孕晚期胎儿超声参数与不良妊娠结局的相关性及其预测价值

目的 探讨孕晚期不同胎儿超声参数与新生儿不良结局的相关性及其在早期预测新生儿不良结局中的应用价值。 方法 回顾性分析2017年1月—2018年5月接受常规产前超声检查并最终在杭州市妇产科医院分娩的孕妇300例，根据新生儿是否存在不良结局分为不良结局组和无不良结局组，分析超声检测指标在预测新生儿不良结局中的应用价值。 结果 不良结局组产妇妊娠期高血压病、妊娠期糖尿病、妊娠期合并亚临床甲减发生率高于无不良结局组(均P<0.05)；孕晚期不良结局组胎儿大脑中动脉S/D值、脐动脉S/D值均高于无不良结局组胎儿(均P<0.05)；不良结局组孕晚期胎儿甲状腺体积、胎儿体重、胎儿生物物理评分(BPS评分)与无不良结局组比较差异有统计学意义(均P<0.05)。多因素分析显示，妊娠期高血压病、胎儿甲状腺体积、脐动脉S/D值、大脑中动脉S/D值是导致新生儿不良结局的相关因素(均P<0.05)。大脑中动脉S/D值在预测新生儿不良结局方面敏感性为82.11%，特异度为41.83%；脐动脉S/D值在预测新生儿不良结局方面敏感性为74.44%，特异度为51.22%；甲状腺体积在预测新生儿不良结局方面敏感性为66.70%，特异度为46.35%。 结论 孕晚期胎儿血流参数及甲状腺参数中脐动脉S/D值>2.975及甲状腺体积>0.424可作为孕晚期预测新生儿不良结局的早期评价指标。 

Correlation between fetal ultrasound parameters and adverse pregnancy outcomes in late pregnancy and its predictive value

Objective To investigate the correlation between different fetal ultrasound parameters and neonatal adverse outcomes in the third trimester and its application value in predicting neonatal adverse outcomes. Methods A retrospective analysis of 300 pregnant women who underwent routine prenatal ultrasound examination and finally delivered in our hospital from January 2017 to May 2018 was divided into adverse outcome group and no adverse outcome group according to whether there were adverse outcomes in neonates. The value of ultrasound detection indicators in predicting neonatal adverse outcomes. Results The incidence of gestational hypertension, gestational diabetes, and gestational subclinical hypothyroidism was higher in the adverse outcome group than in the non-adverse outcome group (all P<0.05). The fetal middle cerebral artery and umbilical artery S/D values in the third trimester pregnancy group were higher than those without adverse outcomes (all P<0.05). The fetal thyroid volume and fetal physical and physical scores in the adverse outcome group were significantly different from those without adverse outcomes (all P<0.05);Multivariate analysis showed that hypertensive disorder of pregnancy, fetal thyroid volume, umbilical artery S/D value, and middle cerebral artery S/D values were the relevant factors leading to neonatal adverse outcomes (all P<0.05). The sensitivity was 82.11% and the specificity was 41.83%. The sensitivity of umbilical artery S/D was 74.44% and the specificity was 51.22% in predicting neonatal adverse outcome. The sensitivity of thyroid volume in predicting neonatal adverse outcome was 66.70%, specificity is 46.35%. Conclusion The umbilical artery S/D value>2.975 and thyroid volume>0.424 in the fetal blood flow parameters and thyroid parameters in the third trimester can be used as an early evaluation index for predicting neonatal adverse outcomes in the third trimester.