Relationship Between Abnormal Maternal-fetal Hemodynamics And Adverse Pregnancy Outcome In FGR

Objective:The aim of this study was to retrospectively analyze the incidence of adverse pregnancy outcome under various maternal-fetal blood flow conditions in FGR,and to explore the relationship between various maternal-fetal hemodynamic abnormalities and adverse pregnancy outcome in FGR.Methods:The research data were obtained from the preganant women and fetuses who were examined and delivered at the First Affiliated Hospital of Hainan Medical University from October 2020 to November 2022.Among them,160 fetuses with normal growth and development were selected as the CPR group(Group 1),and 160 fetuses with growth restriction were selected as the FGR group(Group 2).The blood flow of Ut A,UA,MCA,and DV in the ultrasound indicators of the aforementioned study subjects within 24 hours before delivery were detected and calculated.In FGR group,only abnormal maternal hemodynamics occurred in group 2a,while abnormal UA,DV,MCA and CPR occurred in group 2b(with or without abnormal maternal uterine artery blood flow).Follow-up to delivery,the incidence of abnormal maternal-fetal hemodynamic parameters and the incidence of adverse pregnancy outcomes in normal growth and development group and FGR group were counted and compared,and so does the incidence of adverse pregnancy outcomes in Group 2a and Group 2b,the incidence of adverse pregnancy outcome between normal and abnormal fetal hemodynamic parameters in group 2b,and the incidence of serious adverse pregnancy outcome between normal and abnormal fetal hemodynamic parameters in group 2b.Logistic regression was used to analyze the relationship between fetal blood flow parameters and severe adverse pregnancy outcome,and to find independent risk factors related to severe adverse pregnancy outcome.Receiver operating characteristic curve of the predictive value of each blood flow parameter for adverse pregnancy outcome and severe adverse outcome was drawn,and the predictive efficacy of the above indexes in FGR perinatal prognosis was described by receiver’s operating characteristics(ROC)curve.Results:1.The age of pregnant women in normal group and FGR group was not statistically significant(P > 0.05),while the distribution of delivery weeks and the birth weight of newborns were statistically significant(all P=0.001).2.The incidence of abnormal maternal-fetal hemodynamic parameters and adverse pregnancy outcome in FGR group were higher than those in normal group,and the differences were statistically significant(all P=0.001).There was no significant difference in the incidence of adverse pregnancy outcome between normal maternal-fetal hemodynamic parameters and abnormal maternal-fetal hemodynamic parameters(P > 0.05).In FGR group,the incidence of adverse pregnancy outcome in patients with normal maternal-fetal hemodynamic parameters was lower than that in patients with abnormal maternal-fetal hemodynamic parameters,with statistical significance(P=0.024).Whether the maternal-fetal blood flow was normal or not,the incidence of adverse pregnancy outcome in FGR group was significantly higher than that in normal group(all P=0.001).3.There was no significant difference in the incidence of adverse pregnancy outcome between normal and abnormal maternal blood flow parameters in FGR group(P > 0.05).The incidence of adverse pregnancy outcome in FGR group was higher than that in normal group(P = 0.001).In FGR group,the incidence of adverse pregnancy outcome was higher in patients with abnormal fetal blood flow parameters than in patients with abnormal maternal blood flow parameters,with statistical significance(P=0.039).In FGR group,the incidence of adverse pregnancy outcome in patients with simple abnormal uterine artery blood flow was lower than that in patients with abnormal uterine artery blood flow and abnormal fetal blood flow,and the difference was statistically significant(P=0.002).There was no significant difference in the incidence of adverse pregnancy outcomes between those with simple fetal blood flow abnormality and those with uterine artery blood flow abnormality combined with fetal blood flow abnormality in FGR group(P > 0.05).4.In FGR group,the incidence of adverse pregnancy outcome in patients with abnormal UA,MCA and CPR was higher than that in patients with normal UA,MCA and CPR,and the differences were statistically significant(P=0.001,P=0.008,P=0.002).5.In FGR group,the total incidence of severe adverse pregnancy outcome was higher in patients with abnormal UA,MCA,CPR and DV than in patients with normal UA,MCA,CPR and DV,and the differences were statistically significant(P=0.001,P=0.005,P=0.001,P = 0.001).The perinatal mortality rate of patients with abnormal UA,MCA,CPR and DV in FGR group was higher than those with normal UA,MCA,CPR and DV,and the differences were statistically significant(P=0.001,P=0.006,P=0.001,P = 0.001).The preterm delivery rate of newborns with abnormal UA and DV was higher than that with normal UA and DV,and the difference was statistically significant(P=0.048,P = 0.019).Severe asphyxia of newborns with abnormal DV was higher than that of normal newborns,and the difference was statistically significant(P=0.017).6.Logistic regression analysis of various fetal blood flow abnormalities and fetal pregnancy outcome: UA and DV abnormalities were closely related to the serious adverse pregnancy outcome of FGR(OR=5.911,P=0.004;OR=6.139,P=0.001).UA and DV abnormalities were closely related to perinatal death of FGR(OR=6.702,P=0.004;OR=5.860,P=0.001).7.In this group,the adverse pregnancy outcome of FGR was as high as 90.6%,and the sensitivity of various fetal blood flow abnormalities and CPR abnormalities in predicting adverse pregnancy outcome was poor(DV abnormality was only 18.6% at the lowest and UA abnormality was only 51% at the highest).The combined prediction sensitivity of the above indicators was even lower than that of a single indicator,while the specificity of predicting adverse pregnancy outcome was high:UA abnormality and DV abnormality were 100%,MCA abnormality and CPR abnormality were 93.3%.UA abnormality had a predictive sensitivity of 80.0% and specificity of 67% for perinatal death,premature delivery and severe asphyxia of newborn.Although the sensitivity of DV abnormality in predicting three serious adverse outcomes was 42.2%,the specificity was 93%.However,UA abnormality combined with DV abnormality could improve the prediction specificity to 96.5%.For the prediction of perinatal death,UA abnormality had the highest sensitivity(82.9%),and DV abnormality was the single index with the highest specificity(92.4%).The specificity of UA abnormality combined with DV abnormality in predicting perinatal death was 95.8%.For the prediction of preterm labor,the highest sensitivity was UA abnormality(71.4%),and the highest specificity was DV abnormality(85.6%).UA abnormality combined with DV abnormality could improve the prediction specificity to 88.4%.For the prediction of severe neonatal asphyxia,the highest sensitivity was still UA abnormality(83.3%),and the highest specificity was DV abnormality(84.4%).Conclusions:Abnormal maternal-fetal blood flow is important for the occurrence of adverse pregnancy outcomes in FGR.UA and DV are independent risk factors of serious adverse pregnancy outcome and perinatal death in FGR.UA,MCA,CPR and DV abnormalities have low sensitivity and high specificity in predicting adverse pregnancy outcomes in FGR.Among the above parameters,UA abnormalities have the highest sensitivity in comprehensive prediction of perinatal death,super preterm delivery and neonatal severe pregnancy outcomes and individual prediction of severe adverse pregnancy outcomes,while abnormal DV has the highest specificity in predicting severe adverse pregnancy outcomes mentioned above.