Ultrasound Combined With PAPP-A Study On Predicting Fetal Growth Restriction

Purpose:It discusses the clinical value to predict fetal growth restriction using doppler ultrasound combined with Pregnancy Associated Plasma Protein A(PAPP-A)to detect the related blood flow parameters of uterine artery during first trimester of pregnancy in order to make early detection,early diagnosis and clinical intervention for fetal growth.Method:In this study,a prospective study method is adopted,1479 pregnant women who conducted systematic antenatal care at Qingdao University Affiliated Hospital and Linyi Central Hospital from January 2017 to December 2019 are selected as subjects,whose names,heights,weights,gravidity and parity histories and pregnancy information are collected and recorded.Pregnancy outcomes,neonatal weights and other indicators of all subjects are also recorded.All subjects undergo ultrasound examination at 11-13 +6weeks of pregnancy to measure the pulsatility index(PI)and resistance index(RI)of the uterine artery in the early diastolic notch;Serum PAPP-A concentration is detected at 11 weeks and 13 weeks of pregnancy respectively,and the results of the two examinations are averaged and included in the record table.Periodic prenatal examination in the second and third trimester of pregnancy,at least one ultrasound examination is performed in four stages of pregnancy: 20-24 weeks,26-30 weeks,30-34 weeks,and 34-37 weeks.Fetal growth indicators(BPD,AC,HC,FL)are recorded to estimate fetal weight.NICHD Fetal Growth Curve(Asian)are compared to evaluate the fetal growth trend,or all subjects are divided into FGR group and control group according to the birth weight of newborns.The general clinical data and pregnancy outcomes of the above two groups are compared,and the uterine artery blood flow parameters(UTA-PI,UTA-RI,early diastolic notch)and serum PAPP-A concentration of the two groups in the first trimester of pregnancy are compared and analyzed.Results:1.Among the 1479 subjects,103 cases had FGR and 1376 cases in the control group.There is no statistical difference in the general condition between FGR group and control group(P>0.05),however,the incidence of pregnant women with hypertension during pregnancy in FGR group is higher than that in control group,the difference is statistically significant(P<0.05).The termination time of pregnancy in FGR group is earlier than that in control group,and the difference is statistically significant(P<0.05).2.The average values of UTA-PI and Ut A-RI in the first trimester of pregnancy in the FGR group are 1.92 ± 0.41 and 0.75 ± 0.11,respectively,and the proportion of uterine artery early diastolic notches is 66.0%;The average values of Ut A-PI and Ut A-RI in the control group are 1.78 ± 0.63 and 0.71 ± 0.14,respectively,and the proportion of uterine artery early diastolic notch is 45.2%.Compared with the control group,the above indicators in the FGR group are higher,and the difference is statistically significant(P<0.05).3.The concentration of PAPP-A in the FGR group is 0.86 ± 0.17 IU/L,which is significantly lower than that in the control group(1.29 ± 0.32 IU/L),and the difference is statistically significant(P<0.05).4.The AUC and sensitivity of UTA-PI alone for predicting FGR are 72.8% and74.6%,respectively;The AUC and sensitivity of Ut A-RI alone for predicting FGR are70.5% and 71.7%,respectively;The AUC and sensitivity of diastolic early notch alone for predicting FGR are 54.9% and 34.9%,respectively;The AUC and sensitivity of PAPP-A alone in predicting FGR are 64.7% and 54.2%,respectively The AUC and sensitivity of PAPP-A combined with Ut A-PI in predicting FGR are 79.3% and 81.6%,respectively,significantly higher than that of each parameters alone(P<0.05);In addition,the AUC and sensitivity of PAPP-A+ Ut A-PI + diastolic early cut for predicting FGR are81.4% and 82.1%,respectively,the predicting capacity is higher than PAPP-A combined with Ut A-PI,but the difference is not statistically significant(P>0.05)Conclusion:1.The incidence of pregnant women with hypertension during pregnancy in FGR group is higher than that in control group,And the termination time of pregnancy in FGR group is earlier than that in control group.2.Uterine artery-related blood flow parameters(Ut A-PI,Ut A-RI,early diastolic notch)detected by ultrasound Doppler examination have certain clinical value in predicting fetal growth restriction.In the first trimester of pregnancy,pregnancy associated plasma protein A(PAPP-A)also has certain clinical value in predicting fetal growth restriction.3.In the first trimester of pregnancy,multi index combined prediction of FGR has better clinic value than single index prediction,especially ultrasound Doppler detection of Ut A-PI combined detection of serum PAPP-A concentration is the most effective method to predict FGR,its AUC and sensitivity are higher than other indexes combined prediction.