Evaluation Of Placental Perfusion In Patients With ICP By Three-Dimensional Power Doppler Ultrasonography

Objective:To evaluate the value of three-dimensional power Doppler ultrasound and its quantitative parameters in monitoring placental blood perfusion in patients with intrahepatic cholestasis during pregnancy(ICP),and to explore whether 3D-PDU can be used as an important ultrasound monitoring method for the management of pregnant women and fetuses with ICP.Method:Late pregnancy(28-40 weeks)ICP patients who underwent prenatal examination and delivered in the obstetrics Department of Nanchong Central Hospital from November 2020 to July 2021 were included in the ICP group,including 42 patients who met the screening criteria,and 55 normal late pregnancy women were randomly selected as the control group.All patients were examined by GE Voluson E10 via abdominal volume probe with a frequency of 4～8 MHz.General ultrasound examination was performed on the fetus first,and fetal UA and MCA blood flow doppler were collected.The ratio of peak systolic flow rate(S)to end diastolic flow rate(D),pulsing index(PI),resistance index(RI)and fetal heart rate of UA and MCA were measured by automatic wrapping.Recycling volume probe to scan of the placenta,umbilical cord placenta entrance section for imaging the initial section,successively launched energy doppler sampling box and three-dimensional volume sampling frame,through VOCALTM technology for 15° rotation multiple plane for the imaging of the placenta,calculate the volume of the placenta,VI,FI and VFI in value,repeated measurement three times,Calculate the average,and finally analyze the date.First,the sensitivity and specificity of VI,FI and VFI values in the diagnosis of ICP were calculated,and the clinical diagnostic value of 3D-PDU in the diagnosis of ICP was comprehensively discussed.Secondly,the diagnostic value of placental volume,fetal heart rate,umbilical artery and middle cerebral artery values in the diagnosis of ICP was calculated,and compared with the placental blood perfusion index.SPSS 25.0 statistical software was used for statistical analysis of the above data.The measurement data were expressed as mean± standard deviation and M(P25,P75),T-test or Mann-Whitney signed rank sum test was used for comparison between the two groups,and the sensitivity and specificity of vascular index were detected by ROC curve.0.05 test level was used,P<0.05 was considered statistically significant.Result:(1)Comparison of general data between ICP group and normal control group:there were no statistically significant differences in age,gestational age and fetal heart rate between the two groups(P>0.05).(2)Comparison of serological results between ICP group and normal control group:the levels of TBA,ALT and AST in ICP group were significantly higher than those in normal control group,and the differences were statistically significant(P<0.05).(3)Comparison of three-dimensional energy Doppler blood flow parameters of placenta in ICP group and normal control group:VI,FI and VFI in ICP group were significantly lower than those in normal control group,and the differences were statistically significant(P<0.05),while there was no significant difference in placenta volume between the two groups(P>0.05).(4)ROC curve was drawn by VI,FI and VFI values,and the area under THE ICP curve was 0.725,the sensitivity was 75.7%,the specificity was 70.4%,and the cut-off value was 10.625.The area under the ICP curve for FI diagnosis was 0.783,the sensitivity was 70.3%,the specificity was 74.1%,and the cut-off value was 37.444.The area under the ICP curve for VFI diagnosis was 0.784,the sensitivity was 73.0%,the specificity was 70.4%,and the cut-off value was 4.665.(5)Comparison of fetal UA and MCA doppler blood flow parameters between ICP group and normal control group:there were no statistically significant differences in the S/D,PI and RI values of UA between the two groups(P>0.05);There was no significant difference in the S/D,PI and RI values of fetal MCA between the two groups(P>0.05).Conclusion:The placental blood perfusion index VI,FI and VFI measured by 3D-PDU have good sensitivity and specificity for the diagnosis of ICP.Compared with fetal umbilical artery and middle cerebral artery blood flow parameters,3D energy Doppler ultrasound can detect abnormal placental blood perfusion in ICP patients more timely.It provides an important auxiliary examination index of clinical value for predicting fetal distress in intrahepatic cholestasis during pregnancy.