The Predictive Value Of Uterine Artery Blood Flow Parameter、PLGF And MAP For Maternal And Fetal Outcomes In Patiens With Pregnancy Induced Hypertension

Objective:To investigate the changes of uterine arterial Hemodynamics parameters,mean arterial pressure（MAP）and serum placental growth factor（PLGF）in hypertensive disorder complicating pregnancy,to analyze its significance in hypertensive disorder complicating pregnancy and its predictive value for maternal and fetal outcomes,so as to provide reference value for clinical doctors in diagnosis and treatment.Methods:1.A total of 71 Singleton live-born pregnant women who had 2021 and delivered in the hospital during October to November 2022 were selected as case group,in addition,71 healthy singleton pregnant women were selected as control group by 1:1matching（the gestational age and the time of specimen collection were not more than one month different from the case group）.2.Map and serum PLGF were measured by standard method at 11-13⁺⁶ weeks and 20-24⁺⁶ weeks of pregnancy,respectively,at the same time,the uterine artery pulsation index（UTA-PI）、uterine artery resistance index（UTA-RI）and early diastolic notch were measured by color Doppler ultrasound,all data and gestational age at birth、Apgar score、neonatal weight and incidence of adverse pregnancy outcomes were recorded.Adverse pregnancy outcomes were defined as abnormal pregnancy outcomes within the relevant criteria in Obstetrics gynecology 9th edition.The cases with any adverse pregnancy outcome were included in the group with adverse pregnancy（N = 40）,and those with normal delivery and no other abnormalities were included in the group without adverse pregnancy（N = 31）.3.SPSS 26.0 was used to analyze the data.Mean ± standard deviation（（?）±S）was used for Normality test measurement data,and independent sample t-test was used for comparison between groups data that did not conform to the normal distribution were presented as median（quartile）,and Mann-whitney U test was used for comparison between groups.The categorical count data were expressed as percentage,and the Χ² test was used for the comparison between groups.ROC curve was used to analyze the value of each index in predicting adverse pregnancy outcome.The test levels were all P< 0.05 with statistical significance.Results:1.There was no significant difference in age,Body Mass Index（BMI）,parity and family history between Case Group and control group（P > 0.05）.2.The levels of UtA-PI,UtA-RI and MAP in case group were significantly higher than those in control group（p < 0.05）.3.The serum PLGF level in the case group was significantly lower than that in the control group（p < 0.05）.4.The incidence of adverse pregnancy outcome,premature delivery and cesarean section in the case group were higher than those in the control group（p < 0.05）.5.The value of UTA-RI and PLGF in predicting adverse pregnancy outcomes in early pregnancy was statistically significant.The area under the ROC curve of UTA-RI in predicting adverse pregnancy outcomes was 0.740（95% CI: 0.625-0.856）The area under the ROC curve for PLGF alone to predict adverse pregnancy outcomes was0.802（95% CI: 0.699-0.905）;Serum PLGF level had the largest area under the ROC curve for predicting adverse pregnancy outcomes in early pregnancy.6.The values of UTA-PI,UTA-RI,PLGF and MAP in the second trimester were statistically significant in predicting adverse pregnancy outcomes.The area under the ROC curve for UTA-PI alone to predict adverse pregnancy outcomes was 0.844（95% CI:0.754-0.933）,and the area under the ROC curve for UtA-RI alone to predict adverse pregnancy outcomes was 0.692（95% CI: 0.569-0.815）;The area under the ROC curve for PLGF alone to predict adverse pregnancy outcomes was 0.870（95% CI:0.784-0.955）,and the area under the ROC curve for map alone to predict adverse pregnancy outcomes was 0.787（95% CI: 0.680-0.895）.Serum PLGF level had the largest area under the ROC curve for the prediction of adverse pregnancy outcomes in the second trimester.Conclusion:The uterine artery pulsatility index,resistance index,serum PLGF level and mean arterial pressure of pregnant women in the first and second trimester could reflect the incidence of hypertensive disorder complicating pregnancy and predict the adverse maternal and fetal outcomes.PLGF is the most effective index to predict the adverse pregnancy outcome in the early and middle trimester of pregnancy.If combined with the above parameters in clinical work,clinician can get more reliable evidence,appropriate treatment should be taken as early as possible to improve the prognosis of mother and infant.