| Objective To explore effective approaches to analyze and predict the adverse pregnancy outcome of velamentous placenta, and this paper investigates the characteristics of changes in blood-flowing parameters of fetal umbilical artery( UA) in velamentous placenta and middle cerebral artery( MCA) through the application of color Doppler flow imaging( CDFI).Methods Selecting 95 puerperas who were prenatally diagnosed by ultrasonography and pathologically proved as singleton pregnancy and velamentous placenta whose age ranged from 21 to 35, and the average was 26. 70±3. 8; the gestational weeks ranged from 30 to 41, and the average was 34. 11±9. 48. By following the pregnancy outcomes,categorizing them into three groups: good pregnancy outcome group, adverse pregnancy outcome group, and moderate-to severe adverse pregnancy outcome group. Besides,choosing 100 normal puerperas as control group who matched with cases in age,gestational weeks, and hospitalized delivery over the same period. And then analyzing the characteristics of changes in characteristics of changes in blood flow parameters of fetal umbilical artery in velamentous placenta and middle cerebral artery.In the study,using conventional color ultrasonic devices: GE Voluson E8 ultrasound systems. The two instruments are set under obstetric mode with a 3.5–6MHz abdominal probe, a 5–8.5MHz intracavitary probe and a volume transducer. The scanning goes through the regular sequence of an obstetrical ultrasonic examination, when I especially focus on the positional relations between umbilical cord roots and connection parts of placentae,distortions of umbilical vessels.Applying CDFI to show the blood-flowing characteristics in fetal umbilical artery and middle cerebral artery.Using Pulse Doppler( PW) to obtain many data, S/D reading( Peak Systolic Velocity(MAX) / End Diastolic Velocity(MIN))in umbilical artery and middle cerebral artery, RI reading( RI = PSV(MAX)-EDV(MIN)), and calculating the S/D reading and RI of umbilical artery with the autoprogram of instrument. Then storing the images and data for further offline analysis.Results 1 The S/D and RI reading of fetal umbilical artery in severe adverse pregnancy outcome group are remarkably higher than that of those in good pregnancy, adverse pregnancy, moderate pregnancy outcome groups. The S/D and RI reading of middle cerebral artery in moderate-to severe adverse pregnancy outcome group are remarkably lower than that of those in other three pregnancy outcome groups. The difference is statistically significant( P<0.05). 2 The blood-flowing parameters of umbilical artery and middle cerebral artery between light adverse pregnancy outcome group, good pregnancy outcome group and normal control group have no remarkable differences( P>0. 05). 3The S/D and RI reading of fetal umbilical artery and middle cerebral artery are all relating to predictions, especially strong relation existing in S/D and RI. The S/D and RI reading in umbilical artery are positively correlated, and those above in middle cerebral artery are positively correlated. 4High-sensibility of S/D in fetal umbilical artery as well as high-specificity of RI. The area below S/D curve of fetal umbilical artery is 0.851, standard error is 0.027, 95% confidence interval locates between 0.797 and 0.905, when it comes from 3.005 to 3.090, the sensibility and specificity of adverse pregnancy outcome group will be found out. In accordance with the Youden, an index which is or higher 3.045( ≥ 3.045) will be the critical point to judge adverse pregnancy outcome, the sensibility is 81.1% and specificity is 73.0%.The area below RI curve of fetal umbilical artery is 0.879,standard error is 0.023, 95% confidence interval locates between 0.833 and 0.925. The data of sensibility and specificity in judging adverse pregnancy outcome as follows when it comes from 0.655 to 0.715.Likewise, according to the Youden, an index which is or higher 0.685(>0.685) will be the critical point to judge adverse pregnancy outcome, the specificity is 94.0% and the sensibility is 62.1%.Conclusions: 1 There is a strong relation between blood-flowing parameters in fetal umbilical artery, middle cerebral artery and pregnancy outcome of velamentous placenta.2 The degree of adverse pregnancy outcome varies heavily with S/D and RI reading of umbilical artery increasing, whereas heavily with S/D and RI reading of middle cerebral artery decreasing.3 thereinto,S/D and RI reading of umbilical artery,with high sensibility and conveniences,have a diagnostic value in predict the degree of adverse pregnancy outcome and directing the clinical interventions. |
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