复发性流产孕妇孕早期子宫动脉血流参数与妊娠结局的相关性分析

Association analysis of early pregnancy uterine artery flow parameters and pregnancy outcome in pregnant women with recurrent abortion

目的 探讨复发性流产史孕妇孕早期子宫动脉血流参数变化及与妊娠结局的关系。方法 选取2019年2月至2021年1月榆林市第二医院收治的171例孕早期女性,根据有无复发性流产史将其分为观察组(n=66,复发性流产)和对照组(n=105,正常妊娠)。研究对象均在孕12周行彩色多普勒超声检查,比较两组收缩期峰值流速/舒张末期流速(peak systolic flow velocity/end-diastolic flow velocity, S/D)、搏动指数(pulsatility index, PI)、阻力指数(resistance index, RI)、舒张切迹发生率及子宫动脉多普勒波形,比较两组血流参数异常发生率,随访所有研究对象的妊娠结局。采用受试者工作曲线(ROC)分析各参数预测复发性流产史孕妇妊娠结局的价值。结果 观察组S/D、PI、RI及舒张切迹发生率均高于对照组(P<0.05),观察组子宫动脉多普勒波形分类中C型占比低于对照组,A型和O型占比高于对照组(P<0.05),观察组的妊娠丢失率(51.52%)明显高于对照组(3.81%)(P<0.05);S/D、PI、RI及三者联合预测复发性流产患者妊娠丢失的曲线下面积(AUC)分别为0.807、0.818、0.841、0.916,其中联合预测效能最高,敏感性、特异性分别为92.58%、88.42%。结论 复发性流产孕妇孕早期子宫动脉血流动力参数明显增高,子宫动脉血流阻力增大,发生不良妊娠结局的风险增加。血流参数S/D、PI、RI可作为预测复发性流产患者妊娠结局的重要指标,联合预测价值最高。

Objective To explore the changes of uterine artery blood flow parameters of first trimester pregnant women with recurrent abortion history and their relationship with pregnancy outcomes.Methods 171 early pregnancy women treated in the Second Hospital of Yulin were selected between February 2019 and January 2021.According to the presence or absence of recurrent abortion history, the women were divided into observation group(n=66,recurrent abortion) and control group(n=105,normal pregnancy).Two groups of subjects underwent color Doppler ultrasound at 12 weeks of gestation to compare the peak systolic flow velocity/end-diastolic flow velocity(S/D),pulsatility index(PI),resistance index(RI),incidence of diastolic incisura and uterine artery Doppler waveform.The incidence of abnormal blood flow parameters of the two groups of subjects was compared, and the pregnancy outcomes of all subjects were followed up.The receiver operating characteristic(ROC) curve was used to analyze the value of the parameters to predict the pregnancy outcomes of pregnant women with a history of recurrent abortion.Results The of S/D,PI,RI and incidence of diastolic incisura in observation group were higher than those in control group(P<0.05).The type C proportion of uterine artery Doppler waveform classification in observation group was lower than that in control group, and the proportions of type A and type O were higher than those in control group(P<0.05).The pregnancy loss rate of 51.52% in observation group was significantly higher than 3.81% in control group(P<0.05).The areas under the curves(AUC) of S/D,PI,RI and the combination of the three in predicting pregnancy loss in patients with recurrent abortion were 0.807,0.818,0.841 and 0.916 respectively, and their combination had the highest efficiency, with sensitivity of 92.58% and specificity of 88.42% respectively.Conclusion Pregnant women with recurrent abortion have significantly increased uterine artery blood flow parameters in early pregnancy, enhanced uterine artery blood flow resistance and increased risk of adverse pregnancy outcomes.The blood flow parameters S/D,PI and RI can be used as important indicators to predict the pregnancy outcomes of patients with recurrent abortion, and the combined prediction has the highest value.