{"title":"胎儿大脑中动脉的多普勒测速法和其他胎儿健康参数对胎盘功能不全妊娠新生儿存活率的影响","authors":"Roseli Mieko Yamamoto Nomura, Juliana Ikeda Niigaki, Flávia Thiemi Horigome, Rossana Pulcineli Vieira Francisco, Marcelo Zugaib","doi":"10.1016/S2255-4823(13)70493-4","DOIUrl":null,"url":null,"abstract":"<div><h3>Objective</h3><p>To study the Doppler velocimetry of the fetal middle cerebral artery in pregnancies complicated by placental insufficiency, and to verify its role in the prognosis of neonatal survival.</p></div><div><h3>Methods</h3><p>This was a prospective study of 93 pregnant women with diagnosis of placental insufficiency detected before the 34<sup>th</sup> week of pregnancy. Placental insufficiency was characterized by abnormal umbilical artery (UA) Doppler (> 95<sup>th</sup> percentile). The following parameters were analyzed: umbilical artery (UA) pulsatility index (PI); middle cerebral artery (MCA) PI; brain-placenta ratio – BPR (MCA-PI/UA-PI); MCA peak systolic velocity (MCA-PSV); and PI for veins (PIV) of ductus venosus (DV). The parameters were analyzed in terms of absolute values, z-scores (standard deviations from the mean), or multiples of the median (MoM). The outcome investigated was neonatal death during the hospitalization period after birth.</p></div><div><h3>Results</h3><p>Of the 93 pregnancies analyzed, there were 25 (26.9%) neonatal deaths. The group that died, when compared to the survival group, presented a significant association with the diagnosis of absent or reversed end-diastolic flow (88% vs. 23.6%, p<!--> <!--><<!--> <!-->0.001), with a higher median of UA PI (2.9 vs. 1.7, p<!--> <!--><<!--> <!-->0.001) and UA PI z-score (10.4 vs. 4.9, p<!--> <!--><<!--> <!-->0.001); higher MCA-PSV MoM (1.4 vs. 1.1, p<!--> <!-->=<!--> <!-->0.012); lower BPR (0.4 vs. 0.7, p<!--> <!--><<!--> <!-->0.001); higher PIV-DV (1.2 vs. 0.8, p<!--> <!--><<!--> <!-->0.001) and DV z-score (3.6 vs. 0.6, p<!--> <!--><<!--> <!-->0.001). In the logistic regression, the independent variables predictive of neonatal death were: gestational age at birth (OR<!--> <!-->=<!--> <!-->0.45; 95% CI: 0.3 to 0.7; p<!--> <!--><<!--> <!-->0.001) and UA PI z-score (OR<!--> <!-->=<!--> <!-->1.14, 95% CI: 1.0 to 1.3, p<!--> <!-->=<!--> <!-->0.046).</p></div><div><h3>Conclusion</h3><p>Despite the association verified by the univariate analysis between neonatal death and the parameters of fetal cerebral Doppler velocimetry, the multivariate analysis identified prematurity and degree of insufficiency of placental circulation as independent factors related to neonatal death in pregnancies complicated by placental insufficiency.</p></div>","PeriodicalId":101100,"journal":{"name":"Revista da Associa??o Médica Brasileira (English Edition)","volume":"59 4","pages":"Pages 392-399"},"PeriodicalIF":0.0000,"publicationDate":"2013-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1016/S2255-4823(13)70493-4","citationCount":"0","resultStr":"{\"title\":\"Doppler velocimetry of the fetal middle cerebral artery and other parameters of fetal well-being in neonatal survival during pregnancies with placental insufficiency\",\"authors\":\"Roseli Mieko Yamamoto Nomura, Juliana Ikeda Niigaki, Flávia Thiemi Horigome, Rossana Pulcineli Vieira Francisco, Marcelo Zugaib\",\"doi\":\"10.1016/S2255-4823(13)70493-4\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<div><h3>Objective</h3><p>To study the Doppler velocimetry of the fetal middle cerebral artery in pregnancies complicated by placental insufficiency, and to verify its role in the prognosis of neonatal survival.</p></div><div><h3>Methods</h3><p>This was a prospective study of 93 pregnant women with diagnosis of placental insufficiency detected before the 34<sup>th</sup> week of pregnancy. Placental insufficiency was characterized by abnormal umbilical artery (UA) Doppler (> 95<sup>th</sup> percentile). The following parameters were analyzed: umbilical artery (UA) pulsatility index (PI); middle cerebral artery (MCA) PI; brain-placenta ratio – BPR (MCA-PI/UA-PI); MCA peak systolic velocity (MCA-PSV); and PI for veins (PIV) of ductus venosus (DV). The parameters were analyzed in terms of absolute values, z-scores (standard deviations from the mean), or multiples of the median (MoM). The outcome investigated was neonatal death during the hospitalization period after birth.</p></div><div><h3>Results</h3><p>Of the 93 pregnancies analyzed, there were 25 (26.9%) neonatal deaths. The group that died, when compared to the survival group, presented a significant association with the diagnosis of absent or reversed end-diastolic flow (88% vs. 23.6%, p<!--> <!--><<!--> <!-->0.001), with a higher median of UA PI (2.9 vs. 1.7, p<!--> <!--><<!--> <!-->0.001) and UA PI z-score (10.4 vs. 4.9, p<!--> <!--><<!--> <!-->0.001); higher MCA-PSV MoM (1.4 vs. 1.1, p<!--> <!-->=<!--> <!-->0.012); lower BPR (0.4 vs. 0.7, p<!--> <!--><<!--> <!-->0.001); higher PIV-DV (1.2 vs. 0.8, p<!--> <!--><<!--> <!-->0.001) and DV z-score (3.6 vs. 0.6, p<!--> <!--><<!--> <!-->0.001). In the logistic regression, the independent variables predictive of neonatal death were: gestational age at birth (OR<!--> <!-->=<!--> <!-->0.45; 95% CI: 0.3 to 0.7; p<!--> <!--><<!--> <!-->0.001) and UA PI z-score (OR<!--> <!-->=<!--> <!-->1.14, 95% CI: 1.0 to 1.3, p<!--> <!-->=<!--> <!-->0.046).</p></div><div><h3>Conclusion</h3><p>Despite the association verified by the univariate analysis between neonatal death and the parameters of fetal cerebral Doppler velocimetry, the multivariate analysis identified prematurity and degree of insufficiency of placental circulation as independent factors related to neonatal death in pregnancies complicated by placental insufficiency.</p></div>\",\"PeriodicalId\":101100,\"journal\":{\"name\":\"Revista da Associa??o Médica Brasileira (English Edition)\",\"volume\":\"59 4\",\"pages\":\"Pages 392-399\"},\"PeriodicalIF\":0.0000,\"publicationDate\":\"2013-01-01\",\"publicationTypes\":\"Journal Article\",\"fieldsOfStudy\":null,\"isOpenAccess\":false,\"openAccessPdf\":\"https://sci-hub-pdf.com/10.1016/S2255-4823(13)70493-4\",\"citationCount\":\"0\",\"resultStr\":null,\"platform\":\"Semanticscholar\",\"paperid\":null,\"PeriodicalName\":\"Revista da Associa??o Médica Brasileira (English Edition)\",\"FirstCategoryId\":\"1085\",\"ListUrlMain\":\"https://www.sciencedirect.com/science/article/pii/S2255482313704934\",\"RegionNum\":0,\"RegionCategory\":null,\"ArticlePicture\":[],\"TitleCN\":null,\"AbstractTextCN\":null,\"PMCID\":null,\"EPubDate\":\"\",\"PubModel\":\"\",\"JCR\":\"\",\"JCRName\":\"\",\"Score\":null,\"Total\":0}","platform":"Semanticscholar","paperid":null,"PeriodicalName":"Revista da Associa??o Médica Brasileira (English Edition)","FirstCategoryId":"1085","ListUrlMain":"https://www.sciencedirect.com/science/article/pii/S2255482313704934","RegionNum":0,"RegionCategory":null,"ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"","JCRName":"","Score":null,"Total":0}
引用次数: 0
摘要
目的研究妊娠合并胎盘功能不全时胎儿大脑中动脉的多普勒血流速度测定，并验证其在新生儿生存预后中的作用。方法对93例妊娠34周前诊断为胎盘功能不全的孕妇进行前瞻性研究。胎盘功能不全的特征是异常的脐动脉（UA）多普勒（>；第95百分位）。分析了以下参数：脐动脉（UA）搏动指数（PI）；大脑中动脉（MCA）PI；脑胎盘比BPR（MCA-PI/UA-PI）；MCA峰值收缩速度（MCA-PSV）；静脉导管（DV）的静脉（PIV）的PI。根据绝对值、z评分（与平均值的标准差）或中位数的倍数（MoM）对参数进行分析。调查的结果是新生儿在出生后住院期间死亡。结果在分析的93例妊娠中，有25例（26.9%）新生儿死亡。与存活组相比，死亡组与舒张末期血流缺失或逆转的诊断有显著相关性（88%对23.6%，p＜0.001），UA PI中位数（2.9对1.7，p＜001）和UA PI z评分中位数（10.4对4.9，p＜0.001%）较高；MCA-PSV MoM较高（1.4对1.1，p=0.012）；较低的BPR（0.4对0.7，p＜0.001）；较高的PIV-DV（1.2对0.8，p＜0.001）和DV z评分（3.6对0.6，p＜001）。在逻辑回归中，预测新生儿死亡的自变量是：出生时的胎龄（OR=0.45；95%CI:0.3-0.7；p<；0.001）和UA PI z评分（OR=1.14，95%CI:1.0-1.3，p=0.046），多变量分析表明，早产和胎盘循环功能不全程度是导致妊娠合并胎盘功能不全新生儿死亡的独立因素。
Doppler velocimetry of the fetal middle cerebral artery and other parameters of fetal well-being in neonatal survival during pregnancies with placental insufficiency
Objective
To study the Doppler velocimetry of the fetal middle cerebral artery in pregnancies complicated by placental insufficiency, and to verify its role in the prognosis of neonatal survival.
Methods
This was a prospective study of 93 pregnant women with diagnosis of placental insufficiency detected before the 34th week of pregnancy. Placental insufficiency was characterized by abnormal umbilical artery (UA) Doppler (> 95th percentile). The following parameters were analyzed: umbilical artery (UA) pulsatility index (PI); middle cerebral artery (MCA) PI; brain-placenta ratio – BPR (MCA-PI/UA-PI); MCA peak systolic velocity (MCA-PSV); and PI for veins (PIV) of ductus venosus (DV). The parameters were analyzed in terms of absolute values, z-scores (standard deviations from the mean), or multiples of the median (MoM). The outcome investigated was neonatal death during the hospitalization period after birth.
Results
Of the 93 pregnancies analyzed, there were 25 (26.9%) neonatal deaths. The group that died, when compared to the survival group, presented a significant association with the diagnosis of absent or reversed end-diastolic flow (88% vs. 23.6%, p < 0.001), with a higher median of UA PI (2.9 vs. 1.7, p < 0.001) and UA PI z-score (10.4 vs. 4.9, p < 0.001); higher MCA-PSV MoM (1.4 vs. 1.1, p = 0.012); lower BPR (0.4 vs. 0.7, p < 0.001); higher PIV-DV (1.2 vs. 0.8, p < 0.001) and DV z-score (3.6 vs. 0.6, p < 0.001). In the logistic regression, the independent variables predictive of neonatal death were: gestational age at birth (OR = 0.45; 95% CI: 0.3 to 0.7; p < 0.001) and UA PI z-score (OR = 1.14, 95% CI: 1.0 to 1.3, p = 0.046).
Conclusion
Despite the association verified by the univariate analysis between neonatal death and the parameters of fetal cerebral Doppler velocimetry, the multivariate analysis identified prematurity and degree of insufficiency of placental circulation as independent factors related to neonatal death in pregnancies complicated by placental insufficiency.
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