Value Of Fetal Right Ventricular FTI And GSI Index In The Evaluation Of Hypertensive Disorders Complicating Pregnancy

ObjectiveTo explore the diagnostic value of right ventricular fetal TAPSE index(FTI)and global sphericity index(GSI)by studying the fetal cardiac function between normal and hypertensive women using right ventricular Tei index(Tei),FTI,GSI and conventional fetal heart measurements.MethodsA series of 227 pregnant women in the outpatient department from August 2019 to December 2020 were recruited prospectively.The basic clinical data were collected,and Tei,FTI,GSI and conventional fetal heart measurements were measured in each of the fetus by transabdominal ultrasound.Pregnancy outcome and subject’s blood pressure to 3 months after delivery were followed up.Intra-and inter-examiner reliability and consistency of right ventricle Tei,FTI and GSI measurement were assessed in a random selection of 20 fetuses.According to the diagnostic criteria,the subjects were divided into normal value group(63 cases),gestational hypertension(GH)group(23 cases),mild preeclampsia(MPE)group(23 cases)and severe preeclampsia(SPE)group(17 cases).The changes of the above indexes with gestational age in the normal group were observed and the correlation analysis was conducted.The differences of fetal right ventricular Tei FTI and GSI were compared in the four groups,and the differences in the incidence of perinatal adverse outcomes between the low value group and the normal index group of right ventricular FTI and GSI were compared.Results(1)The intra-and inter-examiner reliability and consistency of right ventricle Tei,FTI and GSI were good,and both right ventricle FTI and GSI were better than Tei.(2)The mean of E,A,Em,Am,Sm,TAPSE,E/A of fetal right ventricle increased with the gestational age,and the differences of those indexes between different gestational age were statistically significant(P<0.05).No significant difference was found in right ventricle Tei,FTI and GSI between different gestational age(right ventricle Tei:F=2.095,P=0.082;FTI: F=0.852,P=0.493;GSI: F=0.045,P=0.996).(3)With the increase of the severity of hypertension in pregnancy,right ventricle Tei increased gradually(F=2.762,P<0.05),while right ventricle FTI and GSI decreased gradually(F was 8.103 、 3.827 respectively,P<0.05).Right ventricle Tei in SPE group was significantly higher than that in normal group,while the right ventricle GSI in SPE group was in contrast(P<0.05).And the right ventricle FTI in SPE group was significantly lower than that in normal group,GH group and MPE group(P<0.05).(4)The incidence of premature birth,emergency delivery due to continuous abnormal fetal heart monitoring in the low value group of right ventricle FTI was higher than those in the normal value group(P<0.05).There was no significant difference in the incidence of low birth weight,5 min Apgar score of newborn<7 score,NICU admission between the low value group and the normal index group of right ventricular FTI(P>0.05).The incidence of premature delivery,emergency delivery due to continuous abnormal fetal heart rate monitoring,low birth weight,NICU admission in the low value group of right ventricle GSI were higher than those in the normal group(P<0.05).There was no significant difference in the incidence of 5 min Apgar score of newborn<7 score between the low value group and the normal index group of right ventricular FTI(P>0.05).Conclusions(1)With the increase of the severity of hypertension in pregnancy,the right ventricular FTI index and GSI index decreased gradually.Compared with right ventricular Tei,right ventricular FTI and GSI had better performance in evaluating fetal cardiac function and change of morphology in hypertensive women.(2)FTI index and GSI index can be used as a predictor of adverse perinatal outcomes.