Abuhamad A Z, Mari G, Cortina R M, Croitoru D P, Evans A T
Department of Obstetrics and Gynecology, Eastern Virginia Medical School, Norfolk 23507, USA.
Am J Obstet Gynecol. 1997 May;176(5):985-90. doi: 10.1016/s0002-9378(97)70390-9.
Our purpose was to determine whether Doppler velocimetry of the superior mesenteric artery and its mesenteric branches and ultrasonographic assessment of bowel can predict postnatal outcome in fetuses with gastroschisis.
The normal reference range for the superior mesenteric artery pulsatility index was determined by studying 161 normal fetuses. Over a 24-month period superior mesenteric artery pulsatility index, superior mesenteric artery mesenteric branches systolic/diastolic ratio, bowel diameter, and bowel wall thickness were prospectively and longitudinally obtained from 17 fetuses with gastroschisis. Poor neonatal outcome was defined by bowel resection or staged repair of the defect or a hospital stay > 50 days.
Doppler velocimetry of the superior mesenteric artery and its mesenteric branches proved minimally useful in prognosticating neonatal outcome. No difference was found in the superior mesenteric artery pulsatility index between the good and poor neonatal outcome groups (p = 0.99). Longitudinal data analysis on all fetuses with gastroschisis showed an increase in bowel diameter with advancing gestation (p < 0.0001). A greater rate of increase in bowel diameter with advancing gestation was noted in the poor-neonatal-outcome group compared with the good-neonatal-outcome group (p < 0.01). Mean bowel diameter obtained before delivery was significantly greater in the poor-neonatal-outcome group (p = 0.03). Bowel diameter obtained at 28 to 32 weeks was the best predictor of poor neonatal outcome. A cutoff value of bowel diameter > 10 mm at 28 to 32 weeks had a sensitivity of 83%, a specificity of 88%, a positive predictive value of 83%, and a negative predictive value of 88% for poor neonatal outcome.
Doppler velocimetry of the superior mesenteric artery and its branches is not predictive of poor neonatal outcome in fetuses with gastroschisis. A bowel diameter > 10 mm between 28 and 32 weeks appears to be the best predictor of poor neonatal outcome. This newly defined variable warrants further investigation given its significant predictive power.
我们的目的是确定肠系膜上动脉及其肠系膜分支的多普勒测速法以及肠道的超声评估能否预测腹裂胎儿的出生后结局。
通过研究161例正常胎儿确定肠系膜上动脉搏动指数的正常参考范围。在24个月的时间里，前瞻性地纵向获取了17例腹裂胎儿的肠系膜上动脉搏动指数、肠系膜上动脉肠系膜分支的收缩/舒张比、肠直径和肠壁厚度。不良新生儿结局定义为肠切除、分期修复缺损或住院时间>50天。
肠系膜上动脉及其肠系膜分支的多普勒测速法在预测新生儿结局方面作用甚微。新生儿结局良好组与不良组之间的肠系膜上动脉搏动指数无差异（p = 0.99）。对所有腹裂胎儿的纵向数据分析显示，随着孕周增加肠直径增大（p < 0.0001）。与新生儿结局良好组相比，不良结局组肠直径随孕周增加的速率更高（p < 0.01）。分娩前获得的不良新生儿结局组的平均肠直径显著更大（p = 0.03）。28至32周时获得的肠直径是不良新生儿结局的最佳预测指标。28至32周时肠直径>10 mm的临界值对不良新生儿结局的敏感性为83%，特异性为88%，阳性预测值为83%，阴性预测值为88%。
肠系膜上动脉及其分支的多普勒测速法不能预测腹裂胎儿的不良新生儿结局。28至32周时肠直径>10 mm似乎是不良新生儿结局的最佳预测指标。鉴于其显著的预测能力，这个新定义的变量值得进一步研究。
