Analysis Of Application Value And Influence Factors Of Adverse Outcomes In Preeclampsia By Color Doppler Ultrasound

Research background and purpose:Preeclampsia is a pregnancy-specific cdisease,which can lead to serious maternal and fetal complications without prompt medical treatment.Terminating the pregnancy is an effective measure to improve the maternal symptoms,However,the incidence rate of adverse fetal outcomes increases because of premature birth.Previous researches have proved that fetal blood ciculation has been redistributed to protect the function of critical organ before fetal abnormalities.The value of color Doppler ultrasound in detecting the hemodynamics of uterine artery(UtA)?umbilical artery(UmA)?middle cerebral artery(McA)and cerebroplacental ratio(the ratio of McA to UmA pulse index)in predicting the adverse perinatal outcome of preeclampsia patients has attracted much attention of domestic and foreign researchers.However,there is still a lack of effective prediction indicators and unniform standard for each vascular parameter.In this study,CDFI was used to compare the hemodynamic changes of UtA?UmA and McA in preeclampsia and normal pregnant women,compare the hemodynamic changes of UtA,UmA and McA in the fetus with adverse and positive outcomes in preeclampsia,explore the clinical value of the ratio of MC A-PI to MC A-PI in predicting the adverse outcome of preeclampsia.Finally,we explored the related factors of fetal adverse outcomes in preeclampsia.We hope to provide a reference for clinicians and ultrasound doctors to assess the risks of disease?expectant treatment and grasp the proper time of pregnancy termination.Materials and Methods:According to the inclusion and exclusion criteria,from July 2018 to January 2020,94 cases of preeclampsia in 26-37 weeks admitted by Sichuan Provincial People's hospital were selected as the preeclampsia group,and 96 normal pregnant women who were examined in our hospital at the same time were selected as the normal pregnancy group.With the informed consent of patients,basic clinical data of patients are recorded.The fetal growth characters were recorded by color Doppler ultrasound.At the same time,CDFI was used to detect UtA?UmA and McA of pregnant women in two groups.PI of each vessel were recorded as UtA-PI?UmA-PI?McA-PI,respectively.The ratios of McA to UmA and UtA were calculated and recorded as PI-McA/UTA and PI-McA/UmA respectivdy.The patients with preeclampsia were assessed by ultrasound weekly,and the data of the last examination before delivery were taken as the final data.Comparing UtA-PI?UmA-PI?McA-PI?PI-McA/UtA?PI-McA/UmA between normal pregnant group and preeclampsia group.According to the adverse outcomes of fetus,the preeclampsia group was divided into two groups,comparing the differences of UtA-PI.UmA-PI?McA-PI?PI-McA/UtA?PI-McA/UmA between the two groups.Drawing the ROC curve of PI-McA/UtA which is used to predict the adverse outcomes of fetus,Analyzing the predictive value of fetal adverse outcomes of preeclampsia and comparing with other parameters.Single factor analysis was used to analyze the fetal adverse outcome in preeclampsia.Then,we took the Logistic regression analysis with the absent or reverse dastolic flow in umbilical artery?Bilateral uterine artery notches?Ultrasonic examination indicates FGR and other factors as independent variables to analyze the influencing factors of fetal adverse outcome in preedampsia.Result:1.UtA-PI and UmA-PI in preeclampsia group were higher than those in normal group,the difference was statistically significant(P<0.05).The McA-PI,PI-McA/UtA and PI-McA/UmA of preeclampsia group were lower than those in normal group,the difference was statistically significant(P<0.05).2.In the preeclampia group,54 casra were adverse outcomes and 40 cases were positive outcomes,UtA-PI and UmA-PI in the adverse group were higher than those in the positive group(P<0.05);McA-PI?PI-McA/UtA and PI-McA/UmA in the adverse group were lower than those in the positive group(P<0.05).3.UtA-PI?UmA-PI?McA-PI?PI-McA/UtA and PI-McA/UmA can predict the adverse outcomes of the fetus in preedampsia(AUC was 0.826?0.797?0.705?0.878 and 0.819 respectively),PI-McA/UtA tad the highest AUC and the second highest specifcity.But only the difference between PI-McA/UtA and McA-PI was statistically signifcant(P<0.05).4.Compared with the positive outcome group,the incidence of the absent or reverse diastolic flow in umbilical artery?Bilateral uterine artery notches increased in the adverse outcome group.the difference was statistically significant(P<0.05).Multivariate analysis showed that preeclampsia develops into severe degree?absent or reverse diastolic flow in umbilical artery and suspected fetal intrauterine growth restrction by ultrasonography are independent risk factors for adverse pregnancy outcome of fetus in preeclampsia patients.Conclusion:1.Compared with normal pregnancy,the resistance of UtA and UmA in preeclampsia patients is higher,the resistance of McA,PI-McA/UtA and PI-McA/UmA are lower,Hiere is a certain degree ofblood flow redistribution in the fetus.2.Compared with the positive outcome fetus of preeclampsia patients,the resistance of UtA and UmA in adverse outcome fetus is higher;The McA's resistance:PI-McA/UtA and PI-McA/UmA is lower,and the redistribution of fetal blood flow is more obvious.3.UtA?UmA?McA?PI-McA/UtA and PI-McA/UmA have a moderate predictive value for fetal adverse outcomes in preeclampsia.The accuracy of PI-McA/UtA in predicting adverse outcomes is significantly higher than that of McA.It has certain clinical value in predicting fetal outcome of preeclampsia and reducing perinatal mortality.4.Preeclampsia develops into severe degree?absent or reverse diastolic flow in umbilical artery and suspected fetal intrauterine growth restriction by ultrasonography are independent risk factors for adverse pregnancy outcome of fetus in preeclampsia patients.When the above abnormalities appear,the expectant manageement should be carefully considered.