Assessing the umbilical artery pulsatility index via Doppler measurements plays a crucial role in evaluating fetal growth impairment. This study aimed to investigate perinatal outcomes associated with discordant pulsatility indices of umbilical arteries in fetuses with growth restriction. In this retrospective cohort study, all singleton pregnancies were included if their estimated fetal weight and/or abdominal circumference fell below the 10th percentile for gestational age (2017–2022). Eligible cases included singleton pregnancies with concurrent sampling of both umbilical arteries within 14 days of birth at the ultrasound evaluation closest to delivery. The exclusion criteria included births before 22 weeks of gestation, evidence of absent or reverse end-diastolic flow in either umbilical artery, and known fetal genetic or structural anomalies. The study compared cases with discordant umbilical artery pulsatility index values (defined as 1 umbilical artery pulsatility index at ≤95th percentile and the other umbilical artery pulsatility index at >95th percentile for gestational age) to pregnancies where both umbilical artery pulsatility indices had normal pulsatility index values and those with both umbilical arteries displaying abnormal pulsatility index values. The primary outcome assessed was the occurrence of composite adverse neonatal outcomes. Multivariable logistic regressions were performed, adjusting for relevant covariates. The study encompassed 1014 patients, including 194 patients (19.1%) with discordant umbilical artery pulsatility index values among those who had both umbilical arteries sampled close to delivery, 671 patients (66.2%) with both umbilical arteries having normal pulsatility index values, and 149 patients (14.7%) with both umbilical arteries exhibiting abnormal values. Pregnancies with discordant umbilical artery pulsatility index values displayed compromised sonographic parameters compared with those with both umbilical arteries showing normal pulsatility index values. Similarly, the number of abnormal umbilical artery pulsatility index values was associated with adverse perinatal outcomes in a dose-response manner. Cases with 1 abnormal (discordant) umbilical artery pulsatility index value showed favorable sonographic parameters and perinatal outcomes compared with cases with both abnormal umbilical artery pulsatility index values, and cases with both abnormal umbilical artery pulsatility index values showed worse sonographic parameters and perinatal outcomes compared with cases with discordant UA PI values. Multivariate analysis revealed that discordant umbilical artery pulsatility indices were significantly and independently associated with composite adverse perinatal outcomes, with an adjusted odds ratio of 1.75 (95% confidence interval, 1.24–2.47; = .002). Evaluating the resistance indices of both umbilical arteries may provide useful data and assist in assessing adverse perinatal outcomes among fetuses with growth restriction.

中文翻译：

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生长受限胎儿脐动脉阻力不一致与不良后果之间的关系

通过多普勒测量评估脐动脉搏动指数在评估胎儿生长障碍中起着至关重要的作用。本研究旨在调查与生长受限胎儿脐动脉搏动指数不一致相关的围产期结局。在这项回顾性队列研究中，如果估计胎儿体重和/或腹围低于胎龄第 10 个百分位（2017-2022 年），则所有单胎妊娠均被纳入。符合条件的病例包括单胎妊娠，并在出生后 14 天内在最接近分娩的超声评估中同时采样双侧脐动脉。排除标准包括妊娠 22 周之前出生、脐动脉舒张末期血流缺失或反向的证据，以及已知的胎儿遗传或结构异常。该研究将脐动脉搏动指数值不一致的病例（定义为胎龄的 1 个脐动脉搏动指数≤第 95 个百分位，另一个脐动脉搏动指数>第 95 个百分位）与两个脐动脉搏动指数均正常的妊娠情况进行比较值以及双侧脐动脉显示异常搏动指数值的患者。评估的主要结局是复合不良新生儿结局的发生。进行多变量逻辑回归，调整相关协变量。该研究涵盖 1014 名患者，其中 194 名患者（19.1%）在临近分娩时双侧脐动脉采样的患者脐动脉搏动指数值不一致，671 名患者（66.2%）双侧脐动脉搏动指数值正常，149 名患者双侧脐动脉搏动指数值均正常。双侧脐动脉均显示异常值的患者（14.7%）。与双侧脐动脉均显示正常搏动指数值的妊娠相比，脐动脉搏动指数值不一致的妊娠显示超声参数受损。同样，异常脐动脉搏动指数值的数量以剂量反应方式与不良围产期结局相关。与脐动脉搏动指数值均异常的病例相比，有 1 个脐动脉搏动指数值异常的病例显示出良好的超声参数和围产期结局，而与脐动脉搏动指数值均异常的病例相比，超声参数和围产期结局均较差。 UA PI 值不一致的情况。多变量分析显示，不一致的脐动脉搏动指数与复合不良围产期结局显着且独立相关，调整后的优势比为 1.75（95% 置信区间，1.24–2.47；= .002）。评估双侧脐动脉的阻力指数可以提供有用的数据，并有助于评估生长受限胎儿的不良围产期结局。