43例中晚期妊娠胎儿大脑中动脉舒张末期血流反向的临床分析

Clinical analysis of reversed flow in the last stage of middle cerebral artery diastole by 43 fetuses in middle and late pregnancy

目的分析中晚期妊娠胎儿MCA舒张末期血流反向的临床特点及妊娠结局,为临床诊疗提供指导。方法回顾性分析2013年4月-2019年8月在我院产检的43例中晚期妊娠胎儿MCA舒张末期血流反向的临床特点及妊娠结局。结果43例孕周中位数为28.29周(21.57-34.57周)。胎儿发育异常情况包括胎儿颅脑发育异常、胎儿水肿、胎儿肾脏发育异常、胎儿生长受限、胎儿三尖瓣反流。不同原因导致的羊水过少12例,占比27.91%;24例未发现胎儿及附属物异常,占比55.81%。本组患者中8例因胎儿发育异常或晚期难免流产要求放弃胎儿,其余35例患者中,除1例持续舒张末期血流反向出现死胎外,复查MCA大脑中动脉血流均恢复正常(97.12%),新生儿结局良好。结论MCA多普勒血流测定易受检查操作及胎儿生理状态影响,短暂出现单纯MCA舒张末期血流反向的新生儿结局良好,如持续出现并伴有其他指标异常则提示胎儿预后不良,存在死胎风险。

Objective To analyze the clinical characteristics and pregnancy outcome of end diastolic blood flow reversal of fetal MCA in middle and late pregnancy,so as to provide guidance for clinical diagnosis and treatment.Methods We performed a retrospectively study on the cases of second and third trimester with color doppler ultrasound indicating reversed end-diastolic flow in the MCA,which were collected in our hospital from April 2013 to August 2019.The clinical characteristic and pregnancy outcomes were analyzed.Results 43 cases met the inclusion criteria,and the incidence of reversed MCA end-diastolic flow was 0.043%in the delivery cases in our hospital,the median gestational age was 28.29 weeks(range,21.57-34.57 weeks).The fetal abnormalities included:Fetal brain dysplasia,fetal edema,Fetal renal dysplasia,fetal growth restriction,fetal tricuspid regurgitation.There were 12 cases(27.91%)with oligohydramnios caused by different reasons,and 24 cases(55.81%)with no evident of fetal dysplasia.Because of fetal dysplasia or inevitable late abortion,8 cases abortion was induced.Among the remaining 35 patients,34 patients(97.12%)of which returned to normal MCA flow within 3 days.Except for one case resulted in intrauterine demise.With prolonged reversed MCA end-diastolic flow,the rest of the newborns all have a good outcome.Conclusion The fetal MCA flow is susceptible to be influenced by examination operations and fetal physiological state.In the majority of the cases,the transient occurrence of a single reversed MCA end-diastolic flow was not associated with fetal pathology,but if it continues to occur with other abnormal indicators,it may indicate a poor fetal prognosis and the risk of stillbirth.