甲胎蛋白联合人绒毛膜促性腺激素升高对妊娠中期严重胎盘并发症的预测  

Second-trimester prediction of severe placental complications in women with combined elevations in alpha-fetoprotein and human chorionic gonadotrophin

作　　者：Alkazaleh F. Chaddha V. Viero S. 张新艳 

机构地区：[1]Department of Obstetrics and Gynaecology (Maternal- Fetal Medicine Division Placenta Clinic), Mount Sinai Hospital, University of Toronto, Toronto, Ont., Canad,Dr.

出　　处：《世界核心医学期刊文摘（妇产科学分册）》2006年第6期6-7,共2页Core Journal in Obstetrics/Gynecology

摘　　要：Objective: The purpose of this study was to determine the ability of uterine artery Doppler and placental ultrasound to identify adverse clinical outcomes attributable to severe placental dysfunction in women with second- trimester unexplained elevated maternal serum screening of alpha- fetoprotein and human chorionic gonadotropin. Study design: Fifty singleton pregnancies with elevated alpha- fetoprotein (3.5 multiples of median [range 2.1 to 10.5]) and human chorionic gonadotropin (5.3 multiples of median [range 2.5 to 21.7]) and a normal fetal anatomical ultrasound were prospectively evaluated with placental ultrasound and uterine artery Doppler at referral between 19 and 23 weeks’ gestation. Results: Abnormalities in both placental ultrasound and uterine artery Doppler (n = 24) predicted preterm delivery less than 32 weeks from any cause (n = 24) (75% sensitivity, 75% positive predictive value; likelihood ratio positive 3.3 [1.6 to 6.8]), intrauterine fetal death (n = 12) (100% sensitivity, 50% positive predictive value; likelihood ratio positive 3.1 [2.0 to 5.0]), and intrauterine growth restriction with absent/reversed end- diastolic flow (n = 17) (sensitivity 94% , positive predictive value 67% , likelihood ratio positive 3.9 [2.0 to 6.2]) . Ischemic- thrombotic pathology was present in 88% of placentas examined (n = 32). Conclusion: Uterine artery Doppler and placental morphology identified most pregnancies with combined abnormal maternal serum screening destined to result in extremely premature delivery and/or perinatal death. Abnormal maternal serum screening reports could include a recommendation for placental ultrasound testing when no fetal explanation has been identified.Objective： The purpose of this study was to determine the ability of uterine artery Doppler and placental ultrasound to identify adverse clinical outcomes attributable to severe placental dysfunction in women with second-trimester unexplained elevated maternal serum screening of alpha-fetoprotein and human chorionic gonadotropin. Study design： Fifty singleton pregnancies with elevated alpha-fetoprotein （3.5 multiples of median [range 2. 1 to 10. 5] ） and human chorionic gonadotropin （5.3 multiples of median [range 2. 5 to 21.7] ） and a normal fetal anatomical ultrasound were prospectively evaluated with placental ultrasound and uterine artery Doppler at referral between 19 and 23 weeks＇ gestation. Results： Abnormalities in both placental ultrasound and uterine artery Doppler （n = 24） predicted preterm delivery less than 32 weeks from any cause （n = 24） （75% sensitivity, 75% positive predictive value; likelihood ratio positive 3.3 [ 1.6 to 6.8]）, intrauterine fetal death （n = 12） （100% sensitivity, 50% positive predictive value; likelihood ratio positive 3.1 [2. 0 to 5.0]）, and intrauterine growth restriction with absent/reversed end-diastolic flow （n = 17） （sensitivity 94%, positive predictive value 67%, likelihood ratio positive 3.9 [2.0 to 6.2]） Is- chemic-thrombotic pathology was present in 88% of placentas examined （n = 32） .

关 键 词：人绒毛膜促性腺激素 血清甲胎蛋白 阳性预测值 胎盘缺血 妊娠中期 联合 绒毛膜促性腺激素增高 并发症 多普勒检查 脐动脉舒张末期 

分 类 号：R714.22[医药卫生—妇产科学] R735.7[医药卫生—临床医学]