| Objective: To detection the spectrum and blood flow of fetal venous in normal pregnancy and preeclampsia by Doppler Ultrasonography,and to record the related information when fetal birth.The aim of this study was to find the changes rule in fetal venous blood flow parameters and gestational age,through contrastive analysis to obtain the change rule of fetal venous blood flow parameters and blood flow ratio during preeclampsia,and to explore the application value of fetal venous hemodynamics in the evaluation of fetal intrauterine status during preeclampsia,and evaluate perinatal outcome.Methods:1 Select a total of 90 cases of preeclampsia were divided into mild preeclampsia group and severe preeclampsia group,which were in the period of gestational age is 20 to 40 weeks of intrauterine pregnancy and single live fetus,as an observation group.With inclusion criteria as follows:(1)Refer to the eighth edition of "Obstetrics and Gynecology" pregnancy hypertension classification criteria.Mild preeclampsia: after 20 weeks of pregnancy,systolic blood pressure≥140mmHg and/or diastolic blood pressure≥90mmHg with albuminuria≥0.3g/24 h,or random albuminuria(+).Severe preeclampsia: blood pressure and albuminuria both increased continually,systolic blood pressure≥160mmHg and/or diastolic blood pressure≥110mmHg;albuminuria ≥5.0g/24 h,or random albuminuria≥(+++);Maternal organ dysfunction or fetal complications occurred.(2)Pregnant women in addition to suffering from hypertensive disorders of pregnancy do not merge gestational diabetes,kidney disease,cardiovascular abnormalities and other diseases.(3)The fetal have no structural malformation or chromosomal abnormalities.2 Select 195 cases of pregnant women who were examined on time in our hospital and follow-up confirmed after birth,neonatal physical examination is normal infants,as the control group.With inclusion criteria as follows: pregnant women usually have regular menstrual cycle,the last menstrual period accurately,without autoimmune disease,without chronic diseases of affecting the hemodynamics or other complications of pregnancy;gestational age is 20 to 40 weeks of intrauterine pregnancy single live fetus,and grow in ultrasonic parameters measurement and gestational age is in accord with that of clinical size in 10 to 90 percentile growth curve,the fetal without structural malformation or chromosomal abnormalities,and the amniotic fluid volume within the normal range.According to the size of the gestational weeks,195 cases of control group can be divided into 5 groups: 20~23+6 weeks,24~27+6 weeks,28~31+6 weeks,32~ 35+6 weeks and 36~40 weeks.3 Detection of control group and preeclampsia group of fetal venous blood flow(umbilical vein,ductus venosus,inferior vena cava),included their internal diameter and blood flow parameters(average peak velocity TAmax,ventricular systolic peak velocity S,ventricular diastolic peak velocity D,maximal atrial contraction reflux velocity A,venous preload index PLI,pulsatility index PI,venous peak velocity index PVIV),and the ratio of ductus venosus and umbilical vein blood flow.At the same time record the birth of the fetus with gestational age,delivery methods,neonatal weight and Apgar score.4 SPSS22.0 software statistical system are applied to analyzed,measurement data with the mean ± standard deviation,and the use of t test;count data with n(%),used Chi-square test,when P<0.05,the difference between the statistics.Comparison between groups used Kruskal-Wallis Test,when P <0.05,the difference between the statistics.Result:1 In this study,we obtained the reference range of the inner diameter measurement of the umbilical vein,ductus venosus and inferior vena cava with different gestational weeks in the control group.As the increment of pregnancy gestational age,the vein inside diameter measured values are increased gradually,a linear positive correlation existed between them.2 The control group in this study,we obtained that the hemodynamic parameters measured range of fetal umbilical vein,ductus venosus and inferior vena cava in every group.The venous blood flow velocity parameters(UV-TAmax,DV-S,D,A,TAmax,IVC-S,D,A)were gradually increased with the increase of gestational age,and ductus venosus blood flow resistance parameter values(DV-PLI,PI,PVIV)had no significant correlation with gestational age,and the mean value was 0.5.3 The study found that in the control group,fetus umbilical venous blood flow(QUV)and ductus venosus blood flow(QDV)both increase with the increase of gestational weeks,the ratio of QDV/QUV decreases with the increase of gestational age,and its ratio was negatively correlated with gestational weeks.4 Compared with the control group,ductus venosus blood flow resistance parameter values(DV-PLI,PI,PVIV)of the mild and severe preeclampsia group were higher than those in the control group,and the ratio of QDV/QUV was higher than that in the control group,groups were statistically different.5 Compared with the control group,the gestational age,neonatal weight and Apgar score of the mild and severe preeclampsia group were lower than those of the control group,but the rate of cesarean section and induced abortion were higher than that of the control group,groups were statistically significant differences.Conclusion: The study found that in normal pregnancy,along with the increment of gestational age,the inner diameter,blood flow velocity parameters and blood flow of fetal venous are increased gradually,reflected the increase in oxygen demand during fetal growth and development.However,the ratio of ductus venosus and umbilical venous blood flow decreased gradually with the increased of gestational age,which reflected that between fetal and maternal blood circulation in the process of pregnancy gradually perfect,reduced the placental resistance caused fetal ventricular compliance increased.Compared with normal pregnancy,the ratio of ductus venosus to umbilical vein blood flow during preeclampsia was higher,furthermore associated with the severity of preeclampsia.This may be due to systemic arteriolar spasms of pregnant women during preeclampsia,increased vascular resistance leads to blood supply decreased,caused lack of placental blood supply,which appeared the fetal intrauterine hypoxia,hence ductus venosus need to through its own adjust blood flow and make more oxygenated blood "pump" into the fetal heart,in order to supply heart,brain and other vital organs development.Therefore,detection of fetal vein hemodynamic changes and blood flow are particularly important,can indirectly reflect the status of fetal intrauterine time of preeclampsia,able to provide more for clinicians to intervene in time to deal with reference data,to improve the poor perinatal outcomes,to reduce the perinatal mortality,improve the quality of maternal-fetal medicine to provide effective basis. |
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