| Objective:The purpose of this study was to evaluate the predictive value of uterine arterial blood flow parameters monitored by color doppler ultrasound combined with blood HCG and progesterone for threatened abortion and adverse pregnancy outcomes.Methods:A total of 134 pregnant women who were diagnosed with early pregnancy in our hospital from February to July 2017 without clinical intervention were selected.The pregnant women were 20 to 35 years old,with an average age of 28.92±5.74 years old,and the gestational age was 40 to 56 days.All ultrasonographic examinations were performed through vaginal exploration,and the instrument used was the Samsung WS80 A color doppler ultrasonic diagnostic instrument made by South Korea,with probe frequency ranging from 5 to 9MHz.The Abbott i2000 SR microparticle chemiluminescence system was used for biochemical immunoassay.the uterine blood flow parameters,monitored by ultrasound was collected at the first visit,as well as indicators of HCG and progesterone in blood at the first visit and at a 48-hour interval,The pregnant women were followed up until the end of pregnancy,and the correlation between these parameters and pregnancy outcome was retrospectively analyzed.At the first visit,the following examination results were obtained by vaginal ultrasonography:(1)the size,position and shape of uterus and pregnancy bursa,the presence of yolk sac and embryo and primitive cardiac beat,and the shape and size of bilateral ovaries.(2)uterine artery blood flow value: peak systolic velocity PSV,pulastility index PI and resistance index RI.The average value of the three measurements were taken as the final value.When comparing the hemodynamic parameters,the mean value of the blood flow parameters of bilateral uterine arteries was taken for comparison.Pregnant women’s venous blood was extracted at the first visit and 48 hours after the interval.The blood HCG and progesterone levels were measured by the automatic microparticle chemiluminescence immune system(abbott i2000SR).The included pregnant women were followed up until the end of pregnancy,and the pregnant women who successfully delivered the fetus were classified into the normal pregnancy group(group A,67 cases).Pregnant women who terminated their pregnancies due to cystic blight,embryo insemination,inevitable abortion and intrauterine stillbirth were classified as adverse pregnancy group(group B,67cases).According to the presence or absence of threatened abortion symptoms in early pregnancy,group A was divided into group A1(33 cases): group A without threatened abortion symptoms in early pregnancy;Group A2: the group A with threatened abortion symptoms in early pregnancy(34 cases).The uterine artery blood flow parameters,HCG 48-hour growth rate and progesterone of group A and group B,group A1 and group A2 were statistically analyzed.Results:1.There were no statistically significant differences in age,body mass index(BMI)and gestational age between the groups(P>0.05).2.There was no significant difference in the uterine artery PSV and RI values between group A and group B(P>0.05).The uterine artery PI value in group A were lower than those in group B,while the HCG 48-hour growth rate and progesterone in group A were both higher than those in group B,and the difference was statistically significant(P<0.05).3.In group A,comparing group A1 and group A2,there was no statistically significant difference between uterine artery PSV value、RI value and progesterone(P>0.05).The uterine artery PI value in group A1 were lower than those in group A2,while the HCG 48-hour growth rate in group A1 was higher than that in group A2,and the difference was statistically significant(P<0.05).4.Pearson correlation coefficient analysis showed that the uterine artery PI value was negatively correlated with the HCG 48-hour growth rate and progesterone value(r=--0.305,P<0.001).R =--0.278,P=0.001),and the HCG 48-hour growthrate was positively correlated with the progesterone value(r= 0.759,P<0.001).5.With pregnancy outcome as the dependent variable and uterine artery PSV value,RI value,PI value,HCG 48-hour growth rate and progesterone value as covariables,logistic regression analysis showed that the uterine artery PI value,HCG48-hour growth rate and progesterone value were closely related to adverse pregnancy outcomes(P < 0.05).6.The area under the ROC curve(AUC)of predicting adverse pregnancy outcomes by uterine artery PSV value,RI value,PI value,progesterone and HCG48-hour growth ratewas 0.483,0.525,0.735,0.904 and 0.912,The AUC value ofcombined uterine artery PI valuewith HCG 48-hour growth rate and progesterone value to predict adverse pregnancy outcome was 0.936.7.The prediction threshold of each parameter was determined according to the ROC curve: HCG 48-hour growth rate was less than or equal to 58.45%,the progesterone value was less than or equal to 21.09ng/ml,and the uterine artery PI value was greater than or equal to 2.71.The sensitivity ofHCG 48-hour growth rate,progesterone,uterine artery PI value and the combined prediction of adverse pregnancy outcome were 85.1%,80.6%,74.6% and 88.1%.Their specificity was88.1%,89.6%,64.2%and 94%.Their positive predictive values were 87.7%,86.9%,67.6% and 93.7%.Their negative predictive values were 85.5%,82.2%,71.7%and88.7%.Their accuracy was 86.6%,84.3%,69.4% and 91%.Conclusion:1.In early pregnancy,adverse pregnancy outcomes could be predicted by observing the uterine artery PI value,HCG 48-hour growth rate and progesterone value.And thepredictive value of the HCG 48-hour growth rate and progesterone value were higher.Uterine artery PSV and RI values had no predictive value for adverse pregnancy outcomes.There was a correlation between uterine artery PI,value,HCG 48-hour growth rate and progesterone.2.In early pregnancy,the abnormal of uterine artery PI value,HCG 48-hour growth rate and progesterone value predicted the possibility of threatened abortion,and had predictive value for the pregnancy outcome of threatened abortion afterpregnancy preservation.The abnormal uterine artery PSV value,RI value and progesterone had no value in the prediction of threatened abortion.3.The combination of uterine artery PI value,HCG 48-hour growth rate and progesterone had the highest accuracy and the greatest significance in predicting adverse pregnancy outcomes. |
PDF Full Text Request