The Value Of Doppler Ultrasonography In Uterine Artery,Middle Cerebral Artery And Umbilical Artery Of High-risk Pregnancy

Objective: To investigate the value of detecting uterine artery(Ut A),middle cerebral artery(MCA)and umbilical artery(UA)hemodynamic index by color Doppler ultrasound in the third trimester of pregnancy and the clinical value of the above indexes in high-risk.Methods: 173 women whose gestational age were 32 to 34 weeks for hospital inspection from November 2017 to December 2018 were included,and they were all hospital childbirths with all singletons,routine ultrasound examined.The pregnant women were divided into two groups:81 cases of high-risk pregnancies including hypertensive disorders of pregnancy(HDP),gestational diabetes mellitus(GDM),intrahepatic cholestasis of pregnancy(ICP),hypothyroidism,polyhydramnios,oligohydramnios and so forth and 92 cases of normal pregnant women in the third trimester of pregnancy.Using color Doppler flow imaging(CDFI)to show uterine artery、fetal middle cerebral artery and umbilical artery.Then,the blood flow parameters of each artery were measured by spectral Doppler.The peak systolic velocity(S)and diastolic velocity(D)ratio(S/D),Pulsation index(PI),Resistant index(RI).The hemodynamic index and the perinatal outcome was analyzed respectively.1.Comparison of PI,RI and S/D of uterine artery,middle cerebral arteryand umbilical artery in high-risk pregnancy group and normal control group;2.Comparison of pregnancy outcomes between high-risk pregnant and normal controls;3.Comparison of PI,RI,S/D of uterine artery,middle cerebral arteryand umbilical artery in normal and abnormal pregnancy groups in high-risk group;4.To analyze the specificity and sensitivity of PI,RI and S/D single indicators of uterine artery,fetal middle cerebral artery and umbilical artery in diagnosing adverse pregnancy outcomes;5.To analyze the specificity and sensitivity of multi-parameter joint diagnosis of adverse pregnancy outcomes;6.Analysis of the specificity and sensitivity of each parameter combination for the diagnosis of adverse pregnancy outcomes in this study.Outcome: 1.The PI,RI and S/D values of uterine artery and umbilical artery in high-risk pregnancy group were higher than those in normal control group.The PI,RI and S/D values of fetal middle cerebral artery were lower than the normal control group,and the difference was statistically significant(P<0.05).2.The adverse perinatal outcome incidence in the high risk pregnant group was 41.96%,which was significant higher than 4.35% of normal pregnant group.There was significant difference between the two groups(P<0.05).3.The PI,RI and S/D of uterine artery and umbilical artery in the group with abnormal pregnancy outcome in high risk pregnancy were higher than those in the group with normal pregnancy outcome.The PI,RI and S/D of fetal middle cerebral artery were lower than those in the group with normal pregnancy outcome,and the difference was statistically significant(P<0.05).4.Among the single blood flow parameters of uterine artery,umbilical artery and fetal middle cerebral artery,MCAS/D has the highest diagnostic value.The AUC,sensitivity and specificity of MCAS/D were 0.86,79%和 87%;MCARI<0.68 has the highest specificity of 89% and sensitivity is 59%;Ut A RI>0.61 has the highest sensitivity of 88.2% and specificity is 54.3%.5.The AUC,sensitivity and specificity of these parameters were0.99,93.8% and 95.3%。 6.In the diagnosis of adverse perinatal outcomes in this study,the combination of these parameters has the highest diagnostic value for fetal distress,with the highest specificity of 87% and sensitivity is 84.6%.The diagnostic sensitivity to FGR is up to 92.3%,but its specificity is lower at 40.7%.Conclusion: 1.The application of color Doppler ultrasonography to monitor the changes of blood flow parameters of uterine artery,umbilical artery and fetal middle cerebral artery in the third trimester of pregnancy is of certain clinical value in judging the intrauterine condition of the fetus and predicting the pregnancy outcome.2.The combination of parameters can improve the accuracy of diagnosis and provide a basis for guiding treatment and deciding the best time for delivery.