第二个三个月异常的子宫动脉多普勒和不良的产科和新生儿结局,当PAPP-a正常时
Michelle Jie1, Shireen Jaufuraully2,3, James Lambert4
1Ultrasound Screening Unit, Elizabeth Garrett Anderson Wing, University College London Hospital, London, United Kingdom of Great Britain and Northern Ireland.
概括
妊娠中异常的子宫动脉多普勒,即使是正常的PAPP-A,也与子宫前,剖腹产和新生儿不良后果的风险增加有关. 常规的多普勒查可以改善检测小的妊娠年龄胎儿.
科学领域:
- 产科和妇科 产科和妇科
- 胎儿医学 胎儿医学
- 孕产妇和胎儿医学 孕产妇和胎儿医学
背景情况:
- 子宫动脉多普勒 (UAD) 速度测量评估胎盘 perfusion.
- 异常的UAD,以脉动性指数 (PI) >2.5表示,可能表明胎盘缺陷.
- 异常UAD和不良结果之间的关联,特别是正常PAPP-A,需要进一步调查.
研究的目的:
- 调查异常子宫动脉多普勒 (PI > 2.5) 与正常PAPP-A以及不良产科和新生儿结局之间的关联.
- 为了确定常规的UAD查是否改善了对妊娠年龄小 (SGA) 胎儿的检测.
主要方法:
- 一项回顾性队列研究包括400名非正常UAD和正常PAPP-A的女性,与400名正常UAD和PAPP-A的对照进行了匹配.
- 数据是在2019年3月至2021年11月期间从英国一家高等医院收集的.
- 结果包括出生方式,产后并发症,出生体重,阿帕尔分数,分娩时的妊娠年龄,新生儿单位入院和新生儿低血糖症. 进行了多变量分析.
主要成果:
- 患有异常UAD和正常PAPP-A的女性的诱导率 (46.5%与35.5%相比),剖腹产 (46.0%与38.0%相比),紧急剖腹产 (35.0%与26.5%相比) 和子宫前 (5.8%与2.5%) 显著更高.
- 他们的新生儿面临新生儿单位入院 (15.3%对6.3%),低血糖 (4.0%对1.0%),对于妊娠年龄 (26.5%对11.5%),子宫内生长限制 (10.8%对1.3%) 和早产 (10.0%对3.5%) 的风险增加.
- 常规UAD测量提高了SGA胎儿的检测率15.1%;在异常UAD组中,不明原因占新生儿低血糖病例的一半以上.
结论:
- 异常的子宫动脉多普勒,即使是正常的PAPP-A,也与子宫前,胎儿生长限制,紧急剖腹产和新生儿不良后果的风险增加有关.
- 在这个队列中,新生儿低血糖症可能与早产,胎盘问题以及潜在的未被诊断的葡萄糖代谢障碍有关.
- 在可行的情况下,在所有怀孕中进行例行UAD查,可以帮助产前管理和针对不良结果的咨询.
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