| Objective: To detect the fetal hemodynamics of umbilical artery(UA)and middle cerebral artery(MCA)in patients with preeclampsia(PE)using the color doppler flow imaging(CDFI),follow-up fetal outcomes,compare and analyze the variations of UA and MCA doppler parameters between PE and normal pregnancy,and predict their clinical value for fetal adverse outcomes.Methods: Thirty five pregnant women with preeclampsia who were hospitalized in the obstetrics ward of our hospital and underwent prenatal ultrasound examination from December 2017 to December 2018 were selected as PE group.Thirty five normal pregnant women who received health examination in the hospital during the same period were included in the normal group.General clinical data including education level,number of pregnancy,number of births,pre-pregnancy body mass index(pre-pregnancy BMI),and family history of hypertension were collected for each subject to analyze the risk factors related to preeclampsia.CDFI were performed on the two groups to measure the fetal UA and MCA hemodynamics by Philips iU22 from the Netherlands and Samsung H60 color doppler ultrasonography from the Korea,and obtained the peak systolic velocity,end diastolic velocity,pulsatility index,resistance index and systolic/diastolic ratio,remarked as UA PSV,UA EDV,UA PI,UA RI,UA S/D and MCA PSV,MCA EDV,MCA PI,MCA RI,MCA S/D,respectively.The corresponding ratios of MCA to UA were calculated and marked as MCA/UA PI,MCA/UA RI and MCA/UA S/D,respectively.The hemodynamic parameters of UA and MCA were compared between the two groups.And then we followed-up and counted the number of adverse outcomes.Analyzed and screened the predictive value of UA and MCA hemodynamic parameters to fetal adverse outcome and estimated the predictive boundary.Results :(1)The related risk factors including education level,pre-pregnancy BMI,family history of hypertension,and odds ratio were 0.517,1.322 and 2.931,respectively.(2)The incidence of adverse outcomes in the PE group was significantly higher than that in the normal pregnancy group,and the gestational weeks,birth weight,and 1-minute / 5-minute apgar score of the PE group were all lower than those in the normal group,with statistically significant differences(P<0.05).(3)There were no statistically significant differences in the incidence of fetal UA diastolic blood flow absent or reverse and MCA spectrum parameters between early-onset and late-onset preeclampsia,but the mortality of fetus in early-onset was higher than that in late-onset PE(P < 0.05).(4)The incidence of UA diastolic blood flow absent or reverse in the dead fetus was higher than that in the survived fetus(P < 0.05).(5)UA PSV,UA EDV,MCA S/D,MCA PI,MCA RI,MCA/UA PI,MCA/UA RI and MCA/UA S/D in the PE group were all lower than those in the normal pregnancy group,and the differences were statistically significant(P < 0.05).UA S/D,UA PI and UA RI were all higher than the normal group,but the difference was not statistically significant(P > 0.05).UA PI,MCA PI,MCA RI,and MCA S/D could be used as predictors of adverse fetal outcomes(P < 0.05),but their predictive values were not high.The predicted thresholds for adverse fetal outcomes were 1.04,1.38,0.76,and 4.16,respectively.Conclusion :(1)The fetal mortality rate in early-onset PE is higher than late-onset PE.(2)Fetal UA resistance index increased,while MCA and MCA/UA resistance parameters decreased in PE group.MCA PI,MCA RI,and MCA S/D had moderate predictive values for adverse fetal outcomes,with the predicted thresholds of 1.38,0.76,and 4.16,respectively.(3)When UA diastolic blood flow absent or reversed in the PE fetus,it may suggested that fetal intrauterine distress was severe,which to some extent could provide certain value for clinical treatment. |
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