Relationship between the prognosis of pregnant women with velar placenta and ultrasonic parameters of fetal umbilical artery blood flow
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摘要:
目的 分析帆状胎盘孕妇预后与胎儿脐动脉血流超声参数的关系。 方法 选取2018年10月~2021年10月本院收治的102例帆状胎盘孕妇的临床资料及产前超声检查结果进行回顾性分析，依据产妇妊娠结局情况分为妊娠结局良好组(n=60)和妊娠结局不良组(n=42)，并选取同期于本院接受孕检的正常孕妇50例作为对照组。采用脉冲多普勒超声检查测定胎儿脐动脉血流收缩末期峰值流速与舒张末期峰值流速的比值(S/D)及阻力指数。比较各组的S/D比值及阻力指数情况，采用Pearson相关性分析S/D比值、阻力指数与分娩孕周、胎儿出生体质量的关系，采用Spearman相关性分析S/D比值、阻力指数与胎儿不良结局率及产妇产后出血率的关系。 结果 妊娠结局不良组的S/D比值及阻力指数均高于妊娠结局良好组和对照组(P < 0.05)。随着S/D比值及阻力指数的增加，孕妇的分娩孕周越短、胎儿的出生体质量越低，胎儿结局不良率及产妇产后出血率越高(P < 0.05)。进一步相关性分析显示，S/D比值、阻力指数与分娩孕周、胎儿的出生体质量呈反比，与胎儿的结局不良率、产妇产后出血率呈正比(P < 0.05)。 结论 胎儿脐动脉血流超声参数S/D比值、阻力指数与帆状胎盘孕妇预后明显相关，且S/D比值、阻力指数越高，分娩孕周越提前、胎儿的出生体质量越低，胎儿的结局不良率越高。 Abstract:Objective To analyze the relationship between the prognosis of pregnant women with velar placenta and ultrasonographic parameters of fetal umbilical artery blood flow. Methods The clinical data and prenatal ultrasound examination results of 102 pregnant women with Vela placenta admitted to our hospital from October 2018 to October 2021 were retrospectively analyzed. According to pregnancy outcomes, they were divided into good pregnancy outcome group (n=60) and poor pregnancy outcome group (n=42). At the same time, fifty normal pregnant women who underwent pregnancy examination in our hospital at the same period were selected as control group. The ratio of end-systolic peak flow velocity to end- diastolic peak flow velocity (S/D) and resistance index of fetal umbilical artery were measured using pulsed Doppler ultrasonography, and the S/D ratio and resistance index of each group were compared. Pearson correlation was used to analyze the relationship between S/D ratio and resistance index and gestational week of delivery and birth weight of fetus. Spearman correlation analysis was used to analyze the relationship between S/D ratio and resistance index, fetal adverse outcome rate and postpartum haemorrhage rate. Results The S/D ratio and resistance index in poor pregnancy outcome group were higher than those in good pregnancy outcome group and control group (P < 0.05), with the increase of S/D ratio and resistance index, the shorter gestational age of pregnant women, the lower the birth weight of the fetus, and the higher the rate of poor fetal outcome and postpartum hemorrhage (P < 0.05). Further correlation analysis showed that S/D ratio and resistance index were inversely correlated with gestational week of delivery and fetal birth mass and positively proportional to the rate of poor fetal outcome and postpartum hemorrhage (P < 0.05). Conclusion Fetal umbilical artery flow ultrasound parameters S/D ratio and resistance index are significantly correlated with the prognosis of pregnant women with velar placenta. The higher the S/D ratio and resistance index, the earlier the gestational week of delivery, the lower the birth weight of the fetus, and the higher the rate of poor outcomes of the fetus. -
表 1 各组脐动脉S/D比值和阻力指数比较
Table 1. Comparison of S/D ratio and resistance index of umbilical artery among all groups (Mean±SD)
参数指标 妊娠结局不良组（n=42） 妊娠结局良好组（n=60） 对照组（n=50） F P S/D比值 4.04±1.12α 3.25±0.62 3.13±0.73 16.407 < 0.001 阻力指数 0.76±0.22α 0.59±0.12 0.55±0.16 20.409 < 0.001 αP < 0.05 vs妊娠良好组、对照组. 
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表 2 帆状胎盘孕妇不同脐动脉血流超声参数妊娠结局比较
Table 2. Comparison of pregnancy outcomes with different ultrasonic parameters of umbilical artery blood flow in pregnant women with velar placenta
参数 例数 分娩周期(周，Mean±SD) 胎儿出牛体质量(kg，Mean±SD) 胎儿结局不良率[n(%)] 产妇产后出血率[n(%)] S/D比值 < 3.0 45 39.04±5.02 3.24±0.72 5(11.11) 3(6.67) 3.0~4.0 29 37.21±5.72 2.81±0.58 8(27.59) 5(17.24) > 4.0 28 32.37±5.89 2.14±0.59 17(60.71) 8(28.57) F/χ2 14.624 24.836 20.521 6.336 P < 0.001 < 0.001 < 0.001 0.004 阻力指数 < 0.66 42 38.96±3.24 3.31±0.92 4(9.52) 2(4.76) 0.66~0.70 31 37.01±3.58 2.94±0.84 9(29.03) 5(16.13) > 0.70 29 33.06±3.79 1.97±0.44 17(58.62) 9(31.03) F/χ2 24.473 25.425 19.921 8.960 P < 0.001 < 0.001 < 0.001 0.011
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表 3 胎儿脐动脉S/D比值、阻力指数与不良妊娠结局的相关性分析
Table 3. Correlation analysis of fetal umbilical artery S/D ratio, resistance index and adverse pregnancy outcome
项目 分娩周期 胎儿出牛体质量 胎儿结局不良率 产妇产后出血率 S/D比值 r -0.441 -0.502 0.389 0.396 P < 0.05 < 0.05 < 0.05 < 0.05 阻力指数 r -0.399 -0.421 0.376 0.375 P < 0.05 < 0.05 < 0.05 < 0.05
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