子宫动脉和胎儿脐动脉血流多普勒参数在高危妊娠晚期中的应用

Application of Doppler parameters of uterine artery and fetal umbilical artery in high risk late pregnancy

目的分析子宫动脉和胎儿脐动脉血流多普勒参数变化与高危妊娠晚期妊娠结局的关系,为预测不良妊娠结局提供依据。方法选取2018年10月至2019年10月我院收治的孕34w^36w的高危妊娠孕妇95例作为研究组,选择同期在我院进行孕期检查的正常妊娠孕妇80例作为对照组,检测两组孕妇子宫动脉和胎儿脐动脉的血流搏动指数、阻力指数及收缩期与舒张期流速比,分析上述参数指标与妊娠结局的关系。结果(1)研究组妊娠结局中早产、胎儿宫内窘迫、胎儿生长受限及新生儿窒息发生率分别为24.21%、32.63%、17.89%及15.79%,对照组中无胎儿生长受限及新生儿窒息病例,早产、胎儿宫内窘迫发生率分别为10.00%、3.75%,各组间比较差异有统计学意义(P<0.05);(2)研究组孕妇中妊娠结局异常发生率为42.11%,对照组为5.00%,组间比较差异有统计学意义(χ~2=31.769,P<0.05);(3)研究组孕妇子宫动脉和胎儿脐动脉血流参数PI、RI及S/D比值均明显高于正常对照组孕妇,研究组中妊娠结局异常组孕妇子宫动脉和胎儿脐动脉血流参数PI、RI及S/D均明显高于妊娠结局正常孕妇,差异均有统计学意义(P<0.05);(4)子宫动脉PI、RI及S/D比值预测胎儿状况的敏感性分别为91.0%、89.0%、87.0%,特异性分别为89.0%、85.0%、98.0%;胎儿脐动脉PI、RI及S/D比值预测胎儿状况的敏感性分别为87.0%、94.0%、87.0%,特异性分别为90.0%、90.0%、91.0%。结论应用彩色多普勒超声监测高危妊娠晚期子宫动脉和胎儿脐动脉血流参数,对于判断胎儿宫内状况具有一定的临床价值。

Objective:To analyze the relationship between the changes of blood flow Doppler parameters of uterine artery and fetal umbilical artery and the late pregnancy outcome of high-risk pregnancy,so as to provide basis for predicting adverse pregnancy outcomes.Methods:95 cases of high-risk pregnant women with 34 to 36 weeks of gestation in our hospital from October 2018 to October 2019 were selected as the research group,and 80 cases of normal pregnant women with pregnancy examination in our hospital during the same period were selected as the control group.The blood flow pulsatility index,resistance index and the ratio of systolic to diastolic flow velocity of uterine artery and umbilical artery were detected,and the relationship between the above parameters and pregnancy outcome was analyzed.Results:(1)The incidences of preterm birth,fetal distress,fetal growth restriction and neonatal asphyxia in the study group were 24.21%,32.63%,17.89%and 15.79%,respectively.There were no cases of fetal growth restriction and neonatal asphyxia in the control group,and the incidence rates of preterm birth and fetal distress were 10.00%and 3.75%respectively in the control group,and the differences were statistically significant(P<0.05);(2)The incidence of abnormal pregnancy outcomes was 42.11%in the study group and 5.00%in the control group,with significant difference between the two groups(χ~2=31.769,P<0.05);(3)The blood flow parameters PI,RI and S/D of uterine artery and fetal umbilical artery in the study group were significantly higher than those in the normal control group.In the study group,the blood flow parameters PI,RI and S/D of uterine artery and fetal umbilical artery in the abnormal pregnancy outcome group were significantly higher than those in the normal pregnant women,the differences were statistically significant(P<0.05);(4)The sensitivity of PI,RI and S/D ratio of uterine artery in predicting fetal status was 91.0%,89.0%,87.0%,and the specificity was 89.0%,85.0%and 98.0%.The sensitivity of PI,RI and S/D ratio of fetal umbilical artery in predicting fetal condition was 87.0%,94.0%,87.0%,and the specificity was 90.0%,90.0%,91.0%.Conclusion:The application of color Doppler ultrasound in monitoring the blood flow parameters of uterine artery and fetal umbilical artery in late high-risk pregnancy has a certain clinical value for judging fetal intrauterine status.