Diagnostic Value Of Fetal Distress In Using Maternal Serum Estriol, Electronic Fetal Heart Rate Monitoring And Umbilical Artery Blood Flow S/D Value

Objective:To investigate diagnostic value of maternal blood estriol level combined with fetal heart monitoring and umbilical artery blood flow S/D value for fetal distress.Methods:404healthy pregnant women who delivered(cesarean delivery or natural labor) in the department of Obstetrics and gynecology of Tengzhou central people,s hospital between February2012and August2013were analysed retrospectively. Maternal blood estriol level, fetal heart monitoring and umbilical artery blood flow S/D value were detected before these women were sent to operation room or delivery room.These women were divided into seven group:single maternal blood estriol level detection group; single fetal heart monitoring group; single umbilical artery blood flow S/D value detection group; combined maternal blood estriol level detection and umbilical artery blood flow S/D value detection group; combined maternal blood estriol level detection and fetal heart monitoring group; combined umbilical artery blood flow S/D value detection and fetal heart monitoring group, and combined maternal blood estriol level detection、umbilical artery blood flow S/D value detection and fetal heart monitoring group. Epidemiological indicators of concordance rate, kappa value, sensitivity, specificity, omission diagnostic rate, misdiagnosis rate, positive likelihood ratio, negative likelihood ratio, positive predictive value, negative predictive value and Youden index were used for evaluating the diagnostic value for fetal distress.Results:202cases of postpartum diagnosis of fetal distress, including mother maternal blood estriol positive for183people, true positive maternal126, maternal cardiac monitoring positive for209people, true positive maternal131, ultrasonic umbilical artery S/D ratio of positive maternal blood flow,168people, true positive maternal 104people;202cases of postpartum and diagnosis of the fetal distress in mother blood estriol for negatie maternal221people, true negative maternal for145people, the heart guardianship for negatie maternal181people, true negative maternal for110people, ultrasonic umbilical artery S/D ratio for negatie maternal blood flow,236people, true negative maternal138people.Compared with the clinical diagnose of fetal distress after labor, the concordance rate, kappa value, sensitivity, specificity, omission diagnostic rate, misdiagnosis rate, positive likelihood ratio, negative likelihood ratio, positive predictive value, negative predictive value and Youden index of And the single maternal blood estriol level detection group were67.079%,0.342,0.642,0.718,0.376,0.282,2.211,0.524,0.689,0.656,0.341in turns.And the single fetal heart monitoring group were59.653%,0.193,0.649,0.545,0.351,0.455,1.424,0.645,0.587,0.608,0.193in turns.And the single umbilical artery blood flow S/D value detection group were59.901%,0.198,0.515,0.683,0.485,0.317,1.625,0.710,0.619,0.585,0.198in turns.And the Serial test of combined maternal blood estriol level detection and fetal heart monitoring group were64.356%,0.307,0.510,0.777,0.490,0.223,2.289,0.631,0.696,0.613,0.287in turns,And the Serial test of combined maternal blood estriol level detection and umbilical artery blood flow S/D value detection group were63.614%,0.272,0.460,0.812,0.540,0.188,2.447,0.665,0.710,0.601,0.272in turns,The Serial test of combined umbilical artery blood flow S/D value detection and fetal heart monitoring group were63.614%,0.238,0.525,0.748,0.475,0.252,2.078,0.636,0.675,0.611,0.272in turns.And the Serial test of combined maternal blood estriol level detection, umbilical artery blood flow S/D value detection and fetal heart monitoring group were64.604%,0.292,0.391,0.901,0.609,0.099,3.950,0.676,0.798,0.597,0.292in turns. Conclusion:In single tests, the diagnostic value of single maternal blood estriol level detection was higher than single umbilical artery blood flow S/D value detection and single fetal heart monitoring group.In serial tests of the multiple tests, the diagnostic value of combined umbilical artery blood flow S/D value detection and fetal heart monitoring was much higher than the others, and when maternal blood estriol level detection was added, the specificity of diagnostic Test rose. Therefore, combined umbilical artery blood flow S/D value detection and fetal heart monitoring should be the prime choice of preliminary screening for chronic fetal distress, and maternal blood estriol level was detected as an effective approach for further screening. In parallel tests, the diagnostic value of combined maternal blood estriol level detection、umbilical artery blood flow S/D value detection and fetal heart monitoring was highest, therefore, combined maternal blood estriol level detection、umbilical artery blood flow S/D value detection and fetal heart monitoring should be the prime choice of preliminary screening for acute fetal distress.Multiple tests were more effective than single tests, and multiple tests were more useful for early diagnosis for fetal distress.