中孕期宫内生长受限胎儿静脉导管多普勒频谱表现及妊娠结局分析

Doppler Spectrum Performance of the Ductus Venosus in Fetus of Fetal Growth Restriction During the Second Trimester and Analysis in Pregnancy Outcome

目的:探讨中孕期宫内生长受限胎儿的静脉导管多普勒频谱表现与妊娠结局的关系。方法:将2010年1月-2013年6月在我院作产前检查为健康的中孕期胎儿422例作为对照组;临床诊断为宫内生长受限的中孕期胎儿200例作为研究组,采用彩色多普勒超声诊断仪测量两组胎儿静脉导管多普勒血流参数(RI、PI和S/D),以对照组所测静脉导管血流参数范围为正常参考值,将研究组200例宫内生长受限胎儿进行分组分析,并对这些胎儿追踪,随访至妊娠结束,记录妊娠结局。结果:对照组422例正常中孕期胎儿静脉导管血流参数为RI:0.45±0.09;PI:0.53±0.13;S/D:1.87±0.34。研究组200例胎儿中39例(19.50%)胎儿静脉导管血流频谱出现异常,根据胎儿静脉导管血流频谱表现分组:(1)研究一组共30例,胎儿静脉导管血流参数为RI:0.76±0.04,PI:1.18±0.08,S/D:4.52±1.51。RI、PI和S/D值较对照组均增高(P<0.05),两组间差异有统计学意义。30例胎儿中有6例伴有结构畸形和羊水过少而最终引产,10例分娩后诊断为FGR,14例(46.67%)妊娠至足月分娩正常体重儿。(2)研究二组共9例,静脉导管A谷血流消失或出现反流,其中7例经临床诊断为不良妊娠而引产,另2例为双胎输血综合征中的供血儿,供血儿死亡后受血儿均妊娠至足月后分娩正常体重儿。(3)研究三组共161例,静脉导管血流频谱正常。47例分娩后诊断为FGR,其中2例伴有胎儿畸形(四肢短小),1例在产程进展中胎儿死亡,余114例(70.81%)妊娠至足月分娩正常体重儿。结论:中孕期宫内生长受限胎儿静脉导管多普勒血流频谱可反映胎儿宫内血氧及右心功能情况;当胎儿静脉导管多普勒血流频谱出现A谷血流消失或反流预示胎儿妊娠结局不良可能;静脉导管多普勒血流参数可作为预测FGR胎儿完好生存率的重要指标之一。

Objective ：To investigate the relationship of Doppler spectrum performance of the ductus venosus in fetus of fetal growth restriction during the second trimester and the pregnancy outcome .Methods ：There were a control group （422 normal fetuses） and a study group（200 fetuses with FGR ） .We measured and analyzed Doppler flow parameters （RI ,PI and S/D）of the ductus venosus in fetuses of the two groups ,and the ultrasound findings were observed and re‐corded .200 fetuses were grouped into three groups according to Doppler flow parameters of the ductus venosus refer to the control group .All these fetuses were followed up until the end of pregnancy and the pregnancy outcomes were re‐corded .Results ：Doppler flow parameters of the ductus venosus in 422 normal fetuses in control group were measured ：RI ：0 .45 ± 0 .09 ,PI ：0 .53 ± 0 .13 ,and S/D ：1 .87 ± 0 .34 .Blood flow spectrum of the ductus venosus in 39 fetuses （19.50% ） of study group were abnormal .200 fetuses in study group were divided into three groups based on Doppler flow parameters of the ductus venosus （1） 30 cases appeared as RI ：0 .76 ± 0 .04 ,PI ：1 .18 ± 0 .08 ,S/D ：4 .52 ± 1 .51 .RI , PI and S/D were higher than that in control group（P〈 0 .05） .Among them ,6 fetuses with structure abnormalities and hypamnion were induced abortion ,10 neonatuses were FGR ,and 14 fetuses（46 .67% ） were delivered at term with nor‐mal weight ;（2） 9 cases appeared with absent or reversed wave A .Among them ,7 fetuses were induced labor ,and others were donor‐twins of TTTS ,whose donor‐twins were dead and the recipient‐twins were delivered at term with normal weight .（3） Among 161 cases whose blood flow spectrum of the ductus venosus was normal ,47 neonatuses were FGR ,1 fetuses with short limbs was dead in the course of delivery ,and 114 cases（70 .81% ）were delivered at term with normal weight .Conclusion ：The intrauterine oxygen condition and right heart function can be reflected by measur‐ing and analyzing Doppler flow parameters of the ductus venosus in fetuses of FGR during the second trimester .When the fetus appears with absent or reversed wave A ,pregnancy outcome will be adverse probably .So Doppler flow pa‐rameter of the ductus venosus in fetus during the second trimester is one of the important indicator in evaluating the in‐tact survival rate of fetal growth restriction .