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目的探讨胎儿动脉和静脉多普勒血流波形在晚孕重度子痫前期围产儿结局中的评估和预测价值。方法选取2015年3月-2016年3月该院重度子痫前期患者120例为研究对象,产前应用彩色多普勒超声检测胎儿脐动脉(UA)、大脑中动脉(MCA)、静脉导管(DV)的血流。随访和记录围产儿结局,按照其对应的动脉和静脉血流波形变化分为3组。第1组:MCA搏动指数(PI)>UA PI;第2组:MCA PI2S/D)。结果重度子痫前期围产儿出生孕周与围产儿结局密切相关,出生孕周越早越容易发生围产儿不良结局。第3组静脉血流波形异常,出生孕周、出生体质量和胎盘重量显著低于其他两组。围产儿死亡出现在第3组,其他不良结局发生率亦显著高于其他两组。UA舒张期血流缺失或反向13例,其中9例围产儿发生死亡,占69.2%;DV a波缺失或反向9例均发生围产儿死亡,占100%。结论胎儿动脉和静脉多普勒超声是一种评估和预测重度子痫前期围产儿结局的有效方法之一。胎龄和母体疾病严重程度是迫切分娩时考虑的重要因素。UA舒张期血流缺失或反向和静脉血流波形异常均为晚期血流波形变化,易产生围产儿不良结局,如胎儿已初步具备母体外生存能力应积极终止妊娠,以免进一步恶化,出现围产儿死亡。
Objective To evaluate the value of fetal and venous Doppler waveforms in the prognosis of perinatal infants with severe preeclampsia in the second trimester of pregnancy. Methods A total of 120 patients with severe preeclampsia from March 2015 to March 2016 were selected as study objects. Prenatal application of color Doppler ultrasonography to detect fetal umbilical artery (UA), middle cerebral artery (MCA), intravenous catheter DV) blood flow. Follow-up and record of perinatal outcome, according to their corresponding changes in arterial and venous blood flow waveform is divided into 3 groups. Group 1: MCA pulsatility index (PI)> UA PI; Group 2: MCA PI 2S / D). Results Severe preeclampsia perinatal gestational age and perinatal outcomes are closely related to the sooner the gestational age more prone to perinatal adverse outcomes. Group 3 venous flow waveform abnormalities, birth gestational age, birth weight and placental weight were significantly lower than the other two groups. Perinatal deaths occurred in Group 3, with other adverse outcomes also significantly higher than the other two groups. UA diastolic blood flow was missing or reversed in 13 cases, of which 9 cases of perinatal death occurred, accounting for 69.2%; DVa wave missing or reverse occurred in 9 cases of perinatal death occurred, accounting for 100%. Conclusion Fetal artery and venous Doppler ultrasound is one of the effective methods to evaluate and predict perinatal outcome in severe preeclampsia. The gestational age and the severity of the maternal disease are important factors to consider when giving birth. UA diastolic blood loss or reverse and venous blood flow wave abnormalities are advanced blood flow waveform changes, easy to produce adverse outcomes of perinatal children, such as the fetus has the initial extra-terminal viability should be actively terminated pregnancy, so as not to further deteriorate, Wai Infants died.