超声检查习惯性流产患者早孕期胎心率在妊娠结局中的预测价值

Predictive effect of fetal heart rate in early pregnancy on pregnancy outcome in patients with RSA by ultrasonography

目的探讨超声检查习惯性流产(RSA)患者早孕期胎心率变化在妊娠结局预测中的作用。方法收集行超声检查的妊娠42~69 d的孕妇,其中,有RSA病史孕妇255例,无RSA病史孕妇201例。根据妊娠42~196 d(即6~28周)期间妊娠结局分为3组:RSA异常妊娠组(有RSA病史孕妇本次妊娠期间发生自然流产);RSA正常妊娠组(有RSA病史孕妇本次妊娠至28周以上);非RSA正常妊娠组(无RSA病史孕妇本次妊娠至28周以上)。孕妇经腹或经阴道超声测量孕囊大小及胚芽、胎儿头臀长,启用M取样并放大模式测量胎心率,连续测量3次,取均值,记录孕囊大小、头臀长及胎心率,追踪随访至妊娠28周,比较各组间资料。结果255例RSA孕妇中,83.0%的胚胎停育发生在55 d前,胎心率越低,胚胎停育发生率越高。超声检查与胚胎停育时间相隔越短,胎心率缓慢发生率越高。RSA正常妊娠组与非RSA正常妊娠组各孕龄平均胎心率的差异无统计学意义(P>0.05)。RSA异常妊娠组与非RSA正常妊娠组孕49~62 d平均胎心率差异有统计学意义(P<0.05),孕42~48 d和孕63~69 d平均胎心率之间差异无统计学意义(P>0.05)。用胎心率为检验变量,妊娠结局为金标准,预测胎心率诊断的价值,曲线面积为0.831,结果具有统计学意义(P<0.05)。结论超声检查发现RSA患者早孕期胎心率缓慢对不良妊娠结局有一定的预测价值。

Objective To explore the predictive effect of fetal heart rate in early pregnancy on pregnancy outcome in patients with RSA by ultrasonography.Methods The pregnant women with 42-69 days of gestation who were examined by ultrasound were collected.Among them,255 pregnant women with RSA history and 201 pregnant women without RSA history were enrolled.According to the pregnancy outcome during 42-196 days(Pregnancy 6-28 weeks),the patients were divided into three groups:RSA abnormal pregnancy group:spontaneous abortion occurred during the pregnancy of the pregnant women with previous RSA history;RSA normal pregnancy group:the pregnancy of the pregnant women with previous RSA history was more than 28 weeks;non RSA normal pregnancy group:the pregnancy of the pregnant women without previous RSA history was more than 28 weeks.The size of gestational sac and the length of head and buttock(CRL)were measured by transabdominal or transvaginal ultrasound,and the fetal heart rate was measured by M sampling and amplification mode.The mean value was measured three times continuously,and the size of gestational sac,CRL and fetal heart rate were recorded.The data of each group were followed up to 28 weeks of gestation.The data of each group were compared.Results In 255 cases of RSA,83.0%of the pregnancies were terminated 8 weeks ago.The lower the fetal heart rate,the higher the rate of embryo termination.There was no significant difference between RSA normal pregnancy group and non RSA normal pregnancy group(P>0.05).In RSA abnormal pregnancy group and non RSA normal pregnancy group,there was significant difference between the mean fetal heart rate at 7 and 8 weeks of gestation(P<0.05),and there was no significant difference between the mean fetal heart rate at 6 and 9 weeks of gestation(P>0.05).The fetal heart rate was used as the test variable,the pregnancy outcome was the gold standard,the diagnostic value of fetal heart rate was predicted,the area of the curve was 0.831,the results were statistically significant(P<0.05).Conclusion The slow fetal heart rate in early pregnancy of patients with RSA has a certain predictive value for the adverse pregnancy outcome.