[Value of pulsatile Doppler ultrasound in diagnosis of suspected placental insufficiency in comparison with other examination parameters].
In order to determine the diagnostic value of various methods for placental insufficiency, the following parameters were obtained from 108 patients with intrauterine growth retardation (IUGR) as the only risk factor: A/B-ratio, resistence index (RI), pulsatility index (PI) of the umbilical artery (UA) and descending fetal aorta (FA), maternal serum estriol, grading of the placental maturity according to Grannum, amount of amniotic fluid, and fetal heart rate tracings. All Doppler indices showed the same efficacy as regards prediction of neonatal growth retardation. With a value of 8.0 for the A/B ratio of the FA and 4.5 for the UA neonatal dystrophy may be recognized with a precision of 72.2% (sensitivity 65.2%, specificity 77.4%). Maternal serum estriol has an accuracy of 64% (sensitivity 50%, specificity 74%), fetal heart rate tracings are able to predict neonatal growth retardation with a precision of 63% (sensitivity 43.5%, specificity 77.4%) determination of the amount of amniotic fluid has an accuracy of 58% (sensitivity 69%, specificity 50%) and grading of placental maturity 61% (sensitivity 17%, specificity 95%). The parameters combined yield in an accuracy of 75% (sensitivity 72%, specificity 74%). The fetal outcome of neonates with preceeding pathologic Doppler indices differed significantly from those with normal Doppler indices as regards indication for cesarean section, necessity of therapy in the intensive care unit, and preterm labor rate (chi square test, p < 0.05). This result could be improved to 2-4% by obtaining additional parameters. Pulsed Doppler sonography of fetal vessels is an additional tool in diagnosing intrauterine growth retardation.
Klinik für Gynäkologie und Geburtshilfe der Christian-Albrechts-Universität Kiel.
G
G
Bonatz
E
E
Lörcher
D
D
Weisner
V
V
Schulz
K
K
Semm
D000653:Amniotic Fluid / Q000000981:diagnostic imaging; D004964:Estriol / Q000097:blood; D005260:Female; D005317:Fetal Growth Retardation / Q000000981:diagnostic imaging*; D005333:Fetus / Q000098:blood supply*; D006801:Humans; D007231:Infant, Newborn; D010927:Placental Insufficiency / Q000000981:diagnostic imaging*; D011247:Pregnancy; D011673:Pulsatile Flow / Q000502:physiology; D012016:Reference Values; D018608:Ultrasonography, Doppler; D016216:Ultrasonography, Prenatal; D014655:Vascular Resistance / Q000502:physiology
D004964:Estriol