多指标联合监测妊高征孕晚期胎儿宫内状况

Multiple indexes monitoring the situation of fetuses of advanced pregnancy induced hypertension

目的 :探讨采用彩色多普勒超声测定胎儿脐血流指标、母血胎盘生乳素水平、胎儿生物物理评分的不同意义 ,提出妊高征孕晚期胎儿宫内状况的有效监护模式。方法 :测定 15 6例妊娠晚期妇女 (其中正常妊娠组 87例 ,妊高征组 6 9例 )的胎儿脐动脉 (UA)血流收缩期峰值速度 (S)与舒张末期速度 (D)并监测母血胎盘生乳素 (HPL )水平、胎儿生物物理评分 (BPS) ,追踪围产儿预后。结果 :(1)妊高征组孕 2 8周 UA- S/D值显著高于正常妊娠组 (P<0 .0 0 1)。 (2 )妊高征组 HPL水平低于同孕龄正常妊娠组 ,孕 32周差异具有显著性 (P<0 .0 5 )。 (3) UA- S/D值≥ 3.0组围产儿不良妊娠结局发生率显著增高 (P<0 .0 0 5 )。 (4 )不同方法的联合监测可提高围产儿不良妊娠结局产前诊断的准确性。结论 :UA- S/D值是预测围产儿不良结局的灵敏指标 ;不同指标的联合监测可提高围产儿不良妊娠结局产前诊断的准确性 ;对妊高征患者孕晚期进行多指标的联合监测 ,可以准确评估胎儿宫内状况 ,降低盲目的剖宫产 ,对于降低并防止围产儿不良妊娠结局具有一定意义。

Objective:To evaluate the monitoring effect of Color Doppler flow imaging (CDFI), maternal human placental lactogen lever (HPL) and biophysical profile scores (BPS) in normal pregnancy and pregnancy induced hypertension (PIH) cases. Methods: Color Doppler ultrasound was used to detect the systolic-to-diastolic ratio (S/D) of UA in 156 third trimester pregnant women, of which 87 cases were normal pregnancy and 69 cases were PIH . The maternal human placental lactogen (HPL) and biophysical profile scores (BPS) were measured simultaneously. Results: In PIH group, S/D ratios of UA are higher than that of the normal group after 28 weeks (P<0.001). The level of HPL in PIH group is lower than that of the normal group after 32 weeks (P<0.05).There is a significant difference between S/D ≥3.0 group and S/D <3.0 group in the incidence of poor perinatal outcomes (P<0.005). Applying multiple measures can increase the diagnosis of poor perinatal outcomes accurately before delivery. Conclusion: S/D ratios of UA can predict the poor perinatal outcomes with high sensitivity. Using multiple examining measure can evaluate the situation of fetus accurately, decrease the rate of unnecessary cesarean section, avoid the poor perinatal outcomes, thus improve the quality of perinatal care.