Emergence of Late-Onset Placental Dysfunction: Relationship to the Change in Uterine Artery Blood Flow Resistance between the First and Third Trimesters
Emergence of Late-Onset Placental Dysfunction: Relationship to the Change in Uterine Artery Blood Flow Resistance between the First and Third Trimesters
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DOI：
10.1055/s-0032-1329181
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发表时间：
2013-06-01
影响因子：
2
通讯作者：
Baschat, Ahmet A.
中科院分区：
文献类型：
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作者：
Llurba, Elisa;Turan, Ozhan;Baschat, Ahmet A.
目的探讨妊娠晚期(T3)胎盘功能障碍的发生是否与妊娠早期(T1)和妊娠3个月(T3)子宫动脉血流阻力的阻抗变化有关。计算每个患者的Muta-PI变化([(T3PI-T1PI/间隔天数)]x 100；Delta Muta-PI)。这一参数以及T1和T3Muta-Pi z评分与胎盘相关疾病(PRD)和体质小新生儿(CS)相关。结果47例(5%)PRD患者中，83例(8.7%)产下CS。珠江三角洲患者的T1和T3Muta-Piz-Score得分较高(分别为0.418比-0.097和1.06比-0.13，p<；0.001)。PRD患者的Muta-PI(Delta Muta PI)变化相似。然而，随着Delta Muta-PI的升高，PRD的患病率增加了一倍(11.1%比5.2%，P=0.041)。结论子宫动脉多普勒在诊断晚发性PRD高危人群方面明显优于T1或胎龄变化，提示部分晚期出现的PRD不宜用子宫动脉多普勒进行早期筛查。进一步的研究对于确定晚发性胎盘功能障碍的最佳筛查策略至关重要。
Objectives To test if emergence of third-trimester (T3) placental dysfunction is related to the impedance change in uterine artery blood flow resistance between the first trimester (T1) and T3.Study Design Mean T1 and T3 uterine artery (mUtA) pulsatility index (PI) was measured in 1098 singletons. Each patient's individual mUtA-PI change was calculated ([(T3 PI - T1 PI/interval in days)] x 100; Delta mUtA-PI). This parameter and T1 and T3 mUtA-PI z-scores were related to placenta-related disease (PRD) and to constitutionally small neonates (CS).Results Forty-seven (5%) women had PRD and 83 (8.7%) delivered a CS neonate. T1 and T3 mUtA-PI z-scores were higher with PRD (0.418 versus -0.097 and 1.06 versus -0.13, p < 0.001 for all). Change in mUtA-PI (Delta mUtA PI) was similar for patients with PRD. However, the prevalence of PRD doubled with rising Delta mUtA-PI (11.1% versus 5.2%, p = 0.041).Conclusion T3 uterine artery Doppler performs significantly better in detecting patients at risk for late-onset PRD than T1 or the gestational age change in uterine artery Doppler resistance This suggests that a proportion of late emerging PRD is not amenable to early screening by uterine artery Doppler. Further research is essential to identify the optimal screening strategy for late-onset placental dysfunction.