Prediction of delivery of small-for-gestational-age neonates and adverse perinatal outcome by fetoplacental Doppler at 37 weeks' gestation
Prediction of delivery of small-for-gestational-age neonates and adverse perinatal outcome by fetoplacental Doppler at 37 weeks' gestation
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DOI：
10.1002/uog.15979
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发表时间：
2017-03-01
影响因子：
7.1
通讯作者：
Figueras, F.
中科院分区：
文献类型：
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作者：
Triunfo, S.;Crispi, F.;Figueras, F.
目的探讨胎儿胎盘多普勒在孕37周的预测能力，以确定小于胎龄儿（SGA），胎儿生长受限（FGR）和不良围产儿outcome.MethodsThis是一个前瞻性队列研究的低风险单胎妊娠进行超声评估在37周。在研究入选时，测量估计胎儿体重（EFW）和胎儿胎盘多普勒变量（子宫动脉搏动指数（UtA-PI）、胎盘-子宫比值（CPR）和EFW标准化的脐静脉血流量（UVBF））的生物测量值。根据当地标准，SGA定义为第3和第10百分位数之间的定制出生体重，FGR定义为出生体重<第3百分位数。不良的围产期结局包括紧急剖腹产不放心的胎儿状态，5分钟Apgar评分< 7和新生儿酸中毒在birth.ResultsA共946例孕妇被列入研究。其中，89例（9.4%）被归类为SGA，40例（4.2%）为FGR，围产期不良结局的总体发生率为4.9%。在10%假阳性率（FPR）下，EFW、UtA-PI、CPR、UVBF及UtA-PI、CPR与EFW联合检测的SGA检出率分别为59.2%、10.5%、13.7%、3.2%和61.0%。在FPR为10%时，EFW、UtA-PI、CPR、UVBF及CPR + EFW百分位数联合检测FGR的检出率分别为83.3%、13.9%、27.8%、13.9%和88.6%。在固定的10%FPR下，EFW、UtA-PI、CPR和UVBF对围产儿不良结局的检出率分别为19.2%、9.2%、23.1%和16.9（包括CPR和EFW标准化的UVBF）将检出率提高到近30%。结论在低危妊娠中，孕37周时的多普勒评估与EFW单独评估相比，并没有改善SGA和FGR的预测，但是，将多普勒变量与EFW结合使用，可以改善仅由这些参数提供的不良围产期结局的预测，尽管不显著。Copyright（c）2016 ISUOG.出版社：John Wiley & Sons Ltd
ObjectiveTo explore the predictive capacity of fetoplacental Doppler at 37 weeks' gestation in identifying small-for-gestational-age (SGA) neonates, fetal growth restriction (FGR) and adverse perinatal outcome.MethodsThis was a prospective cohort study of low-risk singleton pregnancies undergoing ultrasound assessment at 37 weeks. At study inclusion, biometry for estimated fetal weight (EFW), and fetoplacental Doppler variables (uterine artery pulsatility index (UtA-PI), cerebroplacental ratio (CPR) and umbilical vein blood flow (UVBF) normalized by EFW) were measured. SGA was defined as a customized birth weight between the 3(rd) and 10(th) centiles, and FGR was defined as a birth weight < 3(rd) centile, according to local standards. Adverse perinatal outcomes included emergency Cesarean section for non-reassuring fetal status, 5-min Apgar score < 7 and neonatal acidosis at birth.ResultsA total of 946 pregnancies were included in the study. Of these, 89 (9.4%) were classified as SGA and 40 (4.2%) as FGR, with an overall rate of adverse perinatal outcome of 4.9%. At a fixed 10% false-positive rate (FPR), the detection rate of SGA by EFW, UtA-PI, CPR, UVBF and by a combination of Doppler variables (UtA-PI and CPR) and EFW was 59.2%, 10.5%, 13.7%, 3.2% and 61.0%, respectively. At a fixed 10% FPR, the detection rate of FGR by EFW, UtA-PI, CPR, UVBF and a combination of CPR and EFW centile was 83.3%, 13.9%, 27.8%, 13.9% and 88.6%, respectively. At a fixed 10% FPR, the detection rate of adverse perinatal outcome by EFW, UtA-PI, CPR and UVBF was 19.2%, 9.2%, 23.1% and 16.9%, respectively, while combining EFW with Doppler variables (including CPR and UVBF normalized by EFW) improved the detection rate to nearly 30%.ConclusionIn low-risk pregnancies, Doppler evaluation at 37 weeks' gestation did not improve the prediction of SGA and FGR compared with that given by EFW alone, however, combining Doppler variables with EFW improved the prediction of adverse perinatal outcomes given by these parameters alone, although not markedly. Copyright (c) 2016 ISUOG. Published by John Wiley & Sons Ltd.