Mari G, Abuhamad A Z, Keller M, Verpairojkit B, Ment L, Copel J A
Department of Obstetrics and Gynecology, Yale University, New Haven, CT, USA.
Ultrasound Obstet Gynecol. 1996 Nov;8(5):329-32. doi: 10.1046/j.1469-0705.1996.08050329.x.
The intrauterine identification of fetuses at risk of developing intraventricular hemorrhage would be helpful to the perinatologist, in light of the recent results which suggest that indomethacin given to the infant reduces the risk of developing intraventricular hemorrhage. We hypothesized that fetuses undergoing brain sparing, as identified by a lowered pulsatility index (PI) in the middle cerebral artery, and delivered prior to 34 weeks may differ in terms of being at risk for intraventricular hemorrhage from those fetuses without the brain-sparing effect. The middle cerebral artery PI was studied in 43 fetuses between 25 and 33.6 weeks' gestation. The pregnancies were complicated by pre-eclampsia, intrauterine growth restriction (IUGR) and preterm labor. A cranial sonogram was performed during the first postnatal week in all the neonates. Intraventricular hemorrhage was present in 6/22 infants with a normal middle cerebral artery PI (group A) and 0/21 with an abnormal middle cerebral artery PI (group B) (p < 0.05). The mothers of the six fetuses who developed intraventricular hemorrhage underwent preterm labor. IUGR fetuses and pre-eclampsia were more common in group B. No difference was found between the two groups when the following variables were compared: (1) gestational age at the time of the Doppler study; (2) gestational age at delivery; (3) antenatal exposure to steroids; (4) antenatal exposure to magnesium; (5) Apgar score greater than 6 at 5 min; (6) respiratory distress syndrome in the newborn; (7) necrotizing enterocolitis; (8) Cesarean section; and (9) sepsis in the infant. Although the mean birth weight was significantly lower in group B than group A, no fetus in this group developed intraventricular hemorrhage. The fetal brain-sparing effect, pre-eclampsia and IUGR were associated with a lower risk of neonatal intraventricular hemorrhage than was preterm labor. Preterm labor appears to be a key factor in the development of intraventricular hemorrhage and must be included when testing associations with intraventricular hemorrhage.
鉴于最近的研究结果表明，给婴儿使用吲哚美辛可降低发生脑室内出血的风险，因此在子宫内识别有发生脑室内出血风险的胎儿，对围产医学专家会有所帮助。我们推测，经大脑中动脉搏动指数（PI）降低识别出存在脑保护效应、且在34周前分娩的胎儿，与那些没有脑保护效应的胎儿相比，发生脑室内出血的风险可能有所不同。对43例妊娠25至33.6周的胎儿进行了大脑中动脉PI研究。这些妊娠合并先兆子痫、胎儿生长受限（IUGR）和早产。所有新生儿在出生后第一周内进行了颅脑超声检查。大脑中动脉PI正常的22例婴儿中有6例发生脑室内出血（A组），大脑中动脉PI异常的21例婴儿中无1例发生脑室内出血（B组）（p<0.05）。发生脑室内出血的6例胎儿的母亲均发生了早产。IUGR胎儿和先兆子痫在B组中更为常见。比较以下变量时，两组之间未发现差异：（1）多普勒检查时的孕周；（2）分娩时的孕周；（3）产前使用类固醇；（4）产前使用镁；（5）5分钟时阿氏评分大于6分；（6）新生儿呼吸窘迫综合征；（7）坏死性小肠结肠炎；（8）剖宫产；（9）婴儿败血症。虽然B组的平均出生体重明显低于A组，但该组中没有胎儿发生脑室内出血。与早产相比，胎儿脑保护效应、先兆子痫和IUGR与新生儿脑室内出血风险较低相关。早产似乎是脑室内出血发生的一个关键因素，在检测与脑室内出血的关联时必须予以考虑。
