van Splunder P, Stijnen T, Wladimiroff J W
Department of Obstetrics and Gynaecology, University Hospital Rotterdam-Dijkzigt, Erasmus University Medical School, Rotterdam, The Netherlands.
Pediatr Res. 1997 Dec;42(6):765-75. doi: 10.1203/00006450-199712000-00008.
Arterial, venous, and intracardiac Doppler flow velocity waveforms were studied in 50 women with a small for gestational age (SGA) fetus according to a cross-sectional study design. No Doppler signals could be obtained in five women for technical reasons. The remaining 45 women were compared with normal control subjects matched for gestational age and maternal parity. The 45 SGA fetuses were divided into birth weight below the 5th centile for gestational age (group I, n = 35) and birth weight between the 5th and 10th centile for gestational age (group II, n = 10). A significant difference in baseline characteristics was found between both SGA subsets and normal controls. In SGA I fetuses, the pulsatility index in the umbilical artery and descending aorta was significantly higher, but lower in the middle cerebral artery when compared with normal controls. At the atrioventricular and venous level (umbilical vein, ductus venosus, and inferior vena cava) reduced time-averaged velocities were established. PIV in the ductus venosus and IVC showed a significant increase. Within the same SGA subset, no relationship could be established between arterial downstream impedance and 1) atrioventricular flow velocities and 2) pulsatility index in the ductus venosus and inferior vena cava. Also, no relationship existed between flow velocity waveforms and pregnancy-induced hypertension and admission to the neonatal intensive care unit. Umbilical venous pulsations and absent/reverse flow in the umbilical artery were associated with a high intrauterine mortality rate and low birth weights. In SGA II fetuses, the pulsatility index in the umbilical artery and descending aorta was significantly higher than in normal controls. It can be concluded that fetuses with a birth weight below the 5th centile demonstrate marked changes in arterial, atrioventricular, and venous flow velocity waveforms. Atrioventricular and venous flow velocity waveforms change independently from arterial downstream impedance, suggesting that other factors, such as reduced volume flow and myocardial contraction force, may play a role in the observed changes.
根据横断面研究设计，对50例胎儿生长受限（SGA）孕妇的动脉、静脉和心内多普勒血流速度波形进行了研究。由于技术原因，5例孕妇未获得多普勒信号。其余45例孕妇与孕周和产妇胎次匹配的正常对照受试者进行比较。45例SGA胎儿分为出生体重低于孕周第5百分位数的组（I组，n = 35）和出生体重在孕周第5至第10百分位数之间的组（II组，n = 10）。发现两个SGA亚组与正常对照组之间的基线特征存在显著差异。与正常对照组相比，SGA I组胎儿脐动脉和降主动脉的搏动指数显著更高，但大脑中动脉的搏动指数更低。在房室和静脉水平（脐静脉、静脉导管和下腔静脉），平均时间流速降低。静脉导管和下腔静脉的PIV显著增加。在同一SGA亚组内，动脉下游阻抗与1）房室流速和2）静脉导管和下腔静脉的搏动指数之间未发现相关性。此外，流速波形与妊娠高血压和新生儿重症监护病房入院之间也没有关系。脐静脉搏动和脐动脉血流缺失/反向与高宫内死亡率和低出生体重相关。在SGA II组胎儿中，脐动脉和降主动脉的搏动指数显著高于正常对照组。可以得出结论，出生体重低于第5百分位数的胎儿在动脉、房室和静脉血流速度波形上有明显变化。房室和静脉血流速度波形的变化独立于动脉下游阻抗，这表明其他因素，如血流量减少和心肌收缩力，可能在观察到的变化中起作用。
