Foetal cerebral blood redistribution in idiopathic polyhydramnios and the impact on perinatal outcomes.

IF 0.9 4区 医学 Q4 OBSTETRICS & GYNECOLOGY Journal of Obstetrics and Gynaecology Pub Date : 2024-12-01 Epub Date: 2024-10-03 DOI:10.1080/01443615.2024.2408678
Inshirah Sgayer, Yousef Haddad, Yara Nakhleh Francis, Ruba Tuma, Lior Lowenstein, Marwan Odeh
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Abstract

Background: Idiopathic polyhydramnios is associated with adverse neonatal outcome. The aim of this study was to examine the value of the middle cerebral artery pulsatility index (MCA-PI) in predicting adverse perinatal outcome in pregnancies affected by idiopathic polyhydramnios.

Methods: A retrospective study was performed during 2013-2022 at a tertiary-care university affiliated hospital. The study included singleton pregnancies with idiopathic polyhydramnios. Obstetrical and perinatal outcomes were compared between women with MCA-PI <10th percentile and women with MCA-P ≥ 10th percentile. A composite adverse perinatal outcome was defined as an Apgar score <7 at 5 minutes, umbilical artery pH <7.15, emergent caesarean delivery (CD) or operative delivery due to foetal distress, neonatal intensive care admission or foetal death.

Results: Among 45,459 pregnancies, 128 (0.3%) had idiopathic polyhydramnios; 27 exhibited MCA-PI <10th percentile. Among the latter, compared to pregnancies with MCA-PI ≥10th percentile group, the rates were higher of emergent CD (25.9% vs. 7.9%, p = 0.017) and adverse perinatal outcomes (37.0% vs. 15.8%, p = 0.020). These differences persisted in a subgroup analysis of women with moderate or severe polyhydramnios. In the MCA-PI <10th percentile group, the median MCA-PI and cerebroplacental ratio were lower: 0.9 vs. 1.7, p < 0.001 and 0.7 vs. 2.1, p < 0.001, respectively. Receiver operating characteristic curve analysis indicated a significant association of MCA-PI with emergent CD/operative delivery for foetal distress (area under curve = 0.672, p = 0.031); the sensitivity was 46.7% and specificity 82.3%. Cerebroplacental ratio values were not associated with adverse perinatal outcomes.

Conclusions: Idiopathic polyhydramnios might be associated with foetal cerebral blood flow redistribution, potentially contributing to an increased risk of adverse neonatal outcomes. Prospective studies are required to establish the role of foetal Doppler studies in the antenatal surveillance of idiopathic polyhydramnios, and to determine whether evidence of abnormal MCA-PI serves as a reliable predictor of perinatal outcomes, potentially necessitating labour induction.

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特发性多胎妊娠的胎儿脑血再分布及其对围产期结局的影响。
背景:特发性多胎妊娠与新生儿不良预后有关。本研究旨在探讨大脑中动脉搏动指数(MCA-PI)在预测特发性多胎妊娠围产儿不良结局中的价值:一项回顾性研究于 2013-2022 年期间在一家三级护理大学附属医院进行。研究对象包括特发性多胎妊娠的单胎妊娠。结果:在 45 459 名妊娠中,有 2.5%的妊娠合并特发性多胎妊娠:在 45 459 名孕妇中,128 人(0.3%)患有特发性多胎妊娠;27 人表现出 MCA-PI p p 结论:特发性多羊水可能与胎儿脑血流重新分布有关,有可能导致新生儿不良预后的风险增加。需要进行前瞻性研究,以确定胎儿多普勒检查在特发性多羊水症产前监测中的作用,并确定 MCA-PI 异常的证据是否可作为围产期结局的可靠预测指标,从而可能需要进行引产。
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来源期刊
CiteScore
2.40
自引率
7.70%
发文量
398
审稿时长
6 months
期刊介绍: Journal of Obstetrics and Gynaecology represents an established forum for the entire field of obstetrics and gynaecology, publishing a broad range of original, peer-reviewed papers, from scientific and clinical research to reviews relevant to practice. It also includes occasional supplements on clinical symposia. The journal is read widely by trainees in our specialty and we acknowledge a major role in education in Obstetrics and Gynaecology. Past and present editors have recognized the difficulties that junior doctors encounter in achieving their first publications and spend time advising authors during their initial attempts at submission. The journal continues to attract a world-wide readership thanks to the emphasis on practical applicability and its excellent record of drawing on an international base of authors.
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