QUALITATIVE ASSESSMENT OF MATERNAL UTERINE AND FETAL UMBILICAL ARTERY BLOOD-FLOW AND RESISTANCE IN LABORING PATIENTS BY DOPPLER VELOCIMETRY
QUALITATIVE ASSESSMENT OF MATERNAL UTERINE AND FETAL UMBILICAL ARTERY BLOOD-FLOW AND RESISTANCE IN LABORING PATIENTS BY DOPPLER VELOCIMETRY
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DOI：
10.1016/0002-9378(88)90100-7
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发表时间：
1988-04-01
影响因子：
9.8
通讯作者：
MEDEARIS, AL
中科院分区：
文献类型：
--
作者：
BRAR, HS;PLATT, LD;MEDEARIS, AL
本研究的目的是评估分娩过程中子宫收缩对子宫和脐带循环的影响。通过连续波多普勒测速仪对 27 名活跃分娩的患者进行了研究。在子宫收缩峰值之前、期间和之后获得脐动脉、左子宫和右子宫动脉波形，并计算最大收缩速度和最小舒张速度的比率。 15 名患者在子宫动脉波形上显示舒张末期血流缺失，并且在子宫收缩峰值期间羊膜内压 (64.5 ± 3.5 mm Hg) 显着高于 12 名舒张末期血流维持的患者 (46.5 ± 2.6 mm Hg；P < 0.05)。在子宫收缩的峰值幅度期间，12 名维持舒张末血流的患者的子宫动脉收缩/舒张比 (6.5 .+-. 1.5) 显着高于收缩前或收缩后 (分别为 2.1 .+-. 0.15 和 2.0 .+-. 0.2；P < 0.05)。此外，这 12 名患者的收缩压/舒张压比与宫内压之间呈线性关系。然而，在所研究的强度范围内的收缩之前、期间或之后，没有观察到脐动脉收缩/舒张比的差异。相反，在收缩期间，子宫动脉阻力增加，舒张末期血流减少或消失，这与收缩强度呈反线性关系。这表明在子宫收缩期间，人类胎儿继续具有不间断的胎儿胎盘血流，而子宫胎盘血流的中断或减少程度取决于子宫收缩的强度。
The purpose of this study is to evaluate the effect of uterine contractions during labor on both the uterine and the umbilical circulations. Twenty-seven patients in active labor were studied by continuous-wave Doppler velocimetry. Umbilical, left uterine, and right uterine arterial waveforms were obtained before, during, and after peak uterine contractions, and the ratio of maximum systolic and minimum diastolic velocities was calculated. Fifteen patients showed absent flow in end diastole on the uterine artery waveform and had significantly higher intra-amniotic pressures (64.5 .+-. 3.5 mm Hg) during the peak amplitude of the uterine contraction compared with the 12 patients with maintained end diastolic flow (46.5 .+-. 2.6 mm Hg; P < 0.05). During the peak amplitude of the uterine contractions the 12 patients maintaining end-diastolic flow had significantly higher systolic/diastolic ratios in the uterine artery (6.5 .+-. 1.5) compared with either before or after a contraction (2.1 .+-. 0.15 and 2.0 .+-. 0.2, respectively; P < 0.05). Also, these 12 patients showed a linear relationship between the systolic/diastolic ratio and the intrauterine pressure. However, no differences were observed in the umbilical artery systolic/diastolic ratios before during or after a contraction in the intensity range studied. On the contrary, during contractions an increase in uterine artery resistance occurs with decreased or absent end-diastolic flow, which bears an inverse linear relationship to the intensity of the contraction. This suggests that during uterine contractions the human fetus continues to have uninterrupted fetoplacental blood flow, whereas the degree of interruption or reduction in uteroplacental blood flow is dependent on the intensity of uterine contraction.