Screening for Placental Insufficiency in High-risk Pregnancies: Is Earlier Better?
Screening for Placental Insufficiency in High-risk Pregnancies: Is Earlier Better?
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DOI：
10.1016/j.placenta.2008.09.004
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发表时间：
2008-12-01
期刊：
影响因子：
3.8
通讯作者：
Kingdom, J. C. P.
中科院分区：
文献类型：
--
作者：
Costa, S. L.;Proctor, L.;Kingdom, J. C. P.
目的：比较妊娠早期和中期胎盘功能的变化。研究设计：对61例单胎妊娠进行前瞻性队列研究。分别于11~13(+6)周和18~23(+6)周测定子宫动脉多普勒和胎盘形态(形态和质地)。测定妊娠早期(妊娠相关胎盘蛋白A[PAPP-A])和妊娠中期(总hCG和甲胎蛋白[AFP])的血清生化。结果：不良围产儿结局发生14例(23%)，3例(4.9%)丢失20周，2例死产(3.3%)，4例(6.6%)IUGR，7例(11.5%)重度先兆子痫/HELLP综合征，10例(16.4%)分娩32周。妊娠中期胎盘形态异常与不良结局显著相关[+LR：3.6，95%CI：1.3-8.5；-LR：0.63，95%CI：0.36-0.93；p=0.025]，如>；=1例中期妊娠试验异常[+LR：5.9，95%CI：1.6-24：-LR：0.6 8，95%CI：0.59-0.89：P=0.005]或2例中期妊娠试验异常[+LR：3.6]。95%氯：1.3~7.7；-LR：0.58，95%氯：0.27~0.94；p=0.035]。早期妊娠试验的组合没有显著预测严重的不良围产儿结局。需要对822名具有相似高危特征的妇女进行研究，以反驳目前的早期筛查方法并不逊于中期筛查重度胎盘功能不全的结论(p=0.05，力量80%，z检验)。结论：在临床高危妊娠中，使用胎盘功能测试预测不良围产儿结局在第二个月比第一个月更有效。(C)2008爱思唯尔有限公司。保留所有权利。
Objective: To compare a profile of placental function between the first and second trimesters in pregnancies at high risk of adverse perinatal outcomes attributable to placental insufficiency.Study design: Prospective cohort study in 61 singleton pregnancies. Uterine artery Doppler and placental morphology (shape and texture) were determined at 11-13(+6) weeks and at 18-23(+6) weeks. First trimester (pregnancy-associated placental protein-A [PAPP-A]) and second trimester (total hCG and alpha fetoprotein [AFP]) serum biochemistry were determined. The two screening periods were compared for the prediction of a range of severe adverse perinatal outcomes (intrauterine growth restriction [IUGR], abruption, severe pre-eclampsia/HELLP syndrome, delivery < 32 weeks, or stillbirth).Results: Adverse perinatal outcomes occurred in 14 (23%) women; 3 (4.9%) losses < 20 weeks, 2 (3.3%) stillbirths > 20 weeks, 4 (6.6%) IUGR, 7 (11.5%) severe pre-eclampsia/HELLP syndrome, and 10 (16.4%) deliveries < 32 weeks. Abnormal second trimester placental morphology was significantly associated with adverse outcome [+LR: 3.6, 95% Cl: 1.3-8.5; -LR: 0.63, 95% Cl: 0.36-0.93; p=0.025], as was >= 1 abnormal second trimester tests [+LR: 5.9, 95% Cl: 1.6-24: -LR: 0.68, 95% Cl: 0.59-0.89: p = 0.005] or >= 2 abnormal second trimester tests [+LR: 3.6. 95% Cl: 1.3-7.7; -LR: 0.58, 95% Cl: 0.27-0.94; p = 0.035]. No combination of first trimester tests significantly predicted severe adverse perinatal outcomes. A study sample size of 822 women with similar high-risk characteristics would be needed in order to refute the conclusion that present methods of first trimester screening are not inferior to second trimester screening for severe placental insufficiency (p = 0.05, power 80%, z-test).Conclusions: In clinically high-risk pregnancies, prediction of adverse perinatal outcomes using placental function testing is More effective in the second compared with the first trimester. (c) 2008 Elsevier Ltd. All rights reserved.