Diagnostic Value Of Color Doppler Ultrasonography For Fetal Middle Cerebral Artery And Umbilical Artery In Intrauterine Distress

Objective:To investigate the hemodynamic changes of the umbilical artery and middle cerebral artery in fetal distress,and to evaluate the diagnostic value of color Doppler blood flow index in fetal intrauterine distress.Methods:A total of 120 pregnant women who were attended the Third Clinical College of Shanxi Medical University from January 2021 to October 2022 were selected as the study object.and the hemodynamic indices（PI,RI,S/D）of the umbilical artery and middle cerebral artery were obtained by color Doppler ultrasound at 34～42 weeks,and the prenatal and postnatal newborns were collected.According to the diagnostic criteria of clinical fetal distress,50 cases of fetal distress were divided into 50 cases（distress group）,70 cases of no distress in the same period（non-distress group）were selected,and the results of umbilical artery and middle cerebral artery ultrasound test in the prenatal week were used as research data to analyze the diagnostic value of umbilical artery,middle cerebral artery and their hemodynamic parameter ratio on fetal distress.The ROC curve was plotted to analyze the predictive value of the ratio of hemodynamic parameters of the umbilical artery and the middle cerebral artery in the diagnosis of fetal distress.Results:1.Umbilical artery pulsatility index（UA-PI）,umbilical artery blood flow resista nce index（UA-RI）,the ratio of peak blood flow velocity to end-diastolic blood flow velocity（UA-S/D）in the distress group were（1.24±0.20）,（0.77±0.22）and（3.12±0.72）.The above indices in the non-distressed group were（0.87±0.19）,（0.54±0.06）and（2.46±0.30）.These results showed that the umbilical arterial hemodynamic indices in the distress group were significantly higher than that in the non-distress group,and the difference was statistically significant（P<0.05）.When UA-S/D>2.785,UA-PI>0.945,and UA-RI>0.625 suggests intrauterine distress,the AUC for diagnosing fetal distres s is the highest with U-S/D.2.Middle cerebral artery pulsatility index（MCA-PI）,middle cerebral artery resistance index（MCA-RI）,the ratio of peak blood flow velocity to end-diastolic blood flow velocity（MCA-S/D）in the distress group were（1.53±0.13）,（0.68±0.07）and（4.02±0.89）.The above indices in the non-distressed groupwere（1.75±0.23）,（0.75±0.09）and（4.58±0.98）.These results showed that the middle cerebral arterial hemodynamic indices in the distress group were significantly lower than that in the non-distress group,and the difference was statistically significant（P<0.05）.When MCA-S/D<3.895,MCA-PI<1.645,MCA-RI<0.695suggests intrauterine distress,the AUC for diagnosing fetal distress is the highest with MCA-PI.3.The ratio of PI in the middle cerebral artery to PI in the umbilical artery(PI_MCA/UA),the ratio of RI in the middle cerebral artery to RI in the umbilical artery(RI_MCA/UA),and the ratio of S/D in the middle cerebral artery to S/D in the umbilical artery(S/D_MCA/UA)in the distress group were（1.27±0.25）,（0.96±0.27）,（1.33±0.36）.The above indices in the non-distressed group were（2.10±0.51）,（1.41±0.24）and（1.88±0.45）.The ratio of middle cerebral artery and umbilical artery hemodynamic index in the distressed group was significantly lower than that in the non-distressed group,and the difference was statistically significant（P<0.05）.4.The sensitivity of PI_MCA/UA（CPR）for predicting intrauterine distress was 94.1%,the specificity was 85.9%,and the cut-off value was 1.665（AUC was 0.941,95%CI was0.902～0.981）;The sensitivity of RI_MCA/UAin predicting intrauterine distress was 88.0%,the specificity was 84.0%,and the cut-off value was 1.195（AUC was 0.896,95%CI was0.831～0.960）.The sensitivity of S/D_MCA/UAfor predicting intrauterine distress was 88.0%,the specificity was 83.1%,and the cut-off value was 1.485（AUC was 0.901,95%CI was0.839～0.963）.In low-risk pregnancies,PI_MCA/UA<1.665 and RI_MCA/UA<1.195 are better for diagnosing fetal distress than single umbilical and middle cerebral arteries.Conclusion:1.Color Doppler ultrasound detection of fetal middle cerebral artery and umbilical artery blood flow parameters is an important non-invasive examination method at present,which can detect fetal intrauterine distress as soon as possible,improve pregnancy outcome,and have important clinical value for the prediction of fetal intrauterine distress.2.The diagnostic value of PI_MCA/UA（CPR）for fetal distress is higher than that of RI_MCA/UA,and regular monitoring CPR can provide a basis for timely correction of fetal intrauterine distress in clinical practice,and can be used as a monitoring index for fetal intrauterine distress and adverse perinatal outcomes.