Evaluation Of Fetal Right Ventricular Function Of ICP Pregnant Women By Right Ventricular Tei Index And Blood Flow Parameters Of Ductus Venosus

Objective:Intrahepatic cholestasis of pregnancy(ICP)is a liver disease that often occurs in the middle and third trimester of pregnancy,which can cause maternal diseases and adverse outcomes of fetal pregnancy.In this study,the right ventricular Tei index of ICP pregnant women were measured by tissue Doppler imaging to evaluate the overall right ventricular function and related factors,so as to provide a theoretical basis for clinical comprehensive evaluation of fetal health status and guide clinical treatment timely and prediction of pregnancy outcome.Methods: The pregnant women(n=90)who were diagnosed as ICP in the obstetric clinic or inpatient of Nanchong Central Hospital from Juanary 2019 to December 2019 were selected in this study.All ICP pregnant women were divided into severe group(TBA ≥ 40μmol / L,n=30)and mild group(40μmol / L > TBA ≥ 10 mol / L,n=60)according to the serum total bile acid(TBA)level,and the healthy pregnant women who came to the hospital for physical examination at the same period were selected as the control group(n=40).The time of isovolumic contraction(ICT),isovolumic relaxation(IRT)and ejection(ET)were measured by color Doppler ultrasound in TDI mode,and the Tei index of right ventricle was obtained.Blood flow parameters of DV were measured,RI,PI,PLI and S / A ratio were calculated with Spectral Doppler Imaging.Serum TBA,ALT,AST,DBIL and TBIL were measured.The serum indexes,Tei index and DV blood flow parameters of three groups of pregnant women were compared.To evaluate the right ventricular function of ICP pregnant fetus,and to analyze the correlation between TBA,Tei index and DV flow parameters.Results:There was no significant difference in age,gestational age and fetal heart rate among the three groups(P > 0.05).The serum TBA,ALT,AST,DBIL and TBIL in ICP severe group were significantly higher than those in ICP mild group and control group(P < 0.05).The serum TBA,ALT and AST in ICP mild group were significantly higher than those in control group(P < 0.05),but there was no significant difference in DBIL and TBIL levels(P > 0.05).Compared with the ICP mild group and the control group,the ICT + IRT and Tei index((79.5±3.1)ms、0.54±0.03)of pregnant women in the ICP severe group were significantly higher,ET was significantly lower,RI,PI,PLI and S / A of DV blood flow parameters were significantly higher(P < 0.05);ICP between mild group and control group of right ventricular Tei index and the blood flow parameters of DV RI 、PI,PLI,S/Athere was no significant difference(P > 0.05).Control group fetal right ventricular Tei index and pregnant women age(r = 0.161,P = 0.223),gestational age(r = 0.247,P = 0.129),heart rate(r = 0.325,P = 0.081)with no correlation.There was a positive correlation between the Tei index of the right ventricle of pregnant women in the severe ICP group and the DV parameter RI(r=0.583,P<0.001),PI(r=0.367,P=0.018),PLI(r=0.405,P=0.009),S/A(r=0.526,P<0.001)and TBA level(r=0.741,P<0.001).There was no significant correlation between the Tei index of right ventricle and the above indexes in the mild ICP group.Conclusion:The Tei index of the right ventricle of the fetus is not affected by the age,gestational age and fetal heart rate of the pregnant woman,and the Tei index of the right ventricle of the pregnant woman with severe ICP is higher than that of the normal fetus and the mild group,indicate that the whole function of the right ventricle of the pregnant woman is impaired,and with the aggravation of the severity of ICP,the whole function of the right ventricle is damaged more significantly.This indicates that tissue doppler Tei index can reflect the whole right ventricular function of the fetus in ICP patients and provide theoretical basis for clinical monitoring.The DV blood flow parameters RI,PI,PLI and S/A of the pregnant fetuses with severe ICP are higher than those of the normal fetuses and the mild group,indicate that the diastolic function of the right heart of the pregnant fetuses with severe ICP is impaired.Severe ICP pregnant women right ventricular Tei index and DV blood flow parameters of RI,PI,PLI,S/A and have positive correlations between serum levels of associates,show that in pregnant women who are severely ICP,joint use of Tei index and venous catheter can more effectively evaluate fetal ultrasound parameters right heart function,combined with the serum levels of associates can provide a reference for right heart function damage severity,fetal monitoring and the selection of treatment for clinical provide more early,more comprehensive guide.