Jauniaux E, Gulbis B, Tunkel S, Ramsay B, Campbell S, Meuris S
Academic Department of Obstetrics and Gynaecology, King's College School of Medicine and Dentistry, London, U.K.
Prenat Diagn. 1996 Dec;16(12):1129-35. doi: 10.1002/(SICI)1097-0223(199612)16:12<1129::AID-PD9>3.0.CO;2-I.
To evaluate the variations and potential clinical use of serial maternal alpha-fetoprotein (AFP) and human chorionic gonadotropin (hCG) in pregnancies at risk of pregnancy-induced hypertension (PIH) and/or intrauterine growth retardation (IUGR), we investigated the relationship between placental sonographic findings, uterine artery Doppler measurements, and maternal serum AFP, hCG, and uric acid levels between 20 and 34 weeks of pregnancy. Maternal serum samples were collected from 41 singleton pregnancies with bilateral uterine notches and/or an increased uterine artery pulsatility index at 20-24 weeks. Maternal serum AFP, intact hCG and free alpha and beta subunits, and uric acid circulating levels were measured in all cases at 20-24 weeks and 25-28 weeks. Placental sonographic investigations comprised measurements of thickness and morphology. Twenty pregnancies had a normal outcome and 21 had an adverse outcome, including eight complicated by severe PIH with fetal IUGR, eight by isolated IUGR, three by mild PIH with normal fetal growth, and two by placental abruption. At the time of the first scan, the placental thickness and maternal serum levels of AFP, hCG, and uric acid were significantly increased in pregnancies with adverse outcomes, compared with those with a normal outcome. In subsequent maternal serum examinations, the incidence of elevated hormonal levels fell for AFP, intact hCG, and beta-hCG, whereas it increased for the uric acid level. No difference was found at any stage for the alpha-hCG level. Seven out of 11 pregnancies complicated by PIH presented with elevated MSAFP and MShCG and a large heterogeneous placenta at the first visit, whereas no pregnancy with a normal outcome presented with similar features. This study has shown a significant association between abnormal development of the utero-placental circulation, elevated MSAFP and MShCG at mid-gestation, and subsequent adverse pregnancy outcome. Serial measurements of MSAFP and MShCG do not provide extra information for the follow-up of these pregnancies.
为评估妊娠高血压综合征（PIH）和/或宫内生长受限（IUGR）风险妊娠中母血甲胎蛋白（AFP）和人绒毛膜促性腺激素（hCG）系列检测值的变化及其潜在临床应用价值，我们研究了妊娠20至34周期间胎盘超声检查结果、子宫动脉多普勒测量值与母血AFP、hCG和尿酸水平之间的关系。收集了41例单胎妊娠孕妇在妊娠20 - 24周时的母血样本，这些孕妇双侧子宫有切迹和/或子宫动脉搏动指数升高。在所有病例中，于妊娠20 - 24周和25 - 28周时测量母血AFP、完整hCG及其游离α和β亚基以及尿酸的循环水平。胎盘超声检查包括测量胎盘厚度和形态。20例妊娠结局正常，21例妊娠结局不良，其中8例并发重度PIH伴胎儿IUGR，8例为单纯IUGR，3例为轻度PIH伴胎儿生长正常，2例为胎盘早剥。首次扫描时，与结局正常的妊娠相比，结局不良的妊娠胎盘厚度及母血AFP、hCG和尿酸水平显著升高。在随后的母血检查中，AFP、完整hCG和β - hCG激素水平升高的发生率下降，而尿酸水平升高的发生率上升。α - hCG水平在任何阶段均未发现差异。11例并发PIH的妊娠中有7例在首次就诊时表现为母血甲胎蛋白（MSAFP）和母血人绒毛膜促性腺激素（MShCG）升高以及胎盘大且不均质，而结局正常的妊娠无类似表现。本研究表明子宫 - 胎盘循环异常、孕中期MSAFP和MShCG升高与随后不良妊娠结局之间存在显著关联。对这些妊娠进行MSAFP和MShCG系列检测并不能为其随访提供额外信息。
