| Hypertensive disorders complicating pregnancy(HDCP) is a peculiar disease during pregnant period and there is higher morbidity in China.HDCP is one of the main reasons for morbidity and mortality of pregnant women and perinatal infant. The pathophysiological changes of HDCP can lead to intrauterine hypoxia, affect fetal growth and development, and result in the occurrence of adverse pregnancy outcomes. The aim of this study is to detect the change of the resistant parameter ratios of fetal renal artery(RA) to middle cerebral artery(MCA) and Tei index and to explore the clinical value of them in predicting intrauterine hypoxia in HDCP.198 sdudies from 28 to 41 gestational age were recruited from these who came to our hospital for pregnancy examination. They were divided into 2 groups: the normal group includes 145 fetuses without HDCP, the abnormal group includes 53 fetuses with HDCP and are confirmed by the clinic and laboratory examination. During a follow-up period of 3 month after delivery, all sdudies had achieved the better pregnant outcome and had not achieved complications. The E8 Ultrasonoscope were used to examine fetuses. Firstly, examine the fetal structure and estimate gestational age.Then, using pulsed wave Doppler(PW), the resistant index(RI), pulsatility index(PI) and S/D of fetal RA and MCA were measured. The resistant parameter ratios of fetal RA to MCA were calculated. Doppler spectrum of mitral and tricuspid annulus were obtained by Tissue Doppler Imaging(TDI). The isovolumic contraction time(ICT), isovolumic relaxation time(IRT) and ejection time(ET) of fetal left ventricle(LV) and right ventricle(RV) were evaluated, then Tei index was calculated according to the formula: Tei index=(ICT+IRT)/ET.SPSS17.0 statistical software was used. The data was expressed as mean ± SD. The t-test was applied in the intergroup comparison. P-value less than 0.05 was considered statistically significant. The relationship between two variables using Pearson correlation analysis. P-value less than0.05 was considered statistically significant.As shown above, the results showed as follows:1 Maternal age, gestational age and fetal heart rate had no difference between the two groups(P>0.05).2 RI, PI and S/D of fetal RA in the abnormal group were higher than those of the normal group(P<0.05).RI, PI and S/D of fetal MCA in the abnormal group were lower than those of the normal group(P<0.05).There was negative correlation between RI, PI and S/D of fetal RA and those of fetal MCA in the abnormal group(RI: r=-0.451,P<0. 01;PI: r=-0.289,P<0. 05;S/D: r=-0.451,P<0. 01).3 RIRA/MCA, PIRA/MCA and S/DRA/MCAin the abnormal group were higher than those of the normal group(P<0.05).4 There was no correlation between Tei index of the normal fetal LV and RV and their gestational age(LV: r=0.065, P>0.05; RV: r=-0.071,P>0.05).There was no correlation between Tei index of the normal fetal LV and RV and their heart rate(LV: r=0.015,P>0.05;RV: r=0.031,P>0.05).5 Tei index had no difference between fetal LV and RV(P>0.05).6 The Tei index of fetal LV and RV in the abnormal group were higher than those of the normal group(P<0.05).7 The resistant parameter ratios of fetal RA to MCA were positively correlated with the Tei index of fetal LV and RV in the abnormal group.In summary, the resistant parameter ratios of fetal RA to MCA canreflect fetal condition of blood circulation much completely and reliably.The Tei index of fetal ventricle is simple to measure, repeatable and easy to calculate. Tei index had no difference between LV and RV(P>0.05). The Tei index of fetal LV and RV is not affected by pregnant age and fetal heart rate. Tei index is more reasonable and objective to evaluate the whole function of fetal ventricle. The resistant parameter ratios of fetal RA to MCA were positively correlated with the Tei index of fetal LV and RV in the abnormal group. The resistant parameter ratios of fetal RA to MCA combined with Tei index can help to predict intrauterine hypoxia in HDCP,then to provide the objective basis for clinical treatment and prognostic evaluation. |
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