| Objective: We analyzed retrospectively the relationship between the abnormalities of uterine artery blood flow spectrum in the second trimester and the coexisted diseases of pregnancy,the complications of pregnancy,the outcome of premature infants.The correlation between them was studied,and the clinical value of uterine artery blood flow spectrum in monitoring and evaluating the pathological pregnancy progress and the outcome of premature infants was investigated,in order to find a reliable pathway and method to solve the tricky problems in clinical work,such as the difficulty of disease monitoring and the evaluation of adverse pregnancy outcome,and in order to provide more theoretical basis for early identification,intrauterine early intervention and early prevention of related diseases and adverse pregnancy outcomes.Method: A retrospective case-control study was used in this study.207 cases of singleton premature delivery patients who underwent fetal ultrasound examination in the second hospital of Hebei Medical University from December 2018 to December 2020 were selected.GE Voluson E10,2.5MHz probe frequency and Mode of "mid late pregnancy in obstetrics" were used in routine obstetric ultrasound examination at 20-24 weeks of these patients,to measure bilateral uterine artery pulsatility index(PI),the average value was taken.According to whether the uterine artery blood flow spectrum was abnormal or not,the patients were divided into normal group and abnormal group.The coexisted diseases of pregnancy and the complications of pregnancy before preterm delivery,birth outcomes of preterm infants were compared between normal group and abnormal group.The correlation between abnormal uterine artery blood flow spectrum and premature delivery and perinatal outcomes caused by common diseases during pregnancy was discussed,and the clinical significance was evaluated.Results:1.There was no significant difference in age,the number of pregnancy,parity and mode of termination between abnormal uterine artery blood flow spectrum group and normal group(P =0.171,0.201,0.336,0.214,respectively).The abnormal uterine artery blood flow spectrum was significa-ntly correlated with the pre-pregnancy body mass index(BMI).The abnormal uterine artery blood flow spectrum was more likely to occur in patients with high pre-pregnancy body mass index(OR=1.08,95%CI1.009-1.156).The incidence of previous cesarean section in the abnormal group was lower than that in the normal group(P<0.05).After excluding the influence of the number of pregnancy,there was no significant difference in the incidence of previous cesarean section between the two groups(OR=0.592,95%CI0.309-1.132).2.There was no significant difference in the incidence of gestational hypertension,gestational diabetes mellitus,intrauterine growth restriction(fetal growth restriction,FGR),premature rupture of membranes(premature rupture of membranes,PROM)and placental weight between the abnormal group and the normal group(P=0.441,0.133,0.617,0.313,0.076,respectively),but the incidences of preeclampsia and chronic hypertension complicated with preeclampsia in the abnormal group were higher than those in the normal group(P<0.076).After excluding the confounding factors such as age,the number of pregnancy,parity and body mass index before pregnancy,abnormal uterine artery blood flow spectrum was significantly correlated with the occurrence of preeclampsia,and those with abnormal uterine artery blood flow spectrum were more likely to develop preeclampsia(OR=3.65,95%CI1.797-7.411)(P<0.001).After excluding confounding factors such as age,the number of pregnancy and parity and body mass index before pregnancy,abnormal uterine artery blood flow spectrum was significantly correlated with chronic hypertension complicated with preeclampsia(OR=3.002,95%CI1.250-7.209 P<0.05.The incidence of placenta previa and threatened preterm delivery in abnormal group was lower than that in normal group.After excluding the interference of age,the number of pregnancy and cesarean section,abnormal blood flow spectrum of uterine artery was significantly correlated with the occurrence of placenta previa.Placenta previa was not easy to occur in patients with abnormal blood flow spectrum of uterine artery(OR=0.195,95%CI0.056-0.68).After excluding confounding factors such as body mass index before pregnancy,abnormal uterine artery blood flow spectrum was significantly correlated with threatened preterm labor.Patients with abnormal uterine artery blood flow spectrum were less likely to have threatened preterm labor(OR=0.098,95%CI0.013-0.759,P<0.05).3.In terms of the outcome of premature infants,the gestational age of premature infants in the abnormal uterine artery blood flow spectrum group was lower than that in the normal group(P<0.05),and the premature infants with abnormal uterine artery blood flow spectrum were more likely to have low gestational age(OR=0.814,95%CI0.728-0.970).The birth weight of premature infants in the abnormal group was lower than that in the normal group(P<0.001).After excluding the interference of gestational age and other factors,the abnormal uterine artery blood flow spectrum was significantly correlated with birth weight,and the patients with abnormal uterine artery blood flow spectrum were more likely to have low birth weight(OR=0.998,95%CI0.998-0.999,P<0.05).The incidence of asphyxia in the abnormal group was higher than that in the normal group.After excluding the confounding factors such as gestational age,the abnormal uterine artery blood flow spectrum was significantly related to the occurrence of premature asphyxia,and the premature asphyxia was more likely to occur in the patients with abnormal uterine artery blood flow spectrum(OR=2.184,95%CI1.110-4.338,P<0.05).The days in(neonatal intensive care unit,NICU of premature infants in abnormal group were higher than those in normal group,and there was a significant correlation between abnormal uterine artery blood flow spectrum and days in NICU.The premature infants with abnormal uterine artery blood flow spectrum had longer days in NICU(OR=1.047,95%CI1.024-1.071,P<0.05).Conclusions:1.The patients who suffered from preterm delivery with abnormal uterine artery blood flow spectrum in the second trimester have mostly high body mass index and are more likely to undergo hypertensive disorder complicating pregnancy,especially preeclampsia and chronic hypertension complicated with preeclampsia.2.Preterm infants with abnormal uterine artery blood flow spectrum in the second trimester of pregnancy have higher incidence of adverse outcome,lower birth weight,higher risk of neonatal asphyxia and longer days of stay in NICU.3.For patients with high-risk factors of premature delivery,the detection of uterine artery blood flow spectrum in the second trimester of pregnancy is helpful to monitor the occurrence and development of pathological pregnancy,and to evaluate the adverse pregnancy outcome before delivery timely,and to provide the possibility and theoretical basis for guiding the related patients’ health care and monitoring during pregnancy,and to implement accurate early intrauterine intervention to improve the pregnancy outcome.4.The incidence of placenta previa and threaten preterm delivery in patients with abnormal uterine artery blood flow spectrum in the second trimester of pregnancy are lower than that in patients with normal uterine artery blood flow spectrum,but its application value in both disorders maybe need to be further discussed. |
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