“胎盘血管阻力的新型评分方法”点评

BackgroundUmbilical artery Doppler veloci-metry is a routine method for fetal surveillance in high-risk pregnancy．Uterine artery Doppler seems to give comparable information，but it can be diffi-cult to interpret as there are two arteries，which might show notching and／or increased pulsatility index （PI）as signs of increased vascular imped-ance．Combining the information on vascular re-sistance on both sides in a new score might simplify and improve evaluation of placental circulation．MethodsUterine and umbilical artery Doppler velocimetry was evaluated in 633 highrisk pregnan-cies．The managing clinician was informed only a-bout the umbilical artery flow．The umbilical ar-tery flow spectrum was semiquantitatively divided into four blood flow classes （BFC ），expressing signs of increasing vascular resistance．The uterine artery Doppler flow spectrum was divided into five uterine artery scores （UAS），taking into account presence／absence of notching and／or increase in PI．By adding UAS to BFC，a new placental score （PLS）was constructed with values ranging from 0 to 7，indicating general placental vascular resistance．The scores were related to three outcome variables：small-for-gestational age （SGA），premature delivery （＜37 weeks），and cesarean section．ResultsAll three score systems showed a significant relationship between signs of increasing vascular resistance and outcome．The new PLS showed the best association to adverse outcomes， with optimal cut-off at values exceeding score 3．ConclusionDoppler velocimetry on both sides of the placenta showed a strong relationship to an adverse outcome of pregnancy． The new PLS showed a better relationship to adverse perinatal outcome than the BFC and the UAS．The PLS can simplify evaluation of uteroplacental and fetopla-cental Doppler velocimetry．