Zimmermann P, Eiriö V, Koskinen J, Kujansuu E, Ranta T
Department of Obstetrics and Gynecology, Päijät-Häme Central Hospital, Lahti, Finland.
Ultrasound Obstet Gynecol. 1997 May;9(5):330-8. doi: 10.1046/j.1469-0705.1997.09050330.x.
During a 20-month period we studied 175 pregnant women at high risk for hypertensive disorders of pregnancy or intrauterine growth retardation, and 172 patients at low risk, in a prospectively designed cross-sectional trial. Using duplex pulsed wave Doppler ultrasound, we recorded blood velocity waveforms from both main uterine arteries, the uteroplacental arteries in the region of placental implantation and the umbilical artery at 21-24 weeks of gestation. Persistent notches in the main stem uterine arteries and elevated resistance indices of > 0.68 in the uterine arteries and > 0.38 in the uteroplacental arteries were defined as abnormal waveforms. The incidence of proteinuric pregnancy-induced hypertension (PPIH) and intrauterine growth retardation (IUGR) were recorded as main outcome measures. Doppler proved to be more efficient at predicting a complicated pregnancy in those patients who were at high risk: a positive medical history alone was associated with a three-fold greater risk of developing PPIH and/or IUGR. In the high-risk group a single pathological Doppler sign accounted for an additional three- to four-fold increased risk, and the combination of all three pathological signs, a seven-fold additional risk for later disease. In this group PPIH and/or IUGR was found in 58.3%, compared to 8.3% if Doppler results were normal. The criterion for the definition of pathological Doppler results, whether persistent notching, the resistance index (RI) of the main stem uterine artery, or the RI in the arteries of the uteroplacental bed, was of minor importance, as all Doppler parameters were strongly correlated. However, the combination of all parameters was superior to a single parameter, and a bilateral notch was superior to a unilateral notch in terms of minimizing false-positive results. However, Doppler was less powerful in the population at low risk. Here PPIH and/or IUGR was seen in 6.1-6.4% in the group with abnormal Doppler findings compared to 5.2% in pregnancies with normal findings. None of the patients showed bilateral notching. In conclusion, pathological Doppler velocimetry of the uterine and uteroplacental circulation was a powerful predictor of PPIH and/or IUGR in high-risk pregnancies, identifying a group in which 58.3% would suffer from disease later in pregnancy. A combination of several Doppler parameters was superior to a single parameter, although the parameters were strongly correlated with each other.
在为期20个月的时间里，我们在一项前瞻性设计的横断面试验中，对175名有妊娠高血压疾病或宫内生长受限高风险的孕妇以及172名低风险患者进行了研究。在妊娠21至24周时，我们使用双功脉冲波多普勒超声记录了双侧子宫主动脉、胎盘着床区域的子宫胎盘动脉以及脐动脉的血流速度波形。子宫主干部位动脉持续出现切迹，子宫动脉阻力指数>0.68且子宫胎盘动脉阻力指数>0.38被定义为异常波形。蛋白尿性妊娠高血压（PPIH）和宫内生长受限（IUGR）的发生率被记录为主要观察指标。结果表明，对于那些高风险患者，多普勒在预测复杂妊娠方面更有效：仅阳性病史就与发生PPIH和/或IUGR的风险增加三倍相关。在高风险组中，单一病理性多普勒征象会使风险额外增加三到四倍，而所有三个病理性征象同时出现，则会使后期发病风险额外增加七倍。在该组中，58.3%的患者出现了PPIH和/或IUGR，而如果多普勒结果正常，这一比例为8.3%。无论将持续切迹、子宫主干部位动脉阻力指数（RI）还是子宫胎盘床动脉的RI作为病理性多普勒结果的定义标准，其重要性都相对较小，因为所有多普勒参数之间都有很强的相关性。然而，所有参数联合使用优于单一参数，并且就减少假阳性结果而言，双侧切迹优于单侧切迹。不过，在低风险人群中，多普勒的预测能力较弱。在多普勒检查结果异常组中，PPIH和/或IUGR的发生率为6.1% - 6.4%，而检查结果正常的妊娠组中这一比例为5.2%。所有患者均未出现双侧切迹。总之，子宫和子宫胎盘循环的病理性多普勒测速是高风险妊娠中PPIH和/或IUGR的有力预测指标，可识别出58.3%的患者在妊娠后期会患病的一组人群。尽管多个多普勒参数之间相关性很强，但联合使用多个参数仍优于单一参数。
