目的:阐明动脉和静脉多普勒超声参数与胎龄较小(SGA)胎儿产时胎儿受损(IFC)和新生儿酸中毒二次剖宫产风险之间的关系。
方法:这种单中心,prospective,失明,队列研究包括单胎妊娠,其估计胎儿体重(EFW)<36孕周以上10分。纳入研究后,所有女性都接受了多普勒超声检查,包括脐动脉(UA)搏动指数(PI),大脑中动脉(MCA)PI,胎儿主动脉峡部(AoI)PI,脐静脉血流量(UVBF),和改良心肌性能指标(mod-MPI)。主要结局定义为IFC二次剖宫产。
结果:总计,包括87次SGA怀孕,其中16%需要为IFC剖腹产。这些胎儿的腹围(AC)校正后的UVBF较低(5.2(4.5-6.3)vs7.2(5.5-8.3),p=0.001)。比较AoIPI时没有差异,UAPI,ACMPI,或mod-MPI。未发现新生儿酸中毒的关联。经过多变量逻辑回归,由于IFC,UVBF/AC与剖宫产保持独立相关(aOR0.61[0.37;0.91],p=0.03),曲线下面积(AUC)为0.78(95%CI,0.67-0.89)。由于IFC,UVBF/AC的第50百分位设定的临界值达到86%的敏感性和58%的特异性(OR8.1;95%CI,1.7-37.8,p=0.003)。
结论:脐静脉血流量(UVBF/AC)水平低与IFC剖宫产SGA胎儿的风险增加相关。
OBJECTIVE: To elucidate the association between arterial and venous Doppler ultrasound parameters and the risk of secondary cesarean delivery for intrapartum fetal compromise (IFC) and neonatal acidosis in small-for-gestational-age (SGA) fetuses.
METHODS: This single-center, prospective, blinded, cohort study included singleton pregnancies with an estimated fetal weight (EFW) < 10th centile above 36 gestational weeks. Upon study inclusion, all women underwent Doppler ultrasound, including umbilical artery (UA) pulsatility index (PI), middle cerebral artery (MCA) PI, fetal aortic isthmus (AoI) PI, umbilical vein blood flow (UVBF), and modified myocardial performance index (mod-MPI). Primary outcome was defined as secondary cesarean section due to IFC.
RESULTS: In total, 87 SGA pregnancies were included, 16% of which required a cesarean section for IFC. Those fetuses revealed lower UVBF corrected for abdominal circumference (AC) (5.2 (4.5-6.3) vs 7.2 (5.5-8.3), p = 0.001). There was no difference when comparing AoI PI, UA PI, ACM PI, or mod-MPI. No association was found for neonatal acidosis. After multivariate logistic regression, UVBF/AC remained independently associated with cesarean section due to IFC (aOR 0.61 [0.37; 0.91], p = 0.03) and yielded an area under the curve (AUC) of 0.78 (95% CI, 0.67-0.89). A cut-off value set at the 50th centile of UVBF/AC reached a sensitivity of 86% and specificity of 58% for the occurrence of cesarean section due to IFC (OR 8.1; 95% CI, 1.7-37.8, p = 0.003).
CONCLUSIONS: Low levels of umbilical vein blood flow (UVBF/AC) were associated with an increased risk among SGA fetuses to be delivered by cesarean section for IFC.