大脑中动脉血流变化对估计脐带绕颈胎儿预后的价值

目的探讨大脑中动脉血流变化对估计脐带绕颈胎儿预后的价值。方法选取2006年1月~2006年9月足月妊娠妇女51例。其中观察组39例,均为脐带绕颈一周并经阴道分娩。结合胎儿预后将观察组分为胎窘组(15例)和正常组(24例)。对照组12例,为随机选择的同期正常妊娠并顺产的妇女。应用彩色多普勒超声技术对全部孕妇于临产前和活跃早期检测胎儿大脑中动脉阻力指标-收缩期峰值流速/舒张末期流速(S/D)、阻力指数(RI)和搏动指数(PI)。结果(1)临产前,胎窘组胎儿大脑中动脉血流S/D、RI、PI值较对照组和正常组皆显著升高(P<0.05);而对照组和正常组比较,差异不显著(P>0.05)。(2)活跃早期胎窘组胎儿大脑中动脉血流S/D、RI、PI值较对照组和正常组皆显著降低(P<0.05);而对照组和正常组比较,差异不显著(P>0.05)。结论大脑中动脉血流阻力指标的变化与脐带绕颈胎儿不良预后密切相关;临产前监测脐绕颈胎儿MCA血流阻力指标的变化可以作为早期评估胎儿预后的理想方法。

The blood flow changes of middle cerebral artery in predicting perinatal outcome of fetus with nuchalcord

Objective:To investigate the value of the blood flow changes of middle cerebral artery(MCA) in predicting adverse outcome of fetuses with nuchalcord.Methods:From January 2006 to September 2006,51 women who delivered at term were studied.39 of them who were complicated with nuchalcord and had vaginal deliveries were devided into two groups according to fetal outcome.Group 1 included 15 cases with fetal distress.Group 2 included 24 cases with favorable fetal outcome.A control group included 12 women who were health pregnant women without nuchal coiling of the umbilical cord and had normal vaginal deliveries.Before labour and during early-active labour,blood flow impedance of fetal middle cerebral artery MCA was assessed by means of color Doppler ultrasonography and measured by the peak-systolic/diastolic ratio(S/D),pulse index(PI)and resistance index(RI).Results:(1)Before labour,the S/D,RI,PI values of fetal MCA in group 1 were significantly higher than those in group 2 and control group,however,there was no significant difference in these parameters between group 2 and control group.(2) In active labour,the S/D,RI,PI values of fetal MCA in fetus with were significantly lower than those in group 2 and control group,however,there was no significant difference in these parameters between group 2 and control group.Conclusions:This study showed the blood flow changes of fetal MCA are closely associated with adverse fetal outcomes.Examination of fetal blood flow in MCA is a valuable method in predicting adverse perinatal outcome of fetal with nuchalcord.