임신 제 1 삼분기 태반 부피와 제 2 삼분기 자궁동맥 도플러 혈류 속도파형이 주산기 예후에 미치는 영향

Abstract

Objective: To determine to what extent the placental quotient (PQ: placental volume/crown-rump length) is able to detect adverse perinatal outcomes and to compare the value of first trimester placental volume and second trimester uterine artery Doppler velocimetry for predicting adverse perinatal outcomes. Methods: This was a prospective study comprising of 263 women with singleton pregnancies attending our hospital for nuchal translucency screening at 10-13 weeks of gestation. Three dimensional ultrasound was used to obtain images for measurement of placenta volume at 10-13 weeks of gestation. In addition, Doppler assessment of both uterine arteries was carried out for measurement of the pulsatility index (PI) in the second trimester and the mean PI of the two vessels was calculated. The variables of adverse perinatal outcomes were preeclampsia, preterm delivery, small for gestational age (SGA), 5-minute APGAR score, and admission to the neonatal intensive care unit. Results: Of the initial 263 pregnancies originally participating, 219 women who delivered at our institution were included in the final analysis. Pregnancy complications occurred in 27 (12.3%) of the 219 pregnancies. Comparison between crownrump length and placental volume proved a significant correlation (r=0.474, p<0.001). There were no correlation between PQ and uterine artery Doppler velocimetry PI. PQ was significantly lower in SGA group and neonatal intensive care unit admission group (p=0.049, p=0.019, respectively). Uterine artery Doppler velocimetry PI was significantly higher in SGA group (p=0.024). PQ in the first trimester and uterine artery Doppler velocimetry in the second trimester had similar sensitivities for predicting SGA. Conclusions: PQ in the first trimester and uterine artery Doppler velocimetry PI in the second trimester have significant difference in SGA group compared to appropriate for gestational age, and have similar sensitivities for predicting SGA. While both methods seem to be insufficient for screening, the PQ method has the potential advantage of being performed in the first trimester