20周胎龄胎儿肠管内径超声检查结果对不良妊娠结局的预测价值研究

背景　胎儿肠管异常与多种不良妊娠结局相关，严重威胁新生儿的生命安全。目的　探究20周胎龄胎儿肠管内径超声检查结果对不良妊娠结局的预测价值。方法　选取2019-01-01至2020-05-03于石家庄市第四医院行多普勒超声产检的孕20周孕妇（单胎妊娠）150例，其中50例胎儿肠管内径扩张，100例胎儿肠管内径正常。采用彩色多普勒超声诊断仪检测胎儿肠管内径（直径）；不良妊娠结局包括羊水过多、染色体异常、引产、死胎、胎儿皮肤水肿、早产。观察20周胎龄胎儿肠管内径超声检查结果对孕妇不良妊娠结局预测价值，比较胎儿不同肠管内径扩张部位的孕妇不良妊娠结局发生率，分析胎儿肠管内径与新生儿Apgar评分的相关性。结果　150例孕妇中47例出现不良妊娠结局。20周胎龄胎儿肠管内径超声检查结果预测孕妇不良妊娠结局的灵敏度为93.6%，特异度为94.2%，阴性预测值为97.0%，阳性预测值为88.0%，诊断准确率为94.0%。50例肠管内径扩张胎儿中十二指肠肠管内径扩张23例、空回肠肠管内径扩张15例、结肠肠管内径扩张12例。胎儿十二指肠肠管内径扩张的孕妇羊水过多、引产、早产发生率高于胎儿空回肠和结肠肠管内径扩张的孕妇（P<0.05）。十二指肠、空回肠、结肠肠管内径与新生儿Apgar评分呈负相关（r值分别为-0.740、-0.721、-0.659，P<0.05）。结论　20周胎龄胎儿肠管内径超声检查结果对母体不良妊娠结局具有较好的预测价值，尤其对羊水过多、染色体异常、引产、死胎、早产的预测，且胎儿肠管内径与新生儿Apgar评分存在相关关系。

Predictive Value of 20-week Ultrasound Scan of Fetal Bowel Diameter for Adverse Pregnancy Outcome

Background　Fetal bowel abnormalities are associated with various adverse pregnancy outcomes，severely threatening the safety of newborns.Objective　To explore the predictive value of 20-week ultrasound scan of fetal bowel diameter for adverse pregnancy outcomes.Methods　150 women with a singleton pregnancy who underwent 20-week scan by Doppler ultrasound at the Fourth Hospital of Shijiazhuang from January 1，2019 to May 3，2020 were selected，by which 50 cases of fetal bowel dilatation and 100 cases of normal fetal bowel were found.Adverse pregnancy outcomes in this study were defined as polyhydramnios，chromosomal abnormalities，induced labor，stillbirth，fetal skin edema，and premature delivery.The value of this scan in predicting adverse pregnancy outcomes was estimated.The association of the location of fetal bowel diameter dilation and incidence of adverse pregnancy outcomes was examined.And the association of the fetal bowel diameter with the Apgar score was analyzed.Results　In total，47 women had adverse pregnancy outcomes.The 20-week scan demonstrated 93.6% sensitivity，94.2% specificity，97.0% negative predictive value，88.0% positive predictive value，and 94.0% diagnostic accuracy.The 50 cases of fetal bowel dilatation included 23 cases of duodenal dilatation，15 of jejunum and ileum dilatation，and 12 of colon dilatation.Women with fetal duodenal dilatation had higher incidence of polyhydramnios，induced labor，and premature delivery than those with fetal jejunum and ileum dilatation or fetal colon dilatation（P<0.05）.The inner diameter of the fetal duodenum，jejunum and ileum，and colon was negatively correlated with the Apgar score （r= -0.740，-0.721，-0.659，P<0.05）.Conclusion　The 20-week ultrasound scan of fetal bowel diameter may has good predictive value for adverse pregnancy outcomes，such as polyhydramnios，chromosomal abnormalities，induced labor，stillbirth，and premature delivery.Moreover，fetal bowel diameter may be associated with Apgar score.