期刊
FETAL DIAGNOSIS AND THERAPY
卷 32, 期 1-2, 页码 116-122出版社
KARGER
DOI: 10.1159/000333001
关键词
Intrauterine growth restriction; Perinatal mortality; Doppler; Ductus venosus; Myocardial performance index; Aortic isthmus
资金
- Fondo de Investigacion Sanitaria (Spain) [PI/060347, PI/0690152]
- Ministerio de Ciencia e Innovacion (Spain) [SAF2009-08815]
- Centro para el Desarrollo Tecnico Industrial [CENIT 20092012]
- Cerebra Foundation for the Brain Injured Child (Carmarthen, UK)
- Thrasher Research Fund (Salt Lake City, Utah, USA)
- Rio Hortega research grant from the Carlos III Institute of Health (Spain) [CM07/00076]
- Marie Curie Host Fellowships for Early Stage Researchers [FETAL-MED-019707-2]
- Fondo de Inversion Local para el Empleo
- Spain
Objective: To assess the value of gestational age and cardiovascular Doppler indices in predicting perinatal mortality in a multicenter cohort of early-onset intrauterine growth-restricted (IUGR) fetuses. Methods: A multicenter prospective cohort study including 157 early-onset (<34 weeks) IUGR cases with abnormal umbilical artery (UA) Doppler was conducted. Cardiovascular assessment included the ductus venosus (DV), the aortic isthmus flow index (IFI), and the myocardial performance index (MPI). Isolated and combined values to predict the risk of perinatal death were evaluated by logistic regression and by decision tree analysis, where the gestational age at delivery, UA, and middle cerebral artery (MCA) were also included as covariates. Results: Perinatal mortality was 17% (27/157). All parameters were significantly associated with perinatal death, with individual odds ratios (OR) of 25.2 for gestational age below 28 weeks, 12.1 for absent/reversed DV atrial flow, 5.3 for MCA pulsatility index <5th centile, 4.6 for UA absent/reversed diastolic end-flow, 1.8 for IFI <5th centile, and 1.6 for MPI >95th centile. Decision tree analysis identified gestational age at birth as the best predictor of death (<26 weeks, 93% mortality; 26-28 weeks, 29% mortality, and >28 weeks, 3% mortality). Between 26 and 28 weeks, DV atrial flow allowed further stratification between high (60%) and low risk (18%) of mortality. Conclusions: Gestational age largely determines the risk of perinatal mortality in early-onset IUGR before 26 weeks and later than 28 weeks of gestation. The DV may improve clinical management by stratifying the probability of death between 26 and 28 weeks of gestation. Copyright (c) 2012 S. Karger AG, Basel
作者
我是这篇论文的作者
点击您的名字以认领此论文并将其添加到您的个人资料中。
推荐
暂无数据