The Study On Diagnostic Value Of Fetal Hypoxia By The Detection Of Umbilical Artery Combined With Fetal Middle Cerebral Artery

Objective: By using color doppler ultrasound instrument to detect the resistance index and its corresponding ratio of late pregnancy fetal umbilical artery and fetal middle cerebral artery, discuss the sensitivity and specificity of above each index respectively and combined use to predict fetal intrauterine hypoxia, to assess the value of the combined detection of fetal umbilical artery and middle cerebral artery on the diagnostic value of fetal hypoxia.Methods: Select the 349 women whose age were 20 to 33 and gestational age were 28 to 41 weeks for the hospital inspection from January 2014 to December 2014, and they were all hospital childbirths with all singletons, routine ultrasound examined. The clinical diagnoses of fetal intrauterine hypoxia 99 cases were as intrauterine hypoxia group, including 28 to 35+6 weeks 37 cases and 36 to 41 weeks 62 cases, 250 cases as normal control group, including 28 to 35+6 weeks 139 cases and 36 to 41 weeks 111 cases. Then use spectrum doppler ultrasonic to exam the fetal MCA and UA blood flow waveforms in the above groups. The peak systolic velocity(S)and end-diastolic velocity(D)ratio(S/D), pulse index(PI), resistant index(RI) and the resistant parameter ratios of MCA to UA were calculated and their sensitivity, specificity and Youden index of diagnoses of fetal hypoxia were analyzed.Results: 1 At the pregnancy 28 to 35+6 weeks, the resistance indexes of fetal umbilical artery in the intrauterine hypoxia group are higher than those in the control group, there is a statistical significance(P<0.01), the resistance indexes of fetal middle cerebral artery in the intrauterine hypoxia group are lower than those in the control group, there is a statistical significance(P<0.01), the ratio of resistance index of MCA and UA are significantly lower than those in the control group, there is a statistical significance(P<0.01). At pregnancy 36 to 41 weeks, The resistance indexes of fetal umbilical artery in the intrauterine hypoxia group are higher than those in the control group, there is a statistical significance(P<0.01), the resistance indexes of fetal middle cerebral artery in the intrauterine hypoxia group are lower than those in the control group, there is a statistical significance(P<0.01), the ratio of resistance index of MCA and UA are significantly lower than those in the control group, there is a statistical significance(P<0.01).2 With single index UA-S/D>2.90, UA-PI>1.61 and UA-RI>0.60 in the diagnoses of fetal hypoxia at pregnancy 28 to 35+6 weeks, the sensitivity and specificity respectively are 81.6% and 94.3%, 72.1% and 93.1%, 79.2% and 89.6%, the Youden index respectively are 75.9%, 65.2% and 68.8%, in the diagnoses of fetal hypoxia at pregnancy 36 to 41 weeks, the sensitivity and specificity respectively are 86.7% and 96.4%, 74.8% and 94. 3%, 83.4% and 91.6%, the Youden index respectively are 83.1%, 69.1% and 75.0%, With single index MCA-S/D<4.0, MCA-S/D<3.30, MCA-PI<1.15 and MCA-RI<0.63 in the diagnoses of fetal hypoxia at pregnancy 28 to 35+6 weeks, the sensitivity and specificity respectively are 77.6% and 89.7%, 80.2% and 85.9%, 76.8% and 86.7%, the Youden index respectively are 67.3%, 66.1% and 63.5%, in the diagnoses of fetal hypoxia at pregnancy 36 to 41 weeks, the sensitivity and specificity respectively are 78.2% and 91.6%, 81.6% and 94.5%, 76.2% and 90.8%, the Youden index respectively are 69.8%, 76.1%, 67.0%, With index(MCA)S/D/(UA)S/D<1.37,(MCA)PI/(UA)PI<1.20 and(MCA)RI/(UA)RI <0.97 in the diagnoses of fetal hypoxia at pregnancy 28 to 35+6 weeks, the sensitivity and specificity respectively are 87.6% and 94.3%, 87.1% and 92.3%, 86.3% and 89.6%, the Youden index respectively are 81.9%, 79.4% and 75.9%; in the diagnoses of fetal hypoxia at pregnancy 36 to 41 weeks, the sensitivity and specificity respectively are 89.4% and 96.3%, 88.3% and 92.6%, 87.5% and 93.6%, the Youden index respectively are 85.7%, 80.9% and 81.1%.Conclusion: Joint detection of fetal umbilical artery and middle cerebral artery resistance index for diagnosis of fetal intrauterine hypoxia have higher sensitivity and specificity than those of single umbilical artery or middle cerebral artery, which can be found in the early fetal hypoxia and predict adverse pregnancy outcome, and clinical can intervene to reduce the birth defects of perinatal fetus.