| Objective:The purpose of this study is to observe the changes of fetal ductus venous(DV),umbilical vein(UV)and fetal liver length(FLL)via two-dimensional ultrasound and color Doppler ultrasound in third trimester of gestational diabetes mellitus(GDM),and to explore further the the predictive value of the ultrasound parameters in evaluating pregnancy outcomes of GDM fetus in the third trimester.Methods:Selected 51 pregnant women in the third trimester who were clearly diagnosed as GDM by 75 g OGTT and gave birth in Changzhou No.2 people Hospital from February 2019 to June 2020 as the case group.At the same time,59 pregnant women in the third trimester with normal prenatal examinations were selected as the normal group.The ultrasound parameters of fetal DV,UV and FLL,including DV inner diameter,peak ventricular systolic velocity(DV-S),peak diastolic velocity(DV-D),peak atrium systolic velocity(DV-A),pulsatility index(DV-PI),preload index(DV-PLI),DV blood flow,DV shunt rate,UV inner diameter,UV peak systolic flow rate(UV-S),UV blood flow and fetal liver length(FLL)were obtained by two-dimensional ultrasound and color Doppler ultrasonography.Recorded the pregnant women’s age,height,weight,gestational age and other clinical data.The pregnancy outcomes of all pregnant women were followed up.According to the different pregnancy outcomes,GDM was divided into 31 cases of normal pregnancy outcome group and 20 cases of adverse pregnancy outcome group.The differences in the age,height,weight,gestational week at the time of examination,and gestational week at delivery of pregnant women were compared between the normal group and the GDM group,and between the GDM normal pregnancy outcome group and the adverse pregnancy outcome group.Compared the differences in fetal DV,UV and FLL parameters between the normal group and the GDM group,and between the GDM normal pregnancy outcome group and the adverse pregnancy outcome group.A receiver operating characteristic(ROC)curve with statistically significant differences between the GDM normal pregnancy outcome group and the adverse pregnancy outcome group was made to analyze the diagnostic efficacy of ultrasound parameters in predicting adverse pregnancy outcomes of GDM fetus in the third trimester of pregnancy.Results:1.Compared the clinical data of pregnant women between the normal group and the GDM group,and between the GDM normal pregnancy outcome group and the adverse pregnancy outcome group,there were no statistically significant differences in age,height,weight,gestational week at the time of examination,and gestational week at delivery(P>0.05).2.Compared the DV parameters of the fetus in the normal group and the GDM group,the DV-S(43.82 ± 11.74cm/s)of the GDM group was lower than the DV-S(49.23±14.03cm/s)of the normal group(P=0.032),the DV-D(36.71±10.64cm/s)of the GDM group was lower than the DV-D(43.12 ±12.27cm/s)of the normal group(P=0.004),the DV-A(26.14±5.56cm/s)of the GDM group was lower than the DV-A(29.82 ± 10.33cm/s)of the normal group(P=0.020),the DV-PI(0.63 ± 0.24)of the GDM group was higher than the DV-PI(0.50±0.22)of the normal group(P=0.003),the DV-PLI(0.44±0.14))of the GDM group was higher than the DV-PLI(0.38±0.11)of the normal group(P=0.012),the DV shunt rate(0.43±0.25)of the GDM group was higher than the DV shunt rate(0.34 ± 0.18)of the normal group(P=0.044),the differences were statistical significant.The DV inner diameter(0.16±0.03cm)of the GDM group was higher than the DV inner diameter(0.15 ± 0.04cm)of the normal group(P=0.805),the DV blood flow(0.61±0.34ml/min)of the GDM group was lower than the DV blood flow(0.67 ± 0.39ml/min)of the normal group(P=0.460),the differences were not statistically significant.3.Compared the UV parameters of the fetus in the normal group and the GDM group,the UV-S(15.04±2.20cm/s)of the GDM group was lower than the UV-S(17.35±3.89cm/s)of the normal group(P<0.01),the UV blood flow(1.53±0.46ml/min)of the GDM group was lower than the UV blood flow(2.15±0.87ml/min)of the normal group(P<0.01),the differences were statistically significant.The UV inner diameter(0.53 ± 0.07cm)of the GDM group was lower than the UV inner diameter(0.55 ±0.09cm)of the normal group(P=0.100),and the differences were not statistically significant.Compared the FLL of the fetus in the normal group and the GDM group,the FLL(4.67±0.67cm)of the GDM group was longer than the FFL(4.40±0.56cm)of the normal group(P=0.024),the difference was statistically significant.4.All fetal pregnancy outcomes were followed up.There were 10 adverse pregnancy outcomes and 49 normal pregnancy outcomes in the normal group,and the incidence of adverse pregnancy outcomes was 16.9%(10/59).There were 20 adverse pregnancy outcomes and 31 normal pregnancy outcomes in the GDM group,and the incidence of adverse pregnancy outcomes was 39.2%(20/51).Compared the incidence of adverse fetal pregnancy outcomes between the two groups,the incidence of adverse fetal pregnancy outcomes in the GDM group was higher than that in the normal group(P=0.009),and the difference was statistically significant.5.Compared the fetal DV,UV and FLL parameters between the normal pregnancy outcome group and the adverse pregnancy outcome group in GDM,the DV-S(38.86±9.32cm/s)of the adverse pregnancy outcome group was lower than the DV-S(47.02±12.15cm/s)in the normal pregnancy outcome group(P=0.014),the difference was statistically significant.There were no statistically significant differences among the remaining parameters,including DV inner diameter,DV-D,DV-A,DV-PI,DV-PLI,DV blood flow,UV inner diameter,UV-S,UV blood flow,DV shunt rate and FFL(P >0.05).6.Toke DV-S of 46.24cm/s as the cutoff value,the area under the ROC curve for predicting adverse fetal pregnancy outcome in GDM was 0.693(P=0.021),95%confidence interval: 0.546～0.839,the sensitivity was 54.8% and the specificity was85.0%.Conclusions:1.The results of this study show that the DV,UV and FLL of the GDM fetus in the third trimester of pregnancy have changed.Mainly manifested as a decline in DV-S,DV-D,DV-A,UV-S and UV blood flow,an increase in DV shunt rate,DV-PI,DV-PLI,and FLL.The application of ultrasound to observe fetal DV,UV and FLL can provide reference for clinical monitoring of GDM fetal hemodynamic changes and growth to a certain extent.2.DV-S can be used as a predictor of adverse pregnancy outcomes in GDM fetuses in the third trimester of pregnancy,which provides a new method for clinical management of GDM fetuses to reduce the occurrence of adverse pregnancy outcomes. |
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