晚孕期胎儿脐血流频谱异常孕妇的妊娠结局分析

Analysis of pregnancy outcomes of abnormal fetal umbilical cord blood flow spectrum in late pregnancy

目的探讨晚孕期胎儿脐血流频谱异常孕妇的妊娠结局。方法选择2014年10月至2016年9月,在四川大学华西第二医院接受产前检查的294例晚孕期孕妇(孕龄≥28孕周)为研究对象。将产前彩色多普勒超声(CDS)检查结果为胎儿脐血流频谱异常的144例孕妇,纳入观察组;胎儿脐血流频谱正常的150例孕妇,纳入正常对照组。采用回顾性分析方法,分析2组孕妇的临床病例资料,统计学比较2组孕妇一般临床资料,胎儿宫内窘迫、胎儿生长受限(FGR)、羊水过少、剖宫产及胎儿或新生儿死亡的发生率。结果(1)2组孕妇年龄、孕龄及产妇类型(初产妇、经产妇)构成比比较,差异均无统计学意义(P>0.05)。(2)观察组CDS检查结果的脐血流频谱异常胎儿中,脐血流收缩期峰值流速(S)与舒张末期最低流速(D)的比值(S/D)≥3.0为80.5%(116/144),舒张期血流消失为18.1%(26/144),舒张期血流反流为1.4%(2/144)。(3)观察组孕妇的胎儿宫内窘迫及FGR发生率,剖宫产率,以及胎儿或新生儿病死率(分别为27.1%、38.3%、54.2%、4.9%),均显著高于正常对照组(分别为6.0%、7.3%、9.3%、0.7%),并且差异均有统计学意义(P<0.05)。2组孕妇羊水过少发生率比较,差异则无统计学意义(P>0.05)。结论晚孕期胎儿脐血流频谱异常,可能导致不良妊娠结局,应用CDS检测晚孕期孕妇胎儿脐带血流动力学是否异常,具有重要临床价值。

Objective To investigate the pregnancy outcomes of abnormal fetal umbilical cord blood flow spectrum in late pregnancy.Methods A total of 294 pregnant women in late pregnancy（gestational age≥28 weeks）who received prenatal examination in West China Second University Hospital,Sichuan University from October 2014 to September 2016,were chosen as study subjects.144 cases of pregnant women with the prenatal color Doppler ultrasonography（CDS）examination results of abnormal fetal umbilical cord blood flow spectrum were included into observation group,and 150 cases of pregnant women with normal fetal umbilical cord blood flow spectrum were included into normal control group.A retrospective analysis of two groups of pregnant women′s clinical cases records were conducted.Statistically compared general clinical data of pregnant women,and the incidence rates of fetal intrauterine distress,fetal growth restriction（FGR）,oligohydramnios,cesarean section delivery and fetal or neonatal death between two groups.Results（1）There were no significant differences between two groups of pregnant women in age,gestational age and constituent ratio of primipara and multipara（P〈0.05）.（2）There were 80.5%（116/144）of umbilical blood flow peak systolic velocity（S）/minimum diastolic flow velocity（D）value≥3.0,18.1%（26/144）of diastolic blood flow disappeared,and 1.4%（2/144）of diastolic regurgitation in observation group of fetus.（3）The incidence rates of fetal intrauterine distress and FGR,cesarean section rate,and fetal or neonatal mortality rate（27.1%,38.3%,54.2%,4.9%,respectively）in observation group were all higher than those of normal control group（6.0%,7.3%,9.3%,0.7%,respectively）,and the differences were statistically significant（P〈0.05）.There was no significant difference between two groups in the incidence rate of oligohydramnios（P〈0.05）.Conclusions Abnormal fetal umbilical cord blood flow spectrum during late pregnancy may lead to adverse pregnancy outcomes.It has important clinical value to detect abnormal fetal umbilical cord hemodynamics by CDS for pregnant women in late pregnancy.