Is cerebroplacental ratio a marker of impaired fetal growth velocity and adverse pregnancy outcome?
Is cerebroplacental ratio a marker of impaired fetal growth velocity and adverse pregnancy outcome?
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DOI：
10.1016/j.ajog.2017.02.005
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发表时间：
2017-06-01
影响因子：
9.8
通讯作者：
Thilaganathan, Basky
中科院分区：
文献类型：
--
作者：
Khalil, Asma;Morales-Rosello, Jose;Thilaganathan, Basky
背景：胎盘-胎盘比率被认为是近期内不能达到生长潜力的一个标志。无论胎儿大小如何，低胎盘比率与手术分娩的必要性和新生儿住院条件有关。目的：本研究的主要目的是评估足月胎盘比率是否是胎儿生长速度降低的标志。第二个目的是调查一个低的胎盘比率在长期，胎儿生长速度降低，不良妊娠outcome.Study设计：这是一个回顾性队列研究的单胎妊娠在三级转诊中心之间的关系。在妊娠20-24周时测量腹围，并在分娩后2周内记录35周或35周以上的腹围和胎儿多普勒。腹围和出生体重值分别转换为Z评分和百分位数，胎儿多普勒参数转换为中位数的倍数，并根据胎龄进行调整。腹围生长速度使用腹围Z评分的差异进行量化，将35周或35周以上的扫描与20-24周的扫描进行比较。进行单变量和多变量logistic回归分析，以研究低胎盘重比和低腹围生长速度（最低十分位数）之间的相关性，并确定和调整潜在的混杂因素。作为一个敏感性分析，我们重新调整了模型，排除了妊娠与小于胎龄儿的数据。结果：该研究包括7944例孕妇。低胎盘比率中位数的倍数与低腹围生长速度显著相关（校正比值比，2.10; 95%可信区间，1.71-2.57，P
BACKGROUND: The cerebroplacental ratio has been proposed as a marker of failure to reach growth potential near term. Low cerebroplacental ratio, regardless of the fetal size, is independently associated with the need for operative delivery for presumed fetal compromise and with neonatal unit admission at term.OBJECTIVE: The main aim of this study was to evaluate whether the cerebroplacental ratio at term is a marker of reduced fetal growth rate. The secondary aim was to investigate the relationship between a low cerebroplacental ratio at term, reduced fetal growth velocity, and adverse pregnancy outcome.STUDY DESIGN: This was a retrospective cohort study of singleton pregnancies in a tertiary referral center. The abdominal circumference was measured at 20-24 weeks' gestation and both abdominal circumference and fetal Dopplers recorded at or beyond 35 weeks, within 2 weeks of delivery. Abdominal circumference and birthweight values were converted into Z scores and centiles, respectively, and fetal Doppler parameters into multiples of median, adjusting for gestational age. Abdominal circumference growth velocity was quantified using the difference in the abdominal circumference Z score, comparing the scan at or beyond 35 weeks with the scan at 20-24 weeks. Both univariable and multivariable logistic regression analyses were performed to investigate the association between low cerebroplacental ratio and the low abdominal circumference growth velocity (in the lowest decile) and to identify and adjust for potential confounders. As a sensitivity analysis, we refitted the model excluding the data on pregnancies with small-for-gestational-age neonates.RESULTS: The study included 7944 pregnancies. Low cerebroplacental ratio multiples of median was significantly associated with both low abdominal circumference growth velocity (adjusted odds ratio, 2.10; 95% confidence interval, 1.71-2.57, P