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Cerebroplacental ratio as predictor of adverse perinatal outcome in the third trimester.

脑胎盘比率作为妊娠晚期不良围产结局的预测因子。

  • 影响因子:2.21
  • DOI:10.1111/aogs.14031
  • 作者列表:"Bonnevier A","Maršál K","Brodszki J","Thuring A","Källén K
  • 发表时间:2021-03-01
Abstract

INTRODUCTION:Fetal growth restriction is associated with adverse perinatal outcome and the clinical management of these pregnancies is a challenge. The aim of this study was to investigate the potential of cerebroplacental ratio (CPR) to predict adverse perinatal outcome in high-risk pregnancies in the third trimester. Another aim was to study whether the CPR has better predictive value than its components, middle cerebral artery (MCA) pulsatility index (PI) and umbilical artery (UA) PI. MATERIAL AND METHODS:The study was a retrospective cohort study including 1573 singleton high-risk pregnancies with Doppler examinations performed at 32+0 to 40+6 gestational weeks at Lund University Hospital and the University Hospital of Malmö between 29 December 1994 and 31 December 2017. Receiver operating characteristics (ROC) curves were used to investigate the predictive value of the gestational age-specific z-scores for CPR, UA PI and MCA PI, respectively, for the primary outcome "perinatal asphyxia/mortality" and the secondary outcomes "birthweight small for gestational age (SGA)" and two composite outcomes: "appropriate for gestational age/large for gestational age liveborn infants with neonatal morbidity" and "SGA liveborn infants with neonatal morbidity." RESULTS:The performance in predicting perinatal asphyxia/mortality was poor for all three variables and did not differ significantly. The ROC area under curve (AUC) was 0.56, 0.55 and 0.53 for CPR, UA PI and MCA PI z-scores, respectively. The ROC AUC for CPR z-scores to predict SGA was 0.73, significantly higher than that for either UA PI or MCA PI (P < .001). The ability of CPR and the MCA PI to predict appropriate for gestational age/large for gestational age infant morbidity and SGA infant morbidity was similar and significantly better than UA PI (P < .001). CONCLUSIONS:In the present study, none of the three Doppler measures proved to be useful in predicting perinatal asphyxia and mortality. CPR and MCA PI were equally good in predicting neonatal morbidity, especially in SGA pregnancies, and both were significantly better predictors than the UA PI. CPR had a high predictive value for SGA at birth, better than that of its two components, UA PI and MCA PI.

摘要

引言: 胎儿生长受限与不良的围产期结局相关,这些妊娠的临床管理是一个挑战。本研究的目的是探讨脑胎盘比率 (CPR) 预测妊娠晚期高危妊娠围生儿不良结局的可能性。另一个目的是研究CPR是否比其成分,大脑中动脉 (MCA) 搏动指数 (PI) 和脐动脉 (UA) PI具有更好的预测价值。 材料和方法: 本研究是一项回顾性队列研究,包括1994年12月29日至20 17年12月31日在隆德大学医院和马尔默大学医院于32 + 0至40 + 6孕周进行的1573例单胎高危妊娠的多普勒检查。受试者工作特征 (ROC) 曲线用于研究CPR、UA PI和MCA PI的胎龄特异性z评分分别对主要结局 “围产期窒息/死亡率” 和次要结局 “出生体重小于胎龄 (SGA)” 的预测价值 "和两个复合结果:"适用于胎龄/大于胎龄儿具有新生儿发病率的活产婴儿 ”和“ SGA具有新生儿发病率的活产婴儿 ”。 结果: 在预测围产期窒息/死亡率方面,所有三个变量的表现都很差,并且没有显著差异。CPR、UA PI和MCA PI z评分的ROC曲线下面积 (AUC) 分别为0.56、0.55和0.53。用于预测SGA的CPR z评分的ROC AUC为0.73,显著高于UA PI或MCA PI (P <.001)。CPR和MCA PI预测适当胎龄/大胎龄婴儿发病率和SGA婴儿发病率的能力相似,显著优于UA PI (P <.001)。 结论: 在本研究中,三种多普勒测量方法都不能用于预测围产儿窒息和死亡率。CPR和MCA PI在预测新生儿发病率方面同样良好,特别是在SGA妊娠中,两者均显著优于UA PI。CPR对出生时的SGA有较高的预测价值,优于其两个组分UA PI和MCA PI。

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