Uterine artery Doppler flow and uteroplacental vascular pathology in normal pregnancies and pregnancies complicated by pre-eclampsia and small for gestational age fetuses
Uterine artery Doppler flow and uteroplacental vascular pathology in normal pregnancies and pregnancies complicated by pre-eclampsia and small for gestational age fetuses
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DOI：
10.1053/plac.2001.0676
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发表时间：
2001-05-01
期刊：
影响因子：
3.8
通讯作者：
Aarnoudse, JG
中科院分区：
文献类型：
--
作者：
Aardema, MW;Oosterhof, H;Aarnoudse, JG
本研究的目的是探讨子宫动脉多普勒血流模式和子宫胎盘血管病理之间的关系，在正常和复杂的妊娠，鉴于最近描述的概念，异质性原因的高血压妊娠并发症。纳入了43名妊娠合并先兆子痫、HELLP（溶血、肝酶升高、低血小板）综合征和/或小于胎龄（SGA）胎儿的妇女和27名接受择期剖腹产的正常妊娠妇女。我们在分娩前平均4天获得子宫动脉多普勒波形。我们在剖腹产时取得胎盘床切片，并分析其生理变化及病理变化，发现子宫动脉多普勒血流异常与妊娠并发症密切相关。在58%的复杂妊娠和40%的正常妊娠中没有发现生理变化。58%的复杂妊娠和53%的正常妊娠出现病理变化;它们发生在螺旋动脉中，有或没有生理变化，与多普勒结果没有显著相关性。总之，生理变化的缺乏与子宫动脉多普勒血流异常和妊娠并发症有关。然而，子宫胎盘血管病理的严重程度存在梯度，与妊娠并发症的相关性并不像之前认为的那么强。在子宫动脉多普勒血流正常的正常妊娠中，也存在显著程度的子宫胎盘血管病变。这种变化可能部分是由于采样误差，因为典型的活检仅包含一个或两个螺旋动脉。我们推测，其他因素可能是必要的，以诱导先兆子痫的临床综合征。(C)2001年哈考特出版社有限公司
This study was conducted to investigate the association between uterine artery Doppler flow patterns and uteroplacental vascular pathology in normal and complicated pregnancies in view of the recently described concept of heterogeneous causes of hypertensive pregnancy complications. Forty-three women whose pregnancies were complicated by pre-eclampsia, the HELLP (Haemolysis, Elevated Liver enzymes, Low Platelets) syndrome and/or small for gestational age (SGA) fetuses and 27 women with normal pregnancies undergoing elective caesarean section were included. We obtained uterine artery Doppler waveforms at a mean of 4 days before delivery. Placental bed biopsies were obtained at caesarean section and analysed for physiological changes and pathological changes.We found that abnormal uterine artery Doppler flow was strongly associated with pregnancy complications. Absence of physiological changes was seen in 58 per cent of complicated pregnancies and 40 per cent of normal pregnancies. Pathological changes were seen in 58 per cent of complicated pregnancies and 53 per cent of normal pregnancies; they occurred in spiral arteries with and without physiological changes, and there was no significant correlation to Doppler results. In conclusion, absence of physiological changes is associated with abnormal uterine artery Doppler flow and pregnancy complications. However, there is a gradient in the severity of uteroplacental vascular pathology and the correlation with pregnancy complications is not as strong as previously thought. There is also a significant degree of uteroplacental vascular pathology in normal pregnancies with normal uterine artery Doppler flow. This variation may be partly due to sampling error, as a typical biopsy contains only one or two spiral arteries. We hypothesize that additional factors might be necessary to induce the clinical syndrome of pre-eclampsia. (C) 2001 Harcourt Publishers Ltd.