脑胎盘率联合无应激胎心监护对高危妊娠结局的诊断意义

The diagnostic value of the cerebroplacental ratio combined with non-stress test for pregnancy outcomes in high-risk pregnancies

目的探讨胎儿脑胎盘率(cerebroplacental ratio,CPR)联合无应激胎心监护(non stress test,NST)对高危妊娠结局的诊断意义。方法选取2018-12至2020-02在石家庄市第六医院产检并分娩的单胎高危妊娠患者120例为研究对象。平均孕周28-41周,进行超声检测胎儿脐动脉(umbilical artery,UA)和大脑中动脉(middle cerebral artery,MCA)血流,测得CPR,同时行产前NST。对母儿分娩结局:羊水污染、胎儿窘迫、剖宫产、助产(产钳/胎吸);新生儿结局:1 min Apgar评分<7分、血气pH<7.25、入住NICU进行比较。比较不同方法对高危妊娠不良妊娠结局评估的效能,主要包括灵敏度、特异度、阳性预测值及阴性预测值。结果根据NST与CPR结果分为4组:A组(NST与CPR均正常),B组(NST异常),C组(CPR异常),D组(NST与CPR均异常)。D组中胎儿窘迫21例(80.77%)、羊水污染23例(88.46%)、剖宫产24例(92.31%)、助产(产钳/胎吸)3例(11.54%)、1 min Apger评分<7分17例(65.38%)、血气pH<7.2516例(61.54%)、入住NICU 18例(69.23%),明显高于其他3个组,且差异有统计学意义(P<0.05)。CPR联合胎心监护对不良妊娠结局预测的灵敏度为97.01%、特异度为93.78%、阳性预测值为91.06%、阴性预测值为97.27%,均高于单纯使用CPR及胎心监护。结论CPR与NST联合应用对高危妊娠中异常情况诊断及时、准确、安全、有效,可有效避免不良妊娠结局的发生,在高危妊娠管理中具有重要意义,值得临床推广。

Objective To explore the diagnostic significance of the cerebroplacental ratio(CPR)combined with non-stress test(NST)in high-risk pregnancies.Methods One hundred and twenty high-risk pregnant women who had given birth to singletons at our hospital between December 2018 and February 2020 were chosen as subjects.The average gestational age was 28-41 weeks.Ultrasound was performed to detect the blood flow of the fetal umbilical artery(UA)and middle cerebral artery(MCA),and the CPR was measured.At the same time,prenatal NST was performed.The results of maternal delivery were compared,including amniotic fluid pollution,fetal distress,cesarean section,midwifery(forceps,fetal aspiration).Neonatal outcomes were analyzed,including an Apgar score less than 7 in 1 min,blood gas pH less than 7.25,and admission to NICUs.The effectiveness of different methods of evaluating high-risk pregnancies and adverse pregnancy outcomes was compared,including the sensitivity,specificity,positive predictive value and implicit predictive value.Results According to the results of NSTs and CPRs,these subjects were divided into four groups:group A(normal NST and CRT),group B(abnormal NST),group C(abnormal CPR),and group D(abnormal NST and CPR).In group D,there were 21 cases of fetal distress(80.77%),23 cases of amniotic fluid pollution(88.46%),24 cases of cesarean section(92.31%),3 cases of assisted delivery(forceps,fetal suction)(11.54%),17 cases with 1 min Apger score less than 7 points(65.38%),16 cases with a blood gas pH value less than 7.25(61.54%),and 18 cases admitted to NICUs(69.23%),and the difference was statistically significant compared with the other three groups.The CPR combined with fetal heart rate monitoring had a sensitivity of 97.01%,a specificity of 3.78%,a positive predictive value of 91.06%,and a negative predictive value of 97.27%for predicting adverse pregnancy outcomes,all of which were higher than when the CPR or fetal heart rate monitoring was used alone.Conclusions The combined use of the CPR and NST can facilitate a quick,accurate,safe and valid diagnosis of abnormal conditions in high-risk pregnancies,and can effectively prevent the occurrence of adverse pregnancy outcomes.This approach is of great significance in the management of high-risk pregnancies.