妊娠早期低风险人群子宫动脉多普勒搏动指数与不良妊娠结局的关系

Association of first-trimester uterine artery pulsatility index with adverse outcomes in low-risk pregnancies

目的探讨妊娠11~13+6周子宫动脉血流的搏动指数(UtA-PI)、阻力指数(UtA-RI)预测异常妊娠结局的可行性。方法随机选取2017年1月1日~2017年6月31日在上海市长宁区妇幼保健院正规产前检查的2567例单胎妊娠孕妇为研究对象。于孕11~13+6周检测每位孕妇的双侧子宫动脉多普勒血流波形,记录子宫动脉UtA-PI、及有无舒张早期切迹。随访所有研究对象的妊娠过程及母胎结局等情况。结果 2567例中,55例因结构畸形或胎死宫内于28周前终止妊娠者被剔除,2512例纳入统计。2512例中,发生不良妊娠结局359例(占14.29%),包括99例妊娠期高血压疾病、88例子痫前期、76例胎儿宫内生长受限、76例小于胎龄儿、11例胎盘早剥、及9例28周后胎死宫内者;余2153例妊娠结局正常。不良妊娠结局组UtA-PI值的平均值(1.8)及第90百分位数(2.4)均高于正常妊娠结局组(1.68,2.19),差异均有统计学意义(P < 0.05)。以UtA-PI第90百分位数为界值,预测严重不良妊娠结局的敏感性为71%、特异性为75%,预测任意一种不良妊娠结局的敏感性虽低(27%)、但特异性较高(89%),并以预测胎儿宫内生长受限这一不良妊娠结局的敏感性最低(19%)、但特异性较高(91%)。以UtA-PI第90百分位数为界值,预测各种不良妊娠结局的阴性预测值均较高。结论妊娠11~13+6周时UtA-PI在低风险人群中预测不良妊娠结局有一定的临床价值,但总体敏感性不高。

Objective To discuss the feasibility of uterine artery pulsatility indexes (UtA-PI) 11-13+6 weeks in predicting adverse pregnancy outcomes. Methods From January 1, 2017 to June 31, 2567 singleton pregnancies presented for routine prenatal care in Shanghai Changning Maternity & Infant Health Hospital, who were recruited as the research object. Doppler blood flow waveforms of bilateral uterine arteries of each pregnant woman were detected at 11-13+6 weeks of gestation were measured, the UtA-PI and resistance indexes (UtA-RI), and the presence or absence of early diastolic notching were recorded. The maternal and neonatal outcomes were followed up. Results Among all the 2567 cases, 55 cases were excluded because of termination for fetal abnormalities or fetal death before 28 weeks of gestation, the other 2512 cases were enrolled in this analysis. Among the 2512 cases enrolled, there were 359 cases (14.29%) of adverse outcomes, including, 99 cases of hypertensive disorder complicating pregnancies, 88 cases of preeclampsia, 76 cases of fetal growth restriction, 76 cases of small for gestational age, 11 cases of placental abruption, 9 cases of stillbirth;and the remaining 2153 cases had normal outcomes. The mean value and the 90th percentile of UtA-PI were higher in the adverse outcome group (1.8, 2.4) than that in normal outcome group (1.68, 2.19), the differences were statistically significant (P < 0.05), respectively. By using the 90th percentile of UtA-PI as cut-off value, the sensitivity was 71% and the specificity was 75% in predicting severe adverse pregnancy outcomes, but the sensitivity was low (27%) and the specificity was high (89%) in predicting any kind of adverse pregnancy outcomes, and the sensitivity (19%) was the lowest while the specificity was high (91%) in predicting fetal growth restriction. By using the 90th percentile of UtA-PI as cut-off value, the negative predicting values were high in all groups in predicting each kind of adverse pregnancy outcomes. Conclusion UtA-PI at 11-13+6 weeks of gestation shows significance in predicting the development of adverse outcomes in low-risk pregnancies, but provides a low sensitivity.