稽留流产超声子宫动脉血流动力学特征及其预测价值

The characteristics of uterine artery blood flow by ultrasonic examination of women with missed abortion and its predictive value for missed abortion

目的:分析稽留流产患者子宫动脉血流动力学指标的变化特点,探讨其对稽留流产的预测价值。方法:选取早期妊娠行超声检查的病例,根据超声结果分为稽留流产组(58例)、稽留流产过渡组(31例)、对照组(120例),应用经阴道多普勒超声检测子宫动脉血流,比较3组子宫动脉血流收缩期峰值/舒张末期流速(S/D)、阻力指数(RI)、搏动指数(PI)并分析对稽留流产的预测价值。结果:子宫动脉S/D、RI及PI值,初诊、妊娠<10周及妊娠10~12周时,稽留流产过渡组高于对照组,稽留流产组低于对照组(均P<0.05)。子宫动脉RI对稽留流产有预测效能(P<0.001),其AUC为0.802,截断值为0.854,敏感度84.5%,特异度74.8%;子宫动脉PI及S/D值对稽留流产无预测效能。结论:稽留流产发生前子宫动脉S/D、RI及PI值会升高,经阴道多普勒超声检测子宫动脉血流阻力指数指标对稽留流产有一定预测价值。

Objective:To analyze the characteristics change of uterine arterial blood flow indictor by ultrasonic examination of women with missed abortion,and to explore its predictive value for missed abortion.Methods:Women with the first trimester pregnancy who had undergone ultrasound examination were selected as research objects,and were divided into group A(58 women with missed abortion),group B(31 women in transition period of missed abortion),and group C(120 normal pregnant women)according to the results by ultrasonic examination.Uterine artery blood flow was detected by transvaginal Doppler ultrasound,and the predictive value of uterine artery blood flow peak/end diastolic flow rate(S/D),resistance index(RI),and pulse index(PI)for missed abortion were compared among the three groups.Results:During initial diagnosis of women with missed abortion,<10 gestational weeks,or 10-12 gestational weeks,the values of S/D,RI and PI of uterine artery of women in group B were significant higher than those of women in group A,while those were significant lower than those of women in group C(P<0.05).RI value of uterine artery had some predictive effect for missed abortion(P<0.001),which’s AUC,the cutoff value,the sensitivity,and the specificity were 0.802,0.854,84.5%,and 74.8%,respectively.But the values of PI and S/D of uterine artery had no predictive efficacy for missed abortion(P>0.05).Conclusion:The S/D,RI and PI values of uterine artery tend to rise before missed abortion,so the uterine artery blood flow resistance indexes by transvaginal Doppler ultrasound has certain predictive value for missed abortion.