| All kinds of complications of mother and fetus during pregnancy seriously endanger the safety of mother and fetus.With the opening of the second birth policy,the distribution of high-risk pregnancies related to age,gestational times,scarred uterus and placenta increased.With the development of perinatal health care,more attention has been paid to the prevention of maternal and child complications.How to predict and identify high-risk pregnant women in early stage and reduce the adverse outcomes of pregnant women is the focus of obstetric research.In the second trimester of pregnancy,AFP,h CG and u E3 have been widely used to screen fetal chromosomal abnormalities and major structural abnormalities.Some studies have shown that the abnormal median multiples(Mo M)of these three indicators were related to a variety of adverse maternal and fetal outcomes,which can be used to evaluate and predict the occurrence of adverse pregnancy outcomes.However,there are different reports on specific predictive values.Objective:To explore the correlation between the abnormal serologic prenatal screening index in the second trimester and the adverse pregnancy outcomes.Methods:1.To collect the general data of pregnant women undergoing serological prenatal screening in the second trimester from August 2018 to February 2019 in the outpatient department of Maternal and Child Health Hospital Affiliated to Anhui Medical University,and record the value of serological prenatal screening index Mo M values.2.Follow up the pregnant women until the end of pregnancy in Maternal and Child Health Hospital Affiliated to Anhui Medical University,record the pregnancy complications and perinatal maternal and infant outcomes,and exclude those who do not meet the inclusion criteria.3.According to the group of three indexes(AFP,?-h CG and u E3),the three indexes were normal as the control group,the abnormal increase or decrease of single index as the increase group or the decrease group,the abnormal increase and / or decrease of two indexes as the two index abnormal groups,and the abnormal increase and / or decrease of three indexes as the three index abnormal groups.Two and three index anomalies are collectively referred to as two or more index anomaly groups4.Compare the incidence of adverse pregnancy outcomes between the control group and other groups,and then use multible Logistic regression analysis AFP,?-h CG and u E3 abnormal Mo M values and the correlation of adverse pregnancy outcomes.Results:1.Comparison results of general data:Compared with the control group,the weight and gestational age of newborns in the AFP increased group were significantly lower(t =2.378,P = 0.020;t = 3.087,P = 0.003).The gestational age of ?-h CG decreased group was lower than that of the control group(t = 2.324,P = 0.020),and the maternal age of?-h CG decreased group was higher than that of the control group(t =-1.975,P =0.048).The weight of neonates in the lower u E3 group was lower than that in the contr ol group(t = 3.107,P = 0.002),while that in the higher u E3 group was higher than that in the control group(t =-2.015,P = 0.044).The proportion of primipara in the lower u E3 group was lower than that in the control group.2.Comparison of the incidence of abnormal adverse pregnancy outcome of single index:The incidence of preterm delivery in AFP increased group was higher than that in the control group(c2= 8.945,P = 0.003);the incidence of gestational diabetes in ?-h CG decreased group was higher than that in the control group(c2= 5.980,P = 0.014),and the incidence of pregnancy with hypothyroidism in ?-h CG increased group was higher than that in the control group(c2= 5.767,P = 0.016);the incidence of small for gestational age in u E3 decreased group was higher than that in the control group(c2=10.094,P = 0.001),the incidence of placental membrane retention was higher in the u E3 group than in the control group(c2= 7.855,P = 0.005).3.Comparison of the incidence of adverse pregnancy outcomes of two or more abnormal indicators: The incidence of hypertensive disorders of pregnancy during pregnancy,oligohydramnios and small for gestational age in the abnormal group were higher than that in the control group(14.44% vs 8.27%;16.67% vs 8.39%;10.71% vs4.45%).The differences were statistically significant(c2= 4.162,P = 0.041;c2= 7.322,P = 0.007;c2= 4.695,P = 0.030).In the abnormal subgroups of two or more indexes,the incidence of low AFP,low ?-h CG and low placenta retention was higher than that of the control group(25.00% vs 9.18%,P = 0.043).Compared with the control group,the incidence of low ?-h CG,low u E3,hypertensive disorders of pregnancy,placenta previa,preterm delivery and small for gestational age was higher(50.00% vs 8.27%,P= 0.037;25.00% vs 0.40%,P = 0.018;50.00% vs 2.85%,P = 0.005;25.00% vs 4.45%,P = 0.012),the incidence of high ?-h CG and preterm labor in AFP group was increased(18.18% vs 2.85%,P = 0.040),the incidence of oligohydramnios in AFP group and u E3 group was increased(36.36% vs 8.39%,P = 0.011),and the incidence of oligohydramnios in ?-h CG group and u E3 group was also increased(42.86% vs8.39%,P = 0.016).4.Multivariate logistic regression analysis showed that the increase of AFP was the risk factor of premature delivery(OR = 3.449,95% CI: 1.582-7.522).The decrease of u E3(OR = 2.939,95% CI: 1.536-5.621)and the abnormality of two or more indexes(OR =2.627,95% CI: 1.263-5.464)were the risk factors of small for gestational age.Conclusions:1.The abnormal Mo M values of AFP,?-h CG and u E3 in the maternal serum in the second trimester were related to the adverse pregnancy outcomes such as hypertensive disorders of pregnancy,gestational diabetes mellitus,hypothyroidism in pregnancy,retention of placental membrane,oligohydramnios,premature delivery and small for gestational age.2.The abnormal increased Mo M values of AFP is a risk factor for premature delivery.3.The abnormal decreased Mo M values of u E3 is a risk factor for the small for gestational age,and the abnormal Mo M values of two or more indexes is a risk factor for small for gestational age. |
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