D. Mackeen, J. Ross, A. Betz, W. Feng, J. Bringman, M. Paglia
{"title":"生长受限胎儿的动脉间不协调","authors":"D. Mackeen, J. Ross, A. Betz, W. Feng, J. Bringman, M. Paglia","doi":"10.1515/pcard-2018-0006","DOIUrl":null,"url":null,"abstract":"Abstract OBJECTIVES: Our objectives were two-fold: 1) to determine the frequency of discordant umbilical artery Doppler systolic to diastolic (S/D) ratios in the individual umbilical arteries of growth-restricted fetuses and 2) to examine the impact of the frequency of discordance on clinical outcomes. METHODS: This was a prospective, observational study of growth-restricted fetuses. Doppler velocimetry was performed weekly and two S/D ratios were obtained for each fetal umbilical artery. Inter-artery discordance was defined as a difference in measurement categories (i.e., normal, elevated, absent, reversed) between the arteries. The number of abnormal measurements per visit was summed to 0-4 out of 4 values. A composite average number of abnormal Doppler measurements was calculated and fetuses were stratified based on degree of average number of abnormalities in increments of 25%: 0-<25%, 25-<50%, 50-<75%, and 75-100% abnormality. RESULTS: Of a total 241 fetuses (1762 visits), 110 (45.6%) had abnormal UAD flow and 189 (66%) demonstrated discordance. Abnormal values were noted in only one artery in 53% (n=151) of visits. Fetuses with any abnormal Doppler testing had smaller birthweights compared to fetuses with consistently normal testing (2485g vs 2623g, p <0.01); birthweight decreased as composite average of abnormal measurements increased (p = 0.03). CONCLUSION: The majority (66%) of fetuses with abnormal testing demonstrated UAD discordance. Up to 53% of fetuses could have been misdiagnosed if only one artery was tested. Fetuses with a higher frequency of Doppler abnormalities had lower birthweights. We propose obtaining two measurements from each umbilical artery in growth-restricted fetuses.","PeriodicalId":415760,"journal":{"name":"Prenatal Cardiology","volume":"1 1","pages":"0"},"PeriodicalIF":0.0000,"publicationDate":"2018-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":"{\"title\":\"Interartery discordance in fetuses with growth restriction\",\"authors\":\"D. Mackeen, J. Ross, A. Betz, W. Feng, J. Bringman, M. Paglia\",\"doi\":\"10.1515/pcard-2018-0006\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"Abstract OBJECTIVES: Our objectives were two-fold: 1) to determine the frequency of discordant umbilical artery Doppler systolic to diastolic (S/D) ratios in the individual umbilical arteries of growth-restricted fetuses and 2) to examine the impact of the frequency of discordance on clinical outcomes. METHODS: This was a prospective, observational study of growth-restricted fetuses. Doppler velocimetry was performed weekly and two S/D ratios were obtained for each fetal umbilical artery. Inter-artery discordance was defined as a difference in measurement categories (i.e., normal, elevated, absent, reversed) between the arteries. The number of abnormal measurements per visit was summed to 0-4 out of 4 values. A composite average number of abnormal Doppler measurements was calculated and fetuses were stratified based on degree of average number of abnormalities in increments of 25%: 0-<25%, 25-<50%, 50-<75%, and 75-100% abnormality. RESULTS: Of a total 241 fetuses (1762 visits), 110 (45.6%) had abnormal UAD flow and 189 (66%) demonstrated discordance. Abnormal values were noted in only one artery in 53% (n=151) of visits. Fetuses with any abnormal Doppler testing had smaller birthweights compared to fetuses with consistently normal testing (2485g vs 2623g, p <0.01); birthweight decreased as composite average of abnormal measurements increased (p = 0.03). CONCLUSION: The majority (66%) of fetuses with abnormal testing demonstrated UAD discordance. Up to 53% of fetuses could have been misdiagnosed if only one artery was tested. Fetuses with a higher frequency of Doppler abnormalities had lower birthweights. 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引用次数: 0
摘要
目的:我们的目的有两个:1)确定生长受限胎儿个体脐动脉多普勒收缩舒张(S/D)比不一致的频率;2)检查不一致频率对临床结果的影响。方法:这是一项针对生长受限胎儿的前瞻性观察性研究。每周进行多普勒测速,获得每条胎儿脐动脉的两个S/D比。动脉间不一致被定义为动脉之间测量类别的差异(即正常、升高、缺失、逆转)。每次访问的异常测量数被求和为0-4(4个值)。计算异常多普勒测量的综合平均次数,并根据平均异常次数的程度以25%的增量对胎儿进行分层:0-<25%,25-<50%,50-<75%和75-100%异常。结果:在共241例胎儿(1762次就诊)中,110例(45.6%)出现UAD流量异常,189例(66%)出现不一致。在53% (n=151)的就诊中,只有一条动脉出现异常值。多普勒检测异常的胎儿出生体重小于正常胎儿(2485g vs 2623g, p <0.01);出生体重随异常测量的复合平均值的增加而降低(p = 0.03)。结论:大多数(66%)检测异常的胎儿表现为UAD不一致。如果只检测一条动脉,高达53%的胎儿可能会被误诊。多普勒异常频率较高的胎儿出生体重较低。我们建议对生长受限胎儿的每条脐动脉进行两次测量。
Interartery discordance in fetuses with growth restriction
Abstract OBJECTIVES: Our objectives were two-fold: 1) to determine the frequency of discordant umbilical artery Doppler systolic to diastolic (S/D) ratios in the individual umbilical arteries of growth-restricted fetuses and 2) to examine the impact of the frequency of discordance on clinical outcomes. METHODS: This was a prospective, observational study of growth-restricted fetuses. Doppler velocimetry was performed weekly and two S/D ratios were obtained for each fetal umbilical artery. Inter-artery discordance was defined as a difference in measurement categories (i.e., normal, elevated, absent, reversed) between the arteries. The number of abnormal measurements per visit was summed to 0-4 out of 4 values. A composite average number of abnormal Doppler measurements was calculated and fetuses were stratified based on degree of average number of abnormalities in increments of 25%: 0-<25%, 25-<50%, 50-<75%, and 75-100% abnormality. RESULTS: Of a total 241 fetuses (1762 visits), 110 (45.6%) had abnormal UAD flow and 189 (66%) demonstrated discordance. Abnormal values were noted in only one artery in 53% (n=151) of visits. Fetuses with any abnormal Doppler testing had smaller birthweights compared to fetuses with consistently normal testing (2485g vs 2623g, p <0.01); birthweight decreased as composite average of abnormal measurements increased (p = 0.03). CONCLUSION: The majority (66%) of fetuses with abnormal testing demonstrated UAD discordance. Up to 53% of fetuses could have been misdiagnosed if only one artery was tested. Fetuses with a higher frequency of Doppler abnormalities had lower birthweights. We propose obtaining two measurements from each umbilical artery in growth-restricted fetuses.