FGR母体胎盘血管灌注不良的影响因素分析

Analysis of Influencing Factors of Poor Placental Vascular Perfusion in FGR Mothers

目的探讨与分析胎儿生长受限(fetal growth restriction,FGR)母体胎盘血管灌注不良的影响因素。方法选择2022年1月—2023年1月在北大医院宁夏妇儿医院、宁夏回族自治区妇幼保健院及银川市妇幼保健院住院分娩并诊断为胎儿生长受限的87例产妇作为研究对象,所有产妇都给予超声检查,记录脐动脉血流动力学参数。同时所有产妇都给予胎盘病理检查,判定母体胎盘血管灌注不良发生情况,调查产妇的一般资料并进行相关性分析。结果在87例产妇中,判断为母体胎盘血管灌注不良27例,占31.0%(灌注不良组),其中绒毛梗死14例、远端绒毛发育不良6例、绒毛成熟加速4例、蜕膜动脉病3例。灌注不良组产妇的子痫前期史、胎盘早剥史等占比高于非灌注不良组,差异有统计学意义(P<0.05)。两组胎儿脐动脉收缩期峰值流速对比,差异无统计学意义(P>0.05);灌注不良组的舒张末期血流速度低于非灌注不良组,搏动指数、阻力指数高于非灌注不良组,差异有统计学意义(P<0.05)。在87例产妇中,Spearman分析显示母体胎盘血管灌注不良与脐动脉舒张末期血流速度、搏动指数、阻力指数等存在相关性,差异有统计学意义(P<0.05)。二元Logistics回归分析显示,脐动脉舒张末期血流速度、搏动指数、阻力指数为导致母体胎盘血管灌注不良发生的重要因素,差异有统计学意义(P<0.05)。结论胎儿生长受限产妇的母体胎盘血管灌注不良发生率比较高,脐动脉舒张末期血流速度、搏动指数、阻力指数为导致母体胎盘血管灌注不良发生的重要因素,胎盘母体血管灌注情况能够为治疗改善胎儿生长受限预后提供依据。

Objective To explore and analysis the influencing factors of poor placental vascular perfusion in fetal growth restriction(FGR)mothers.Methods From January 2022 to January 2023,87 cases of pregnant women who delivered in the First Hospital of Peking University Hospital,Ningxia Women's and Children's Hospital,Ningxia Hui Autonomous Region Maternal and Child Health Care Hospital and Child Health Care Hospital and were diagnosed with fetal growth restriction were selected as the study subjects.All the pregnant women were examined by ultrasound,and the hemodynamic parameters of umbilical artery were recorded.At the same time,all pregnant women were subjected to placental pathological examination,and were to determine the occurrence of poor placental vascular perfusion in the mother,investigated the general information of the pregnant women,and conducted correlation analysis.Results There were 27 cases were diagnosed as maternal placental vascular hypoperfusion,accountied for 31.0%(hypoperfusion group)in the 87 cases,included 14 cases of villous infarction,6 cases of distal villous dysplasia,4 cases of accelerated villous maturation,and 3 cases of decidual artery disease.There were significant difference in the history of preeclampsia and placental abruption compared between the two groups(P<0.05).There were no signifi cant diff erence compared between the two groups in the peak systolic velocity of fetal umbilical artery(P>0.05).The end diastolic blood fl ow velocity in the hypoperfusion group were lower than that in the non hypoperfusion group(P<0.05),and the pulsation index and resistance index were higher than those in the non hypoperfusion group(P<0.05).Spearman analysis showed that maternal placental vascular perfusion were correlated with umbilical artery end diastolic blood fl ow velocity,pulsation index,resistance index,etc.in the 87 cases(P<0.05).Binary logistic regression analysis showed that umbilical artery end diastolic blood fl ow velocity,pulsation index and resistance index were important factors leading to poor vascular perfusion of the mother placenta(P<0.05).Conclusion The incidence of poor maternal placental vascular perfusion in FGR mothers is relatively high.The umbilical artery end diastolic blood fl ow velocity,pulsation index and resistance index are important factors leading to poor maternal placental vascular perfusion.Maternal placental vascular perfusion can provide basis for treatment and improvement of the prognosis of fetal growth restriction.