Association between Adverse Outcomes and Middle Cerebral Artery Pulsatility Index Change Based on Maternal Position Change.

IF 1.5 4区 医学 Q3 OBSTETRICS & GYNECOLOGY
Itamar D Futterman, Rodney A McLaren, Meghna Ramaswamy, Rohit Iyer, Shoshana Haberman
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引用次数: 0

Abstract

We have previously demonstrated that maternal position changes directly affect the fetal middle cerebral artery (MCA) Doppler pulsatility indices (PI) and may serve as a predictor for adverse pregnancy outcomes. We sought to confirm whether changes in fetal MCA Doppler PI due to position changes are associated with adverse outcomes.We conducted a prospective cohort study of pregnant people with a singleton, nonanomalous fetus, recruited between 18 and 24 weeks of gestation, in a single tertiary care center from December 2021 to February 2022. MCA Dopplers were obtained, and PI indices were measured and recorded, first in the supine position and then in the maternal left lateral (LL) position. The primary outcome was a composite of adverse outcomes (preeclampsia, fetal growth restriction, and oligohydramnios). Based on our prior findings suggesting that a PI Δ of 0.22 may serve as a dividing threshold between low- high-risk pregnancies, we divided the cohort into those above and below Δ = 0.22. Demographics were compared using univariable analyses. Multivariable logistic regression was performed comparing the composite and individual pregnancy outcomes controlling for statistically significant variables.We recruited 228 patients and followed them to delivery. There were 107 that had a PI Δ < 0.22 and 121 that had a PI Δ ≥0.22. The primary outcome of composite adverse outcomes did not differ between the groups (adjusted odd ratio [aOR]: 0.53; 95% confidence interval [CI]: 0.26-1.08). However, pregnancies with PI Δ ≥0.22 were more likely to develop preeclampsia than pregnancies with PI Δ < 0.22 (aOR: 3.30; 95% CI: 1.02-10.69).The primary outcome of composite adverse outcomes did not differ between the groups. However, we did find that a second trimester fetal MCA PI Δ ≥0.22 with maternal position changes at anatomy ultrasound was associated with developing preeclampsia. This data suggests that there may be an association between early decreased fetoplacental reserve and the development of preeclampsia. · Second trimester MCA PI Δ ≥0.22 with maternal position changes was associated with preeclampsia.. · There may be a link between decreased fetoplacental reserve and developing preeclampsia.. · Aside from preeclampsia there were no differences in adverse outcomes between the two groups..

基于产妇体位变化的大脑中动脉搏动指数变化与不良结局的关系
我们之前已经证明,产妇体位变化直接影响胎儿大脑中动脉(MCA)多普勒脉搏指数(PI),并可能作为不良妊娠结局的预测因子。我们试图确认胎儿MCA多普勒PI由于胎位改变是否与不良结局相关。我们在2021年12月至2022年2月在单一三级保健中心对妊娠18至24周的单胎、无异常胎儿孕妇进行了一项前瞻性队列研究。先取产妇仰卧位,后取左侧侧卧位,取MCA多普勒,测量并记录PI指数。主要结局是不良结局的综合(先兆子痫、胎儿生长受限和羊水过少)。根据我们之前的研究结果,PI Δ = 0.22可以作为低高危妊娠的划分阈值,我们将队列分为Δ = 0.22以上和以下两组。人口统计数据采用单变量分析进行比较。采用多变量logistic回归比较综合妊娠结局和个体妊娠结局,控制有统计学意义的变量。我们招募了228名患者,并跟踪她们直至分娩。有107个PI Δ
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来源期刊
American journal of perinatology
American journal of perinatology 医学-妇产科学
CiteScore
5.90
自引率
0.00%
发文量
302
审稿时长
4-8 weeks
期刊介绍: The American Journal of Perinatology is an international, peer-reviewed, and indexed journal publishing 14 issues a year dealing with original research and topical reviews. It is the definitive forum for specialists in obstetrics, neonatology, perinatology, and maternal/fetal medicine, with emphasis on bridging the different fields. The focus is primarily on clinical and translational research, clinical and technical advances in diagnosis, monitoring, and treatment as well as evidence-based reviews. Topics of interest include epidemiology, diagnosis, prevention, and management of maternal, fetal, and neonatal diseases. Manuscripts on new technology, NICU set-ups, and nursing topics are published to provide a broad survey of important issues in this field. All articles undergo rigorous peer review, with web-based submission, expedited turn-around, and availability of electronic publication. The American Journal of Perinatology is accompanied by AJP Reports - an Open Access journal for case reports in neonatology and maternal/fetal medicine.
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