The utero-placental-fetal circulation (UPFC) of 150 subjects duringsecond and third trimester was examined by using color DOppler. Of them 89 were normal woman and 58 were patients with intrauterine growth retardation...The utero-placental-fetal circulation (UPFC) of 150 subjects duringsecond and third trimester was examined by using color DOppler. Of them 89 were normal woman and 58 were patients with intrauterine growth retardation (IUGR). Our results showed that UPFC was increased gradually during normal pregnant period. In IUGR patients it was revealed that TAV and Q of UmA,UmV and UtA decreased at 20th week of gestation, especially after 30th week.PI, RI and S/D ratio of UmA were increased, but TAV, Q of UmA and UmV were markly reduced, so was UtA. Pl were increased, but the changes of RI,S/D ratio in UtA were not significant. HemodynamicaI findings of UmA,UmV and UtA were abnormal in 92. 53 % of IUGR patients,Only 81. 03% present abnormal S/D ratio of UmA (P<0. 01) and the difference was statistically significant.Maternal serum E,, HPL level in IUGR were significantly lower than that of thenormal. 6KP level was reduced, TXB,/6KP ratio was significantly increased.TXB2/6KP ratio was markedIy related with TAV, Q of UmA, UmV and UtA.Our results suggested that using color doppler ultrasound for examination of hemodynamical changes of UmA, UmV and UtA could revealed UPFC function directly. It is one of the best methods for monitoring IUGR and might be used forearly diagnosis of IUGR. The main pathophysiological changes of IUGR were UPFC obstruction and placental disfunction.展开更多
Objectives: Two methods have been described to assess fetal cardiac output (CO). It has usually been calculated by using 2D ultrasound to measure the diameter of outflow valves and Doppler ultrasound to measure flow v...Objectives: Two methods have been described to assess fetal cardiac output (CO). It has usually been calculated by using 2D ultrasound to measure the diameter of outflow valves and Doppler ultrasound to measure flow velocity through the valves. Recently CO has been assessed using 3D spatio-temporal image correlation (STIC) to measure stroke volume. We aimed to compare the reproducibility of these techniques. Methods: In 27 women with singleton pregnancies, examinations were performed in three gestational age groups: 13 - 15, 19 - 21 and >30 weeks of gestation. Each mother was scanned once. Using 2D pulsed wave Doppler the duration of flow and average flow velocity in systole were measured through aortic and pulmonary valves. We averaged values from three consecutive Doppler complexes. The outlet valve diameters were measured and the cardiac output was calculated for each valve. The measurements were repeated to assess reproducibility. In the same women, we acquired STIC volumes of the fetal heart. The volume measurements were made using the 3D Slice method by one observer. Using 2 mm slices the circumference of the ventricles was traced at the end of systole and diastole to calculate ventricular volume before and after contractions to calculate stroke volume and hence cardiac output. The measurements were repeated to assess reproducibility. Results: The root mean square difference of log (CO) of repeat measurements ranged between 0.12 and 0.21 using Doppler compared to 0.7 to 1.47 using STIC. The differences in reproducibility reached statistical significance for both sides of the heart at all but one gestation. Conclusions: We found that Doppler assessment of fetal cardiac output was more reproducible than measurement using STIC.展开更多
We aimed to establish gestation age specific reference intervals for Doppler indices of fetal cardiac function from 12 to 40 weeks of pregnancy. In a cross-sectional observational study of singleton pregnancies, exami...We aimed to establish gestation age specific reference intervals for Doppler indices of fetal cardiac function from 12 to 40 weeks of pregnancy. In a cross-sectional observational study of singleton pregnancies, examinations were performed in 221 women evenly distributed across each week of pregnancy. Blood flow through the four cardiac valves was examined with Doppler. For the atrioventricular valves, velocity and duration of early (E) and atrial (A) waves and the interval (a) between E/A complexes was recorded. For the outflow valves, the duration (b), peak and average velocity of flow in systole was measured. Myocardial performance index (MPI) was calculated as (a - b)/b. Outlet valve diameters were measured and cardiac outputs were calculated. Gestation age specific ranges were constructed for all these parameters. We demonstrated that the cardiac output, peak systolic and time-averaged velocity increase with advancing gestation. However the MPI and E/A ratios show little change across gestation. Fetal cardiac physiology can be studied and Doppler indices reliably measured as early as the late first trimester of pregnancy. Establishing gestation age specific ranges for various cardiac indices throughout pregnancy will help the study of development of fetal cardiac function.展开更多
目的:探究产前彩色多普勒超声评估胎儿生长受限(FGR)的价值,分析超声诊断假阴性的影响因素。方法:选择2019年10月至2023年7月于我院行产前彩色多普勒超声诊断为FGR并获得产后随访确诊的118例胎儿作为FGR真阳性组,60例产前彩色多普勒超...目的:探究产前彩色多普勒超声评估胎儿生长受限(FGR)的价值,分析超声诊断假阴性的影响因素。方法:选择2019年10月至2023年7月于我院行产前彩色多普勒超声诊断为FGR并获得产后随访确诊的118例胎儿作为FGR真阳性组,60例产前彩色多普勒超声诊断为FGR阴性而产后确诊为FGR的胎儿作为FGR假阴性组。比较首次检查时两组间不同孕周的超声参数;比较两组胎儿的临床资料,采用随机森林算法及多因素Logistic回归分析筛选影响超声诊断FGR假阴性的因素;构建多因素Logistic回归模型并评价其预测效能。结果:孕12~14周假阴性组胎儿的腹围、股骨长明显长于真阳性组,血流收缩末期峰值(S)/舒张末期峰值(D)明显低于真阳性组(P<0.05);孕15~27周假阴性组胎儿的腹围、股骨长明显长于真阳性组(P<0.05);孕28~37周假阴性组胎儿的腹围明显长于真阳性组(P<0.05);随机森林算法及多因素Logistic回归分析结果显示,孕期增重高于标准、妊娠糖尿病、胎方位为臀位、分娩胎龄>40周、胎儿性别为男性、腹围增加是影响超声诊断FGR假阴性的危险因素(P<0.05);当模型预测超声诊断FGR假阴性概率为0.85时,约登指数最大(74.46),敏感度为86.45%,特异度为88.01%,逻辑回归拟合优度检验结果显示模型Bootstrap验证前后的Nagelkerke R 2=0.602。结论:随着孕周的增加(12~37周),首次超声检查诊断FGR真阳性和假阴性胎儿间存在显著差异的指标数量逐渐减少,孕期增重、妊娠糖尿病、胎方位等是影响超声诊断FGR假阴性的危险因素。展开更多
文摘The utero-placental-fetal circulation (UPFC) of 150 subjects duringsecond and third trimester was examined by using color DOppler. Of them 89 were normal woman and 58 were patients with intrauterine growth retardation (IUGR). Our results showed that UPFC was increased gradually during normal pregnant period. In IUGR patients it was revealed that TAV and Q of UmA,UmV and UtA decreased at 20th week of gestation, especially after 30th week.PI, RI and S/D ratio of UmA were increased, but TAV, Q of UmA and UmV were markly reduced, so was UtA. Pl were increased, but the changes of RI,S/D ratio in UtA were not significant. HemodynamicaI findings of UmA,UmV and UtA were abnormal in 92. 53 % of IUGR patients,Only 81. 03% present abnormal S/D ratio of UmA (P<0. 01) and the difference was statistically significant.Maternal serum E,, HPL level in IUGR were significantly lower than that of thenormal. 6KP level was reduced, TXB,/6KP ratio was significantly increased.TXB2/6KP ratio was markedIy related with TAV, Q of UmA, UmV and UtA.Our results suggested that using color doppler ultrasound for examination of hemodynamical changes of UmA, UmV and UtA could revealed UPFC function directly. It is one of the best methods for monitoring IUGR and might be used forearly diagnosis of IUGR. The main pathophysiological changes of IUGR were UPFC obstruction and placental disfunction.
文摘Objectives: Two methods have been described to assess fetal cardiac output (CO). It has usually been calculated by using 2D ultrasound to measure the diameter of outflow valves and Doppler ultrasound to measure flow velocity through the valves. Recently CO has been assessed using 3D spatio-temporal image correlation (STIC) to measure stroke volume. We aimed to compare the reproducibility of these techniques. Methods: In 27 women with singleton pregnancies, examinations were performed in three gestational age groups: 13 - 15, 19 - 21 and >30 weeks of gestation. Each mother was scanned once. Using 2D pulsed wave Doppler the duration of flow and average flow velocity in systole were measured through aortic and pulmonary valves. We averaged values from three consecutive Doppler complexes. The outlet valve diameters were measured and the cardiac output was calculated for each valve. The measurements were repeated to assess reproducibility. In the same women, we acquired STIC volumes of the fetal heart. The volume measurements were made using the 3D Slice method by one observer. Using 2 mm slices the circumference of the ventricles was traced at the end of systole and diastole to calculate ventricular volume before and after contractions to calculate stroke volume and hence cardiac output. The measurements were repeated to assess reproducibility. Results: The root mean square difference of log (CO) of repeat measurements ranged between 0.12 and 0.21 using Doppler compared to 0.7 to 1.47 using STIC. The differences in reproducibility reached statistical significance for both sides of the heart at all but one gestation. Conclusions: We found that Doppler assessment of fetal cardiac output was more reproducible than measurement using STIC.
文摘We aimed to establish gestation age specific reference intervals for Doppler indices of fetal cardiac function from 12 to 40 weeks of pregnancy. In a cross-sectional observational study of singleton pregnancies, examinations were performed in 221 women evenly distributed across each week of pregnancy. Blood flow through the four cardiac valves was examined with Doppler. For the atrioventricular valves, velocity and duration of early (E) and atrial (A) waves and the interval (a) between E/A complexes was recorded. For the outflow valves, the duration (b), peak and average velocity of flow in systole was measured. Myocardial performance index (MPI) was calculated as (a - b)/b. Outlet valve diameters were measured and cardiac outputs were calculated. Gestation age specific ranges were constructed for all these parameters. We demonstrated that the cardiac output, peak systolic and time-averaged velocity increase with advancing gestation. However the MPI and E/A ratios show little change across gestation. Fetal cardiac physiology can be studied and Doppler indices reliably measured as early as the late first trimester of pregnancy. Establishing gestation age specific ranges for various cardiac indices throughout pregnancy will help the study of development of fetal cardiac function.
文摘目的:探究产前彩色多普勒超声评估胎儿生长受限(FGR)的价值,分析超声诊断假阴性的影响因素。方法:选择2019年10月至2023年7月于我院行产前彩色多普勒超声诊断为FGR并获得产后随访确诊的118例胎儿作为FGR真阳性组,60例产前彩色多普勒超声诊断为FGR阴性而产后确诊为FGR的胎儿作为FGR假阴性组。比较首次检查时两组间不同孕周的超声参数;比较两组胎儿的临床资料,采用随机森林算法及多因素Logistic回归分析筛选影响超声诊断FGR假阴性的因素;构建多因素Logistic回归模型并评价其预测效能。结果:孕12~14周假阴性组胎儿的腹围、股骨长明显长于真阳性组,血流收缩末期峰值(S)/舒张末期峰值(D)明显低于真阳性组(P<0.05);孕15~27周假阴性组胎儿的腹围、股骨长明显长于真阳性组(P<0.05);孕28~37周假阴性组胎儿的腹围明显长于真阳性组(P<0.05);随机森林算法及多因素Logistic回归分析结果显示,孕期增重高于标准、妊娠糖尿病、胎方位为臀位、分娩胎龄>40周、胎儿性别为男性、腹围增加是影响超声诊断FGR假阴性的危险因素(P<0.05);当模型预测超声诊断FGR假阴性概率为0.85时,约登指数最大(74.46),敏感度为86.45%,特异度为88.01%,逻辑回归拟合优度检验结果显示模型Bootstrap验证前后的Nagelkerke R 2=0.602。结论:随着孕周的增加(12~37周),首次超声检查诊断FGR真阳性和假阴性胎儿间存在显著差异的指标数量逐渐减少,孕期增重、妊娠糖尿病、胎方位等是影响超声诊断FGR假阴性的危险因素。
