脐动脉血流检测在宫内发育迟缓中的应用价值

目的探讨检测脐动脉血流S/D和PI值对胎儿宫内发育迟缓的诊断价值。方法对86例胎儿应用多普勒超声行脐动脉血流检测,分别比较S/D和PI值正常组和异常组围产儿的预后。结果脐动脉血流S/D和PI值异常组中围产儿预后不良的发生率显著高于正常组,其中小于胎龄的发生率显著高于正常组(P<0.05)。结论脐动脉血流的S/D、PI值对胎儿宫内发育迟缓的诊断具有明显价值,对围产儿的预后预测有相当重要的临床价值。     

脐动脉血流动力学指数对预测小于胎龄儿预后的价值

目的探讨脐动脉血流动力学指数对于预测小于胎龄儿预后的价值.方法观察对象为49例孕37周以上的孕妇,用超声多普勒检测仪检测胎儿双顶径、腹围、头围、股骨长径估测体重,结合脐动脉血流动力学指数:S/D比值、PI、RI,按围产儿结局分为正常组和不良组进行对比性研究.结果 1.围产儿结局不良组脐动脉血流指数与正常组有显著差异;2.当S/D≥2.5时,围产儿结局不良比例与正常比有显著差异.结论 1.脐动脉血流动力学指标能反映胎儿-胎盘循环状况,胎盘退化程度和对胎儿的影响;2.当脐动脉血流指数S/D比值≥2.5时,要考虑胎儿宫内环境不良,应及早处理.     

子宫动脉血流检测在预测妊娠合并糖尿病围产儿结局中的价值

目的 探讨子宫动脉血流检测在预测妊娠合并糖尿病围产儿结局中的价值.方法 选择妊娠合并糖尿病孕妇58 例,随机选择同期分娩的正常孕妇60 例为对照组,进行子宫动脉血流指数S/D 值、阻力指数(RI),搏动指数(PI)的测定.比较两组数据,并随访围产儿结局.结果 在妊娠合并糖尿病组中S/D 值、PI、RI 分别高于对照组,但差异无统计学意义(均P ＞0.05).病例组低体重儿PI、RI 明显高于正常儿(P ＜0.05).巨大儿RI、PI 低于正常儿(P ＜0.05).病例组其他预后不良PI、RI 高于正常儿(P ＜0.05).结论 在妊娠合并糖尿病孕妇中进行子宫动脉血流监测,对围产儿结局的预测存在一定局限.     

双胎之一脐血流S/D值增高对两胎儿结局的影响研究

目的 研究了双胎之一脐血流收缩末期峰值(S)/舒张末期峰值(D)值增高对两胎儿结局的影响。方法回顾性选择2017年3月至2020年3月在西北妇女儿童医院行产检并确定分娩的双胎之一胎儿S/D值≥3的孕妇41例设为异常组,另选择同期双胎胎儿S/D值均3的孕妇45例纳入正常组。每组根据双胎情况分为两个亚组,即单绒毛膜双羊膜囊双胎(MCDA)组及双绒毛膜双羊膜囊双胎(DCDA)组。比较异常组与正常组脐血流搏动指数(PI)、阻力指数(RI)及大脑中动脉S/D值;比较两组及亚组间围产期并发症发生率,包括胎儿窘迫、发育不均衡、脐带绕颈、早产等;两组及亚组间围产儿预后,包括胎儿宫内生长受限(FGR)、Apgar评分、呼吸窘迫综合征、围产儿预后不良等。结果异常组脐血流PI、RI及大脑中动脉S/D值均较正常组低(1. 02±0. 22 vs. 1. 12±0. 24、0. 63±0. 13 vs. 0. 69±0. 15、4. 72±0. 81 vs. 5. 02±0. 83),差异有统计学意义(P 0. 05)。异常组胎儿窘迫、胎死宫内、发育不均衡、早产、脐带绕颈发生率明显高于正常组,在异常组及正常组内,MCDA组围产期并发症发生率均较DCDA组高,而MCDA及DCDA在异常组的围产期并发症发生率较在正常组高,差异均有统计学意义(P 0. 05);在两组分娩孕周比较中,异常组分娩孕周36周的占51. 22%,明显高于正常组(P 0. 05),而足月产率0%,明显低于正常组4. 4%(P 0. 05)。异常组FGR、Apgar评分及围产儿预后明显高于正常组;异常组中,MCDA组的FGR、新生儿缺血缺氧性脑病、Apgar评分、呼吸窘迫综合征、围产儿预后不良发生率均明显高于DCDA组;正常组中,MCDA组FGR、Apgar评分、呼吸窘迫综合征、围产儿预后不良发生率均明显高于DCDA组; MCDA组的围产儿预后不良发生率在异常组明显高于在正常组,差异有统计学意义(P 0. 05)。结论 脐血流检测简便、快捷、无创,是一种良好的产前监护手段,有助于对双胎妊娠的产前筛查以及管理,临床对双胎之一S/D值异常,特别是MCDA双胎的胎儿,应及时采取干预措施,以降低围产儿不良预后的发生风险。     

多普勒超声检测脐动脉血流的临床分析

目的 :探讨脐动脉血流频谱异常的相关因素及与围产儿结局的关系。方法 :应用多普勒超声检测 3 98例晚期妊娠妇女的胎儿脐动脉血流 ,对 112例脐动脉血流频谱异常 (S/D >3或脐动脉舒张末期血流缺失 )的母儿的临床资料进行分析 ,评估产生脐动脉血流频谱异常的相关因素 ,并比较脐动脉血流频谱异常组与正常组 (2 86例 )的围产儿结局。结果 :脐动脉血流频谱异常与妊高征、羊水过少、脐带异常、胎儿畸形、过期妊娠和胎盘异常有关 ;脐动脉血流频谱异常的孕妇胎儿宫内窘迫发生率 ,胎儿宫内发育迟缓发生率、新生儿窒息率及围产儿病死率增加。结论 :运用多普勒超声对胎儿脐动脉血流进行检测 ,可监测胎儿宫内情况 ,并对围产儿结局有预测价值。     

大脑中动脉及脐动脉血流检测在胎儿宫内发育迟缓预测中的意义

目的:应用彩色多普勒检测正常妊娠和胎儿宫内发育迟缓(IUGR)的脐动脉和大脑中动脉血流阻力指数PI、RI值及S/D值,探讨PI、RI及S/D值在IUGR预测中的价值.方法:应用彩色多普勒分别检测了52例正常妊娠(正常组)和IUGR患者(IUGR组)的脐动脉和大脑中动脉的血流,孕28～41周.结果:正常组和IUGR组的脐动脉和大脑中动脉血流指标均随妊娠周数的增高而降低,但IUGR组的脐动脉血流PI、RI、S/D值明显高于正常组(P<0.05).IUGR组MCA多普勒血流阻力指数RI及S/D明显小于正常组(P<0.05).孕30周后,脐动脉血流S/D值>4,提示胎儿预后不良.结论:脐动脉及大脑中动脉血流检测可为IUGR诊断提供一定的依据,对胎儿预后的估计有一定的临床价值.     

妊娠大于41周时脐动脉及子宫动脉血流动力学的研究

目的：探讨妊娠大于41周时监测脐动脉和子宫动脉血流动力学指数的临床意义。方法：观察对象为94例妊娠满41周至43周的孕妇，用超声多普勒检测仪分别检测其脐动脉和子宫动脉以获得血流动力学指数；S/D比值、PI、RI和FVR，按围产儿结局分为正常组和不良组进行对比性研究。结果：①围产儿结局不良组的脐动脉血流各项指数与正常组有显著差异，子宫动脉血流的S/D比值和RI有显著差异。②当S/D≥2.5时，围产儿结局不良比例与正常比值有显著差异。结论：①脐动脉和子宫动脉血流动力学指标能反映出胎儿-胎盘循环和胎盘-子宫循环的状况，胎盘退化的程度和对胎儿的影响。②当脐动脉血流指数S/D比值≥2.5时就要考虑胎儿内环境不良，应及早处理。     

子痫前期子宫螺旋动脉血流动力学改变

目的探讨子痫前期子宫螺旋动脉血流动力学改变。方法应用彩色多普勒超声对子痫前期孕妇26例,正常孕妇30例,在未经任何药物治疗前,检测子宫螺旋动脉血流动力学参数PI、RI、S/D值。结果①子宫螺旋动脉血流动力学参数子痫前期组较对照组PI值、RI值、S/D比值增高,且有显著统计学差异(P<0.001)。子痫前期重度组与轻度组比较各血流动力学参数值均增高,差异有显著性(P<0.01)。②子痫前期各组和对照组围产儿预后不良发生率比较,子痫前期重度组围产儿预后不良发生率高于轻度组和对照组,且差异有显著性(P<0.01)。结论彩色多普勒超声检测子宫螺旋动脉血流动力学变化有助于子痫前期严重程度的判定及胎儿预后的预测,具有临床实用价值。     

CDFI在预测妊娠期肝内胆汁淤积症围产儿预后中的临床价值

目的　评价彩色多普勒血流显像监测妊娠期肝内胆汁淤积症(ICP)胎儿多指标血流动力学变化在预测围产儿预后中的价值。方法　应用彩超检测42例ICP孕妇及3 0例正常孕妇的胎儿脐动脉、大脑中动脉、肾动脉血流阻力指标(S/D、PI、RI) ,并计算PIMCA/PIUA。结果　ICPⅡ组胎儿脐动脉、肾动脉阻力指标明显高于ICPⅠ组及正常组,大脑中动脉阻力指标明显低于ICPⅠ组及正常组(P <0 .0 1)。ICPⅠ组胎儿脐动脉阻力指标高于正常组(P <0 .0 5 )。以PIMCA/PIUA<2作为围产儿预后不良的预测指标,准确率为88.1%。结论　PIMCA/PIUA<2可作为围产儿预后不良的一个简便、敏感的预测指标,多指标血流参数测量能更加全面地反映胎儿宫内状况。彩色多普勒超声监测ICP胎儿血流变化对于评价胎儿宫内安危、预测围产儿预后、减少不良妊娠结局具有极其重要的临床价值。     

脐血流监测对妊娠期高血压疾病孕妇妊娠结局的意义探讨

目的探讨妊娠期高血压患者胎儿脐动脉血流阻力指标对围产儿结局的影响。方法用粘度仪检测正常妊娠孕妇及妊娠期高血压孕妇血浆粘度(PV);用离心机检测红细胞压积(HCT)等;统计分析其妊娠中期(20~27周)及妊娠晚期(28~36周),并测定收缩期最大血流速度和舒张期血流速度的比值(S/D)和脉搏指数(PI)、阻力指数(RI)。探讨血液流变学各值与胎儿脐动脉血流指标相关性。结果妊娠高血压组妊娠中、晚期S/D、PI及RI值与正常妊娠组比较均有统计学差异。随着病情进展,中度、重度妊娠高血压组RI、PI值逐渐升高。妊娠期高血压病患者血液HCT、PV等值与胎儿脐动脉血流阻力指标各值呈正相关。结论 HCT、PV对妊娠期高血压病的发生、发展、严重程度及脐动脉血流阻力指标可能有重要影响。多项指标监测妊娠期高血压病患者血液流变学及胎儿脐动脉血流动力学,可提高预测妊娠期高血压症发生、发展及严重程度及其对围产儿预后影响的准确性。     

超声检测妊娠期糖尿病孕妇胎儿肾动脉血流动力学的价值

目的 探讨超声检测胎儿肾动脉m流动力学指标在妊娠期糖尿痫（GDM）孕妇中的临床价值：、方法GDM孕妇83例,同期分娩正常孕妇80例为对照组,于妊娠晚期超声榆测胎儿肾动脉阻力指数、搏动指数及收缩期峰值流速和舒张未期流速的比值（S／D）,比较两组肾动脉血流动力学变化及妊娠结局。、结果GDM组胎儿肾动脉阻力指数、搏动指数及S／D均高于对照组（P〈0．05）,GDM组围产儿结局不良高于对照组（P〈0．05）;在GDM组中胎儿肾动脉阻力指数≥0．85,S／D≥6．5,其预测闱产儿结局不良的敏感性分别为72．2％、77．8％,特异性分刖为87．7％、84．6％,二者预测差异尤统计学意义（P〉0．05）．．结论趟声检测GDM孕妇的胎儿肾动脉血流动力学的指标,是了解围产儿预后的有效监护手段,而胎儿肾动脉阻力指数和S／D导常预测围产儿结局不良具有较高的敏感性和特异性。     

Instability of Doppler cerebral blood flow in monochorionic twins.

OBJECTIVE: The purpose of this study was to evaluate Doppler flow velocity changes in cerebral vessels of monochorionic twins with twin-twin transfusion syndrome (TTTS). METHODS: Repeated Doppler umbilical and cerebral blood flow studies were performed in 7 twin pairs with TTTS. Eight monochorionic twin pairs and 11 dichorionic twin pairs served as control groups. The following Doppler parameters were assessed: umbilical artery pulsatility index (PI), middle cerebral artery (MCA) PI, cerebroplacental ratio, delta PI between the umbilical artery and MCA, and peak systolic velocity (PSV) in the MCA. RESULTS: Significant variations in PSV in the MCA and cerebral indices were found in the study group of monochorionic twins with TTTS. Periods of high PSV with low PI in the MCA were followed by lower PSV in the same fetus. Repeated measurements in the comparison groups were stable without significant variations. The delta cerebroplacental ratio was significantly higher in the study group (0.38 versus 0.09 and 0.19 in the comparison groups; P < .02). CONCLUSIONS: Significant changes in Doppler flow velocity and indices suggest instability of cerebral blood flow with episodes of "hyperperfusion" in monochorionic twins with TTTS. Further studies are needed to elucidate the relationship of these transient changes to neurologic sequelae in the neonate.     

生长受限胎儿静脉导管、脐动脉彩色多普勒血流监测的临床价值

目的探讨彩色多普勒超声(CDFI)监测生长受限(FGR)胎儿静脉导管、脐动脉的血流参数的临床价值。方法 50例FGR组胎儿,80例正常胎儿为对照组,CDFI检测其静脉导管前负荷指数(PLI)、心室收缩期峰值流速/心房收缩谷流速(S/a)、脐动脉心室收缩峰值流速/心舒张末期流速(S/D)及搏动指数(PI)。结果与对照组比较,FGR组脐动脉S/D、PI、静脉导管S/a、PLI均增高(P0.05)。脐动脉S/D正常组与S/D异常组比较、静脉导管S/a正常组与S/D异常组比较,分娩时孕龄、出生时新生儿体质量、5 min Apart评分、剖宫产率及围生期死亡率差异均有统计学意义(P0.05)。采用静脉导管S/a和脐动脉S/D均异常较仅采用脐动脉S/D异常预测妊娠结局的误诊率低,诊断指数高。结论应用CDFI监测FGR胎儿静脉导管及脐动脉血流参数有重要的临床价值。     

Uterine and umbilical artery flow velocity waveform analysis in pregnancies complicated by chronic hypertension or preeclampsia

Using continuous wave Doppler ultrasound, we studied the umbilical and uterine flow velocity waveforms in 68 pregnant women who had chronic hypertension and/or preeclampsia. The systolic-diastolic (S/D) ratio was considered an expression of vascular resistance peripheral to the point of insonation. Abnormal umbilical artery S/D ratio (greater than 95th percentile) alone or with abnormal uterine artery S/D ratio was associated with poor pregnancy outcome as judged by incidence of intrauterine growth retardation (IUGR), cesarean section rate, birth weight, perinatal morbidity and mortality, and prematurity. In patients with preeclampsia and abnormal Doppler values, pregnancy outcome was poor, whereas in those with normal Doppler values, pregnancy outcome approached normal. The same relationship was also found in patients with chronic hypertension. The sensitivity and specificity for the prediction of IUGR by the umbilical artery S/D ratio alone was 71% and 93%, respectively. The uterine artery S/D ratio alone yielded a 66% sensitivity and 64% specificity, and when both tests were taken into account, the sensitivity increased to 75% and the specificity to 100%. Abnormal umbilical and uterine artery S/D ratios were associated with 100% IUGR and 25% perinatal mortality. We conclude that in pregnant women with hypertensive disorders there is a significant difference in pregnancy outcome between those with normal and those with abnormal Doppler values. Umbilical artery S/D ratio alone is a better predictor of IUGR and poor pregnancy outcome than the uterine artery S/D ratio.     

彩色多普勒超声检测子宫动脉及脐动脉在晚发型宫内生长受限中的价值

目的：彩色多普勒超声检测母体子宫动脉和胎儿脐动脉在晚发型宫内生长受限的血流动力学价值及预测不良围产儿结局。 方法：分析晚发型宫内生长受限的孕妇169例和58例同期分娩正常孕妇,于妊娠期产前超声多普勒分别检测子宫动脉和脐动脉的搏动指数(PI),比较各组动脉血流异常及妊娠结局不良发生率。 结果：晚发型FGR孕妇中胎儿宫内窘迫所致急诊剖宫产、早产、新生儿1min Apgar评分评分、转入NICU、子宫动脉血流异常及脐动脉血流异常例数发生率分别为48.5%、39.6%、31.4%、35.5%、31.4%和21.9%,均高于对照组(P <0.05);在晚发型宫内生长受限孕妇中妊娠结局不良发生率,D组(子宫动脉和脐动脉血流均异常)明显高于A组(子宫动脉和脐动脉血流均正常),而除了胎儿宫内窘迫所致急诊剖宫产外,B组(子宫动脉异常,脐动脉正常)妊娠结局不良发生率高于C组(子宫动脉正常,脐动脉异常)。 结论：超声多普勒检测检测晚发型胎儿生长受限孕妇的子宫动脉和脐动脉的血流动力学,是了解围产儿预后的有效监护手段,在晚发型胎儿生长受限孕妇中,子宫动脉和脐动脉均异常,提示妊娠合并症增加和围产儿结局不良。     

子宫动脉超声多普勒血流监测在妊娠期高血压疾病晚期中的应用

目的 探讨子宫动脉超声多普勒血流监测在妊娠期高血压疾病晚期中的应用价值.方法 超声检测68例妊娠期高血压疾病和47例正常妊娠孕妇(对照组)的子宫动脉血流动力学参数:收缩-舒张流速比(S/D)、阻力指数、搏动指数,比较两组子宫动脉各血流参数及妊娠结局的差异;同时将妊娠期高血压疾病阻力指数正常组与异常组的妊娠结局进行比较....     

Screening for pre-eclampsia and fetal growth restriction in twin pregnancies at 23 weeks of gestation by transvaginal uterine artery Doppler.

OBJECTIVE: To assess the value of transvaginal uterine artery Doppler at 23 weeks of gestation in predicting the development of adverse perinatal outcomes in twin pregnancies. PATIENTS AND METHODS: Women with twin pregnancies attending for routine ultrasound examination at 23 weeks in any one of seven hospitals underwent Doppler assessment of the uterine arteries. The right and left uterine arteries were identified using color flow mapping and velocity waveforms were obtained using pulsed Doppler. The mean pulsatility index (PI) of the two arteries was determined and the presence of uterine artery notching noted. Results were compared between monochorionic and dichorionic twins, and with our previously reported data from singleton pregnancies. Screening characteristics in the prediction of pre-eclampsia, fetal growth restriction (FGR), placental abruption, fetal death and early preterm delivery were calculated. RESULTS: Uterine artery Doppler at 22-24 weeks of gestation was performed in 360 twin pregnancies, including 324 dichorionic and 36 monochorionic diamniotic twins. Complete outcome data were available in 351 (97.5%). The mean uterine artery PI did not change significantly with gestation and there was no significant difference in mean PI between the dichorionic and monochorionic groups. However, the mean PI was significantly lower in twin pregnancies than in singletons. The pregnancy was complicated by pre-eclampsia in 6.0% of cases, FGR below the 5th centile of both twins in 8.8%, abruption in 0.9%, intrauterine fetal death in 1.7% and early preterm delivery at less than 32 completed weeks of gestation in 5.7% of cases. The respective sensitivities of uterine artery mean PI above the 95th centile for these complications were 33.3%, 9.7%, 66.6%, 33.3% and 18.6%. CONCLUSIONS: In twin pregnancies PI in the uterine arteries is lower than that in singleton pregnancies, but there is no significant difference between dichorionic and monochorionic twins. Doppler assessment of the uterine arteries at 23 weeks identifies a large proportion of twin pregnancies destined to develop adverse outcomes related to uteroplacental insufficiency.     

彩色多谱勒对IUGR脐动脉血流的检测

目的：应用彩色多谱勒检测正常妊娠和胎儿宫内发育迟缓（以简称ＩＵＧＲ）的脐动脉血流指标ＰＩ、ＲＩ、Ｓ／Ｄ值。材料和方法：应用彩色多谱勒检测了２００例正常妊娠和１１１例ＩＵＧＲ的脐动脉血流,孕周从２６－４１周。结果：正常妊娠组及ＩＵＧＲ组的脐动脉血流指标均随妊娠周数的增高而降低,但ＩＵＧＲ组的脐动脉血流ＰＩ、ＲＩ、Ｓ／Ｄ值明显高于正常妊娠组（Ｐ〈０．０１）。孕３０周后,脐动脉血流Ｓ／Ｄ值〉４,揭示胎儿预后不良。结论：脐动脉血流检测不仅是胎儿监护的一种方法,而且可作为诊断ＩＵＧＲ的一个指标及对估计胎儿预后有一定的临床价值。     

Umbilical Artery Doppler Indices in Small for Gestational Age Fetuses

Objective. The purpose of this study was to compare the screening efficiency of the umbilical artery systolic to diastolic ratio (S/D), pulsatility index (PI), and absent end-diastolic flow (AEDF) for adverse pregnancy outcomes and placental abnormalities in small for gestational age (SGA) fetuses. Methods. We conducted a retrospective cohort study of Doppler examinations of 161 nonanomalous SGA fetuses. The reliability of the S/D and PI were quantified by intraclass correlation coefficients. The association of the S/D, PI, and AEDF with adverse outcomes and placental abnormalities was compared by the χ² test. Results. There was a simple association of Doppler results with adverse outcomes, which was mitigated when controlled for gestational age. For all measures of adverse outcomes, the specificity of abnormal Doppler results exceeded the sensitivity, and the negative predictive value was greater than the positive predictive value. Comparing the S/D with the PI, there was no significant difference in the sensitivity; however, the specificity of the PI was at least 90% and exceeded that of the S/D for all outcomes. The intraclass correlation coefficients of the S/D and PI were similar, indicating no difference in reliability. Placental abnormalities were significantly more common in cases with abnormal Doppler values (positive predictive value, 94%) with no overlap in the types of placental lesions in most cases. Conclusions. As an initial screen for adverse outcomes in SGA fetuses, the umbilical artery Doppler S/D, PI, and AEDF were imprecise. However, these measures were all strongly and similarly predictive of placental abnormalities, especially lesions of maternal underperfusion and fetal vascular obstruction.     

Uterine and fetal cerebral Doppler predict the outcome of third-trimester small-for-gestational age fetuses with normal umbilical artery Doppler.

OBJECTIVE: To assess the value of different admission tests in predicting the outcome of small-for-gestational age (SGA) fetuses with normal Doppler waveforms in the umbilical artery. METHODS: Criteria for admission into this retrospective study included: singleton pregnancy with a birth weight < 10th centile; absence of severe maternal complications; no evidence of fetal anomalies on the sonogram; normal umbilical artery Doppler; and availability of complete follow-up. At the first antenatal sonogram classifying the fetus as SGA, Doppler analysis of the uterine and middle cerebral arteries was performed and amniotic fluid volume was assessed. Outcome variables included adverse perinatal outcome (perinatal death, severe morbidity) and emergency Cesarean section for fetal distress. RESULTS: Two hundred and thirty-one pregnancies were included in the study. The mean +/- standard deviation birth weight and gestational age at delivery were 2222 +/- 502 g and 37.3 +/- 2.9 weeks, respectively. In 37 cases (16%), an emergency Cesarean section was performed. There was one intrauterine death and three fetuses delivered by emergency Cesarean section developed severe morbidity. Logistic regression demonstrated that abnormal velocimetry of the uterine arteries and fetal middle cerebral artery were independently correlated with the occurrence of Cesarean section. CONCLUSIONS: SGA fetuses with normal umbilical artery Doppler waveforms and abnormal uterine arteries and fetal middle cerebral artery waveforms have an increased risk of developing distress and being delivered by emergency Cesarean section. Particularly when both uterine and fetal cerebral waveforms are altered at the same time, the risk is exceedingly high (86%) and delivery as soon as fetal maturity is achieved seems advisable. On the other hand, when both vessels have normal waveforms, the chances of fetal distress are small (4%) and expectant management is the most reasonable choice.