妊娠中期唐氏血清学筛查对预防不良妊娠结局的临床价值

Clinical value of mid-pregnancy Down′s serologic screening for the prevention of adverse pregnancy outcomes

目的研究妊娠中期唐氏血清学筛查对预防不良妊娠结局的临床价值。方法回顾性分析2019年1月至2021年12月于江西省浮梁县妇幼保健院产科门诊建档并进行妊娠中期唐氏血清学筛查的2799例孕妇临床资料。采集孕妇空腹静脉血,采用微粒子化学发光法测定β-人绒毛膜促性腺激素(β-hCG)、游离雌三醇(uE3)及甲胎蛋白(AFP)、抑制素A(INH-A),统计妊娠中期唐氏血清学筛查结果,比较不同唐氏筛查风险级别孕妇的不良反应妊娠结局。结果2799例进行妊娠中期唐氏血清学筛查的孕妇中低风险有82.96%(2322/2799),临界风险9.97%(279/2799),高风险7.07%(198/2799);高风险组治疗性引产(2.02%)、剖宫产率(36.87%)高于临界风险组(0.36%、27.96%)、低风险组(0.09%、19.98%),临界风险组剖宫产率高于低风险组,高风险组死胎发生率(1.01%)高于低风险组(0),高风险组巨大儿(15.15%)及早产发生率(5.05%)高于临界风险组(8.96%、1.79%)、低风险组(5.00%、1.77%),临界风险组巨大儿发生率高于低风险组,差异均有统计学意义(P<0.05)。结论妊娠中期唐氏血清学筛查可作为预测不良妊娠结局的辅助检查,妊娠中期唐氏血清学筛查高风险、临界风险孕妇不良妊娠结局发生率较高,需要加强对该类孕妇的监测。

Objective To study the clinical value of Down′s serologic screening in mid-pregnancy for preventing the adverse pregnancy outcomes.Methods The clinical data of 2799 pregnant women who were filed in the obstetrics outpatient clinic of Maternal and Child Health Hospital of Fuliang County,and underwent Down′s serology screening in mid-pregnancy from January 2019 to December 2021 were retrospectively analyzed.Fasting venous blood was collected from pregnant women,andβ-human chorionic gonadotropin(β-hCG),free estriol(uE3),and alpha-fetoprotein(AFP)and inhibin A(INH-A)were measured by microparticle chemiluminescence,so as to statistically analyze the results of mid-pregnancy Down′s serologic screening and compare the adverse pregnancy outcomes of pregnant women with different Down′s screening risk levels.Results Among 2799 pregnant women who underwent Down′s serologic screening in mid-pregnancy,82.96%(2322/2799)were low-risk,9.97%(279/2799)were critical-risk,and 7.07%(198/2799)were high-risk.Therapeutic induced abortion(2.02%)and cesarean section rates(36.87%)were higher in the high-risk group than those in the critical-risk group(0.36%,27.96%),low risk group(0.09%,19.98%).Cesarean section rate was higher in critical risk group than low risk group.Incidence of stillbirth(1.01%)was higher in high risk group than low risk group(0).Incidence of macrosomia(15.15%)and preterm labor(5.05%)was higher in high risk group than critical risk group(8.96%,1.79%),low risk group(5.00%,1.77%),and the incidence of macrosomia in the critical risk group was higher than that in the low risk group,which were statistically different(P<0.05).Conclusion Serologic screening for Down′s syndrome in mid-pregnancy can be used as an auxiliary test for predicting adverse pregnancy outcomes,and the incidence of adverse pregnancy outcomes in mid-pregnancy pregnant women with high risk and critical risk of serologic screening for Down′s syndrome is higher.The monitoring for pregnant women of this group needs to be strengthened.