形切迹消失或改善。我们的研究结果表明，在严重羊水过多的病例中，子宫动脉测速异常可能不是由于螺旋动脉滋养层侵袭不足，而是由于羊水过多导致的宫内压力增加。
