胎心监护、胎儿脐动脉及大脑中动脉血流检测在预测胎儿窘迫中的作用

The value of fetal heart monitoring, blood flow parameters of the fetal umbilical artery and middle cerebral artery for assessing fetal distress

目的 探讨胎心监测联合彩超脐动脉和大脑中动脉血流检测预测胎儿窘迫的作用。方法 选取2018年1月至2021年10月临沂市妇幼保健院收治的365例孕妇,根据胎儿窘迫诊断标准分为观察组(n=186例)、对照组(n=179例),所有孕妇均进行产前胎心监护、彩超脐动脉和大脑中动脉血流监测及新生儿阿普加评分(Apgar评分)和脐带动脉血血气分析。比较观察组和对照组在胎心监护、彩超检测的差异有无统计学意义,比较两组单独及联合检测的灵敏度、特异度、阳性预测值、阴性预测值和约登(Youden)指数等。结果 胎心监护、脐动脉和大脑中动脉血流检测之间无统计学意义(P>0.05),三者联合监测诊断胎儿窘迫的灵敏度、特异度、阳性预测值、阴性预测值和Youden指数均高于单独检测,差异均有统计学意义(P<0.05)。结论 与单独监测相比,胎心监测联合彩超脐动脉和大脑中动脉血流检测诊断胎儿窘迫可互补三者之间的不足,提高了诊断的灵敏度、特异度及阳性预测值和阴性预测值。

Objective To explore the effect of fetal heart monitoring combined with blood flow parameters of the fetal umbilical artery and middle cerebral artery in the diagnosis of fetal distress. Methods 365 pregnant women admitted to Linyi Women and Child Hospital from January 2018 to October 2021 were divided into observation group(N=186 cases) and control group(N=179 cases) according to the diagnostic criteria of fetal distress. All pregnant women underwent prenatal fetal heart monitoring and fetal umbilical artery and middle cerebral artery, Apgar score and blood gas analysis of umbilical artery were tested after delivery. Compared the difference of the observation group and the control group were statistically significant or not in the fetal heart monitoring, color doppler ultrasound detection. The sensitivity, specificity, positive predictive value,negative predictive value and Youden index of the two groups were compared. Results There was no significant difference between fetal heart monitoring, umbilical artery and middle cerebral artery(P>0.05). The combined of fetal heart monitoring,umbilical artery and middle cerebral artery had higher sensitivity, specificity, positive predictive value, negative predictive value and Youden index than the single monitoring, the differences were statistically significant(P<0.05). Conclusion Fetal heart monitoring combined with the fetal umbilical artery and middle cerebral artery can improved the sensitivity, specificity,positive predictive value and negative predictive value of diagnosis.