[The standard curves of pulsatility index from uterine and fetal blood flow, and their efficacy in clinical management of intrauterine growth retardation. A comparison with fetal blood gas analysis].
Pulsed Doppler ultrasonography was used to asses the pulsatility index (PI) on flow velocity waveforms in uterine, umbilical and fetal middle cerebral arteries from a total of 659 pregnancies and the standard curves of each PI in relation with the gestational age were obtained from a total of 472 normal pregnancies. Cordocentesis was performed on 20 patients (centesis group) of PIH (pregnancy-induced hypertension) complicated with intrauterine growth retardation (IUGR) and fetal blood from the umbilical vein was sampled for blood gas analysis. Fetuses in the centesis group were acidemic (pH < 7.25) in 10 cases (50%), hypercapnemic (pCO2 > or = 50 mmHg) in 8 cases (40%), and hypoxemic (pO2 < 20 mmHg) in 6 cases (30%). In 13 cases (65%) in the centesis group, PI of the uterine artery (UTPI) was higher than +1.5 SD (standard division) of the standard curve (high UTPI), in 9 cases (45%) PI of the umbilical artery (UAPI) was higher than +1.5 SD of the standard curve (high UAPI), and in 10 cases (50%) PI of the middle cerebral artery (MCAPI) was lower than -1.5 SD of the standard curve (low MCAPI). All acidemic fetuses (100%) had high UTPI, 9 (90%) had high UAPI, and 8 (80%) had low MCAPI. All hypercapnemic fetuses had high UTPI, high UAPI and low MCAPI. All hypoxemic fetuses had high UTPI, high UAPI and low MCAPI. In the centesis group, the sensitivity, specificity, positive predictive value and negative predictive value of high UTPI to fetal acidosis was 100%, 70%, 76.9% and 100%, respectively. The sensitivity and the specificity of high UAPI and low MCAPI to fetal acidosis was 80% and 100%, respectively. The positive predictive value was 100% and negative predictive value was 83.3%. From this study, we conclude that measurement of uterine and fetal blood flow waveforms by pulsed Doppler ultrasonography is useful to assess fetal well-being in IUGR caused by hypertension during pregnancy.
Iwasaki
T
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Department of Obstetrics and Gynecology, Nippon Medical School, Japan.
D000328:Adult; D001783:Blood Flow Velocity; D001784:Blood Gas Analysis; D005260:Female; D005317:Fetal Growth Retardation / Q000175:diagnosis* / Q000209:etiology / Q000503:physiopathology; D005333:Fetus / Q000098:blood supply*; D005865:Gestational Age; D006801:Humans; D011225:Pre-Eclampsia / Q000150:complications; D011237:Predictive Value of Tests; D011247:Pregnancy; D011673:Pulsatile Flow; D012015:Reference Standards; D012680:Sensitivity and Specificity; D018617:Ultrasonography, Doppler, Pulsed; D016216:Ultrasonography, Prenatal; D014599:Uterus / Q000098:blood supply*