COMPARISON OF COLOR DOPPLER FEATURES AND PATHOLOGICAL FINDINGS IN COMPLICATED EARLY-PREGNANCY
COMPARISON OF COLOR DOPPLER FEATURES AND PATHOLOGICAL FINDINGS IN COMPLICATED EARLY-PREGNANCY
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DOI：
10.1093/oxfordjournals.humrep.a138465
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发表时间：
1994-12-01
影响因子：
6.1
通讯作者：
HUSTIN, J
中科院分区：
文献类型：
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作者：
JAUNIAUX, E;ZAIDI, J;HUSTIN, J
采用经阴道彩色多普勒成像技术，记录30例漏产和30例月经年龄匹配的正常妊娠患者子宫及螺旋动脉阻力指数（RI）、搏动指数（PT）、子宫动脉收缩峰值速度和绒毛间血流量。两组均于多普勒检查24h内行病理检查。与正常对照组相比，漏产组的平均子宫PI显著升高（P < 0.01），而平均子宫RI、峰值收缩速度、螺旋RI和PI无显著差异。在妊娠12周前的23例复杂妊娠中，有16例（69.6%）发现了连续的绒毛间流，而对照组没有发现。在漏流产病例中，53%的滋养层外壳碎裂或缺失，43%和63%的螺旋动脉滋养层浸润和生理变化减少或缺失。这些发现与多普勒指数正常或异常无关。在妊娠12周前出现连续的绒毛间血流的病例，滋养层外壳延伸脱位和大量绒毛间间隙和胎盘床被母体血液浸润。这些发现表明，早期妊娠并发胚胎死亡的异常流速波形与胚胎死亡后胎盘缺陷和滋养层壳脱位有关。母体血液过早进入绒毛间隙破坏母胚界面，可能是导致流产的最终机制。
Resistance index (RI) and pulsatility index (PT) in the uterine and spiral arteries, uterine artery peak systolic velocity and intervillous blood flow were recorded by transvaginal colour Doppler imaging in 30 missed abortions and 30 normal pregnancies matched for menstrual age. Pathological examination was performed in both groups within 24 h of Doppler investigation. The mean uterine PI was significantly (P < 0.01) higher in missed abortions compared to normal controls, whereas the mean uterine RI and peak systolic velocity and spiral RI and PI did not differ. A continuous intervillous flow was found in 16 out of 23 (69.6%) of the complicated pregnancies before 12 weeks of gestation whereas it was not found in controls. In the missed abortion cases, the trophoblastic shell was fragmented or absent in 53% and trophoblastic infiltration and physiological changes in the spiral arteries were reduced or absent in 43 and 63%, respectively. These findings were not related to normal or abnormal Doppler indices. Extended dislocation of the trophoblastic shell and a massive infiltration of the intervillous space and placental bed by maternal blood was also found in cases presenting with a continuous intervillous blood flow before 12 weeks of gestation. These findings suggest that abnormal flow velocity waveforms in early pregnancies complicated by embryonic death are related to deficient placentation and dislocation of the trophoblastic shell that follows embryonic demise. The premature entry of maternal blood into the intervillous space disrupts the materno - embryonic interface and is probably the final mechanism causing abortion.