多普勒超声评分体系在晚孕胎儿监护中的应用及意义

目的评价多普勒超声评分体系(DUPS)在晚孕胎儿监护中的应用价值。方法选择459例孕龄大于32周的孕妇行彩色多普勒超声检查,检测胎儿大脑中动脉搏动指数(MCAPI)、心脏大小、心功能、脐动脉搏动指数(UmAPI)、静脉导管搏动指数(DVPI)及脐静脉血流频谱(UV)。根据上述5项指标计算其DUPS评分,无异常时每项得2分,有异常时得1分或0分。将其评分结果与其围产期结局进行比较和分析。结果459例晚孕胎儿中有402例正常分娩(87.58%),48例因临床上需要而提早终止妊娠(10.46%),9例围产期死亡(1.96%)。正常分娩、提早终止妊娠、围产期死亡组间DUPS评分有显著性差异(P<0.001)。应用受试者工作特性曲线法确定预测围产期结局不良(包括提早终止妊娠和围产期死亡)DUPS评分的最佳诊断界点为8分(灵敏度78.95%,特异度95.52%),预测围产期死亡DUPS评分的最佳诊断界点为6分(灵敏度100.00%,特异度99.11%)。结论DUPS在预测晚孕胎儿的围产期结局不良中具有重要的临床价值,值得进一步研究与应用。

Doppler ultrasound profile score in the fetal surveillance during late pregnancy

Objective To assess the value of a Doppler ultrasound profile score in the fetal surveillance during late pregnancy.Methods In a retrospective study,459 fetuses with gestational age over 32 weeks were examined with ultrasonographic assessment of middle cerebral artery pulsatility index(MCAPI),heart size,cardiac function,umbilical artery pulsatility index(UmAPI),ductus venosus pulsatility index(DVPI) and the umbilical vein(UV).A Doppler ultrasound profile score(DUPS) was constructed by attributing 2 points for normal and taking away 1 or 2 points for abnormal findings in each category.The score of the final examination prior to treatment,delivery,or fetal demise was compared to the perinatal outcome in these 459 fetuses.Results Four hundred and two pregnancies were normal delivery(87.58%).Forty-eight of the remaining 57 fetuses were terminated the pregnancy early(10.46%) and perinatal death(PNM) occurred in 9 fetuses(1.96%).There were significant difference of DUPS in normal delivery,termination of pregnancy early and PNM(P<0.001).Receiver operating characteristic curve analysis indicted that the score less than or equal to 8 was the best critical point of DUPS for predicting an abnormal perinatal outcome including termination of pregnancy early and PNM(the senstivity and specificity were 78.95%,95.52% respectively) and the score less than or equal to 6 was the best critical point of DUPS for predicting PNM(the senstivity and specificity were 100.00%,99.11% respectively).Conclusion The DUPS can be used in the fetal surveillance during late pregnancy for prediction of abnormal perinatal outcome,and it should be further studied.