| Objective:Through measuring the blood flow parameters of middle of cerebral artery(MCA)? umbilical artery(UA)? ductus venosus(DV)and tricuspid valve by Doppler flow imaging technology in late pregnancy fetal,to discuss the application value of evaluating late fetal growth restriction(FGR)and predicting its prognosis.Materials and methods:Choose 180 fetuses whose gestatinal age were 32 to 40 weeks from January 2015 to February 2017,all those fetuses were singletons for regular antenatal examination and hospital childbirth.In 80 fetuses suspected FGR by prenatal ultrasound routine examination,61 fetuses final clinically diagnosed FGR were formed FGR group;in 100 fetuses with normal weight by ultrasound routine examination,the birth weights of all fetuses were in the normal range and those fetuses were formed control group.Retrospective analyzed the values of blood flow parameters of fetal middle of cerebral artery? umbilical artery? ductus venosus and tricuspid valve by using Doppler technology,including pulsation index(PI)? peak systolic velocity(S)and end diastolic velocity(D)ratio(S/D)of UA and MCA;the atrial systole wave(A wave)? ventricular systole wave(S wave)? ventricular diastole wave(D wave)and S/A ratio of DV;early and late diastolic peak flow(E,A)of tricuspid and calculated E/A ratio.Followed-up the pregnancy outcomes of all fetuses.Observed the changes of each blood flow parameter in control group and compared the above blood flow parameters between FGR group and control group by using statistical methods,evaluated the value of using multiple blood flow parameters to monitor FGR and estimate fetal prognosis.Results:1.In control group,the values of PI? S/D in fetal umbilical artery and middle cerebral artery were decreased with gestational age.There was a statistical significance(p<0.001).2.In control group,tricuspid E wave flow velocity was increased with gestational age(p<0.05),and there was not obvious change in A wave flow velocity,so E/A ratio was also increased with gestational age(p<0.05).3.In control group,tri-phasic Doppler waveform was seen in ductus venosus: A wave during atrial contraction,S wave during ventricular contraction and D wave during ventricular diastole.Those waves were in the same direction.The velocities of three waves increased with gestational age,and the change of S/A ratio was the opposite(p<0.001).4.The values of PI? S/D of fetal umbilical artery in FGR group were higher than those in control group,there was a statistical significance(p<0.01).5.The values of PI? S/D of fetal middle cerebral artery in FGR group were lower than those in control group,there was a statistical significance(p<0.05).6.The values of tricuspid E wave and A wave flow velocity in FGR group were lower than those in control group but there was no statistically significant(p>0.05),and the value of tricuspid E/A in FGR group was higher than that in control group(p<0.05).7.The S/A ratio of ductus venosus in FGR group was higher than that in control group(p<0.05),the velocities of three waves(S wave? D wave? A wave)in FGR group were lower than those in control group(p<0.05).8.Comparison of pregnancy outcome between FGR group and control group,the incidence rate of adverse pregnancy outcome such as fetal distress? neonatal asphyxia and perinatal death respectively were 41%?17%.There was a statistical significance(p<0.001).9.There were 12 cases with abnormal doppler performances which were too serious to measure the blood flow parameter values in two groups,11 cases in FGR group and 1 case in control group.Among the nine fetuses with absent or reversed umbilical end-diastolic flow in FGR group,4 cases were death in perinatal period,4 cases were associated with fetal distress and acidosis after birth,1 case was in normal physical condition after birth;1 fetus with A wave deepened of ductus venosus and with absent umbilical end-diastolic flow was intrauterine death,another fetus with A wave inverted of ductus venosus and with reversed umbilical end-diastolic flow and E/A>1 of tricuspid inflow was also intrauterine death.1 fetus with absent umbilical end-diastolic flow in control group got 4 to 7 points in Apgar score after elective delivery.Conclusion:1.With the increase in gestational age,vascular resistances of fetal middle cerebral artery? umbilical artery? and ductus venosus were decreased in order to increase the blood flow through these vessels to satisfy the needs of fetal growth and development;tricuspid E/A value was increased with gestational age and indicated that the diastolic function of the heart was constantly mature.2.The blood flow parameters of middle cerebral artery,umbilical artery,ductus venosus and tricuspid were important indicators of evaluating FGR.3.When severe abnormalities appeared in the Doppler spectrum,FGR fetuses were often associated with adverse perinatal outcome and needed to strengthen the guardianship. |
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