妊娠早期低风险人群子宫动脉多普勒搏动指数与不良妊娠结局的关系
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摘要
目的探讨妊娠11～13~(+6)周子宫动脉血流的搏动指数(UtA-PI)、阻力指数(UtA-RI)预测异常妊娠结局的可行性。方法随机选取2017年1月1日～2017年6月31日在上海市长宁区妇幼保健院正规产前检查的2567例单胎妊娠孕妇为研究对象。于孕11～13~(+6)周检测每位孕妇的双侧子宫动脉多普勒血流波形,记录子宫动脉UtAPI、及有无舒张早期切迹。随访所有研究对象的妊娠过程及母胎结局等情况。结果 2567例中,55例因结构畸形或胎死宫内于28周前终止妊娠者被剔除,2512例纳入统计。2512例中,发生不良妊娠结局359例(占14.29%),包括99例妊娠期高血压疾病、88例子痫前期、76例胎儿宫内生长受限、76例小于胎龄儿、11例胎盘早剥、及9例28周后胎死宫内者;余2153例妊娠结局正常。不良妊娠结局组UtA-PI值的平均值(1.8)及第90百分位数(2.4)均高于正常妊娠结局组(1.68,2.19),差异均有统计学意义(P <0.05)。以UtA-PI第90百分位数为界值,预测严重不良妊娠结局的敏感性为71%、特异性为75%,预测任意一种不良妊娠结局的敏感性虽低(27%)、但特异性较高(89%),并以预测胎儿宫内生长受限这一不良妊娠结局的敏感性最低(19%)、但特异性较高(91%)。以UtA-PI第90百分位数为界值,预测各种不良妊娠结局的阴性预测值均较高。结论妊娠11～13~(+6)周时UtA-PI在低风险人群中预测不良妊娠结局有一定的临床价值,但总体敏感性不高。
Objective To discuss the feasibility of uterine artery pulsatility indexes(UtA-PI) 11-13~(+6) weeks in predicting adverse pregnancy outcomes. Methods From January 1, 2017 to June 31, 2567 singleton pregnancies presented for routine prenatal care in Shanghai Changning Maternity & Infant Health Hospital, who were recruited as the research object. Doppler blood flow waveforms of bilateral uterine arteries of each pregnant woman were detected at 11-13~(+6) weeks of gestation were measured, the UtA-PI and resistance indexes(UtA-RI), and the presence or absence of early diastolic notching were recorded. The maternal and neonatal outcomes were followed up. Results Among all the 2567 cases, 55 cases were excluded because of termination for fetal abnormalities or fetal death before 28 weeks of gestation,the other 2512 cases were enrolled in this analysis. Among the 2512 cases enrolled, there were 359 cases(14.29%) of adverse outcomes, including, 99 cases of hypertensive disorder complicating pregnancies, 88 cases of preeclampsia, 76 cases of fetal growth restriction, 76 cases of small for gestational age, 11 cases of placental abruption, 9 cases of stillbirth; and the remaining 2153 cases had normal outcomes. The mean value and the 90 th percentile of UtA-PI were higher in the adverse outcome group(1.8, 2.4) than that in normal outcome group(1.68, 2.19), the differences were statistically significant(P < 0.05), respectively. By using the 90 th percentile of UtA-PI as cut-off value, the sensitivity was 71% and the specificity was 75% in predicting severe adverse pregnancy outcomes, but the sensitivity was low(27%) and the specificity was high(89%) in predicting any kind of adverse pregnancy outcomes, and the sensitivity(19%) was the lowest while the specificity was high(91%) in predicting fetal growth restriction. By using the 90 th percentile of UtA-PI as cut-off value, the negative predicting values were high in all groups in predicting each kind of adverse pregnancy outcomes. Conclusion UtA-PI at 11-13~(+6) weeks of gestation shows significance in predicting the development of adverse outcomes in low-risk pregnancies,but provides a low sensitivity.
Objective To discuss the feasibility of uterine artery pulsatility indexes(UtA-PI) 11-13~(+6) weeks in predicting adverse pregnancy outcomes. Methods From January 1, 2017 to June 31, 2567 singleton pregnancies presented for routine prenatal care in Shanghai Changning Maternity & Infant Health Hospital, who were recruited as the research object. Doppler blood flow waveforms of bilateral uterine arteries of each pregnant woman were detected at 11-13~(+6) weeks of gestation were measured, the UtA-PI and resistance indexes(UtA-RI), and the presence or absence of early diastolic notching were recorded. The maternal and neonatal outcomes were followed up. Results Among all the 2567 cases, 55 cases were excluded because of termination for fetal abnormalities or fetal death before 28 weeks of gestation,the other 2512 cases were enrolled in this analysis. Among the 2512 cases enrolled, there were 359 cases(14.29%) of adverse outcomes, including, 99 cases of hypertensive disorder complicating pregnancies, 88 cases of preeclampsia, 76 cases of fetal growth restriction, 76 cases of small for gestational age, 11 cases of placental abruption, 9 cases of stillbirth; and the remaining 2153 cases had normal outcomes. The mean value and the 90 th percentile of UtA-PI were higher in the adverse outcome group(1.8, 2.4) than that in normal outcome group(1.68, 2.19), the differences were statistically significant(P < 0.05), respectively. By using the 90 th percentile of UtA-PI as cut-off value, the sensitivity was 71% and the specificity was 75% in predicting severe adverse pregnancy outcomes, but the sensitivity was low(27%) and the specificity was high(89%) in predicting any kind of adverse pregnancy outcomes, and the sensitivity(19%) was the lowest while the specificity was high(91%) in predicting fetal growth restriction. By using the 90 th percentile of UtA-PI as cut-off value, the negative predicting values were high in all groups in predicting each kind of adverse pregnancy outcomes. Conclusion UtA-PI at 11-13~(+6) weeks of gestation shows significance in predicting the development of adverse outcomes in low-risk pregnancies,but provides a low sensitivity.
引文
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[13]Pilalis A,Souka AP,Antsaklis P,et al. Screening for preeclampsia and fetal growth restriction by uterine artery Doppler and PAPP-A at 11-14 weeks′gestation[J]. Ultrasound Obstet Gynecol,2007,29(2):135-140.
[14]Gomez O,Martinez JM,Figueras F,et al. Uterine artery Doppler at 11-14 weeks of gestation to screen for hypertensive disorders and associated complications in an unselected population[J]. Ultrasound Obstet Gynecol,2005,26:490-494.
[15]Albaiges G,Missfelder-Lobos H,Lees C,et al. Onestage screening for pregnancy complications by color Doppler assessment of the uterine arteries at 23 weeks′gestation[J]. Obstet Gynecol,2000,96(4):559-564.
[16]Martin AM,Bindra R,Curcio P,et al. Screening for preeclamp sia and fetal growth restriction by uterine artery Doppler at 11-14 weeks of gestation[J]. Ultrasound Obstet Gynecol,2001,18(6):583-586.
[17]Li N,Ghosh G,Gudmundsson S. Uterine artery Doppler in high-risk pregnancies at 23-24 gestational weeks is of value in predicting adverse outcome of pregnancy and selecting cases for more intense surveillance[J]. Acta Obstet Gynecol Scand,2014,93(12):1276-1281.
[18]Velauthar L,Plana MN,Kalidindi M,et al. First-trimester uterine artery Doppler and adverse pregnancy outcome:a meta-analysis involving 55,974 women[J]. Ultrasound Obstet Gynecol,2014,43(5):500-507.
[19]D’Silva A,Fyfe R,Hyett J. First trimester prediction and prevention of adverse pregnancy outcomes related to poor placentation[J]. Curr Opin Obstet Gynecol,2017,29(6):367-374.
[20]Hafner E,Metzenbauer M,Honfinger D,et al. Comparison between three-dimensional placental volume at 12weeks and uterine artery impedance/notching at 22weeks in screening for pregnancy-induced hypertension,pre-eclampsia and fetal growth restriction in a low-risk population[J]. Ultrasound Obstet Gynecol,2006,27(6):652-657.
[2]Bujold E,Roberge S,Nicoladids KH. Low-dose aspirin for prevention of adverse outcomes related to abnormal placentation[J]. Prenat Diagn,2014,34(7):642-648.
[3]VanWijk MJ,Kublickiene K,Boer K,et al. Vascular function in preeclampsia[J]. Cardiovasc Res,2000,47(1):38-48.
[4]Monte S. Biochemical markers for prediction of preeclampsia:review of the literature[J]. J Prenat Med,2011,5(3):69-77.
[5]Afrakhteh M,Moeini A,Taheri MS,et al. Uterine Doppler velocimetry of the uterine arteries in the second and third trimesters for the prediction of gestational outcome[J].Rev Bras Ginecol Obstet,2014,36(1):35-39.
[6]Jamal A,Abbasalizadeh F,Vafaei H,et al. Multicenter screening for adverse pregnancy outcomes by uterine artery Doppler in the second and third trimester of pregnancy[J]. Med Ultrason,2013,15(2):95-100.
[7]Nicoladids KH. A model for a new pyramid of prenatal care based on the 11 to 13 weeks′assessment[J]. Prenat Diagn,2011,31:3-6.
[8]Bujold E,Roberge S,Lacasse Y,et al. Prevention of preeclampsia and intrauterine growth restriction with aspirin started in early pregnancy:a meta-analysis[J]. Obstet Gynecol,2010,116(2 Pt 1):402-414.
[9]Roberge S,Nicolaides KH,Demers S,et al. Prevention of perinatal death and adverse perinatal outcome using low dose aspirin:a meta-analysis[J]. Ultrasound Obstet Gynecol,2013,41(5):491-499.
[10]Roberge S,Nicolaides KH,Demers S,et al. The role of aspirin dose on the prevention of preeclampsia and fetal growth restriction:systematic review and meta-analysis[J].Am J Obstet Gynecol,2017,216(2):110-120.
[11]Kafkasl A,Turkcuoglu I,Turhan U. Maternal,fetal and perinatal characteristics of preeclampsia cases with and without abnormalities in uterine artery Doppler indexes[J].J Matern Fetal Neonatal Med,2013,26(9):936-940.
[12]Madzli R,Yuksel MA,Imamoglu M,et al. Comparison of clinical and perinatal outcomes in early-and late-onset preeclampsia[J]. Arch Gynecol Obstet,2014,290(1):53-57.
[13]Pilalis A,Souka AP,Antsaklis P,et al. Screening for preeclampsia and fetal growth restriction by uterine artery Doppler and PAPP-A at 11-14 weeks′gestation[J]. Ultrasound Obstet Gynecol,2007,29(2):135-140.
[14]Gomez O,Martinez JM,Figueras F,et al. Uterine artery Doppler at 11-14 weeks of gestation to screen for hypertensive disorders and associated complications in an unselected population[J]. Ultrasound Obstet Gynecol,2005,26:490-494.
[15]Albaiges G,Missfelder-Lobos H,Lees C,et al. Onestage screening for pregnancy complications by color Doppler assessment of the uterine arteries at 23 weeks′gestation[J]. Obstet Gynecol,2000,96(4):559-564.
[16]Martin AM,Bindra R,Curcio P,et al. Screening for preeclamp sia and fetal growth restriction by uterine artery Doppler at 11-14 weeks of gestation[J]. Ultrasound Obstet Gynecol,2001,18(6):583-586.
[17]Li N,Ghosh G,Gudmundsson S. Uterine artery Doppler in high-risk pregnancies at 23-24 gestational weeks is of value in predicting adverse outcome of pregnancy and selecting cases for more intense surveillance[J]. Acta Obstet Gynecol Scand,2014,93(12):1276-1281.
[18]Velauthar L,Plana MN,Kalidindi M,et al. First-trimester uterine artery Doppler and adverse pregnancy outcome:a meta-analysis involving 55,974 women[J]. Ultrasound Obstet Gynecol,2014,43(5):500-507.
[19]D’Silva A,Fyfe R,Hyett J. First trimester prediction and prevention of adverse pregnancy outcomes related to poor placentation[J]. Curr Opin Obstet Gynecol,2017,29(6):367-374.
[20]Hafner E,Metzenbauer M,Honfinger D,et al. Comparison between three-dimensional placental volume at 12weeks and uterine artery impedance/notching at 22weeks in screening for pregnancy-induced hypertension,pre-eclampsia and fetal growth restriction in a low-risk population[J]. Ultrasound Obstet Gynecol,2006,27(6):652-657.