Harrington K, Carpenter R G, Goldfrad C, Campbell S
Department of Obstetrics and Gynaecology, Homerton Hospital, London, UK.
Br J Obstet Gynaecol. 1997 Jun;104(6):674-81. doi: 10.1111/j.1471-0528.1997.tb11977.x.
To evaluate the predictive value of transvaginal Doppler ultrasound studies of the uterine and umbilical arteries in early pregnancy, in identifying pregnant women at risk of subsequently developing pre-eclampsia, or the delivery of a small for gestational age infant.
A multivariate logistic regression of Z scores of Doppler indices obtained from the uterine and umbilical arteries of 652 women with singleton pregnancies at 12 to 16 weeks of gestation. Measurements included the presence or absence of a notch, bilateral (right and left waveform) notching, vessel diameter, the resistance index, the pulsatility index, time averaged mean velocity (cm/s), maximum systolic velocity (cm/s), and volume flow (mL/min). Stepwise logistic regression and multivariate analysis of all the parameters measured was used to construct several scoring systems.
Pre-eclampsia, birthweight, preterm delivery.
In women that developed complications, there was a trend towards increased resistance and reduced velocity and volume flow. If bilateral notches were present there was an increased risk of pre-eclampsia (odds ratio [OR] 21.99, 95% CI 6.55-73.79), premature delivery (OR 2.38, 95% CI 1.19-4.75), and the delivery of a small for gestational age baby (OR 8.63, 95% CI 3.95-18.84). Using multivariate analysis, a seven parameter model was selected (after removal of vessel diameter, uterine and umbilical resistance index). This model produces a scoring system with a sensitivity of 92.9% and a specificity of 85.1% for the prediction of pre-eclampsia. A three parameter model (bilateral notches, uterine resistance index, umbilical pulsatility index) provides similar sensitivities, but lower specificities, when compared with the seven parameter model.
These data indicate that there are differences in uterine and umbilical artery Doppler blood flow indices at 12 to 16 weeks, in pregnancies with a normal or complicated outcome. Scoring systems derived from multivariate analysis of Doppler indices demonstrate the potential of being able to identify, in early pregnancy, a group of women at increased risk of the subsequent development of pre-eclampsia, premature delivery, or the birth of a small for gestational age baby.
评估孕早期经阴道多普勒超声检查子宫动脉和脐动脉，对识别有子痫前期或小于胎龄儿分娩风险孕妇的预测价值。
对652名单胎妊娠孕妇在妊娠12至16周时子宫动脉和脐动脉多普勒指数的Z评分进行多因素逻辑回归分析。测量指标包括有无切迹、双侧（左右波形）切迹、血管直径、阻力指数、搏动指数、时间平均平均速度（cm/s）、最大收缩速度（cm/s）和血流量（mL/min）。对所有测量参数进行逐步逻辑回归和多因素分析，以构建多个评分系统。
子痫前期、出生体重、早产。
发生并发症的女性中，存在阻力增加、速度和血流量降低的趋势。若存在双侧切迹，则子痫前期风险增加（比值比[OR]21.99，95%可信区间6.55 - 73.79）、早产风险增加（OR 2.38，95%可信区间1.19 - 4.75）以及小于胎龄儿分娩风险增加（OR 8.63，95%可信区间3.95 - 18.84）。通过多因素分析，选择了一个七参数模型（去除血管直径、子宫和脐阻力指数后）。该模型产生的评分系统预测子痫前期的敏感性为92.9%，特异性为85.1%。与七参数模型相比，三参数模型（双侧切迹、子宫阻力指数、脐搏动指数）提供相似的敏感性，但特异性较低。
这些数据表明，在妊娠结局正常或复杂的情况下，妊娠12至16周时子宫动脉和脐动脉多普勒血流指数存在差异。通过对多普勒指数进行多因素分析得出的评分系统显示，有可能在孕早期识别出一组后续发生子痫前期、早产或小于胎龄儿出生风险增加的女性。
