脐动脉血流对预测子痫前期新生儿和产妇结局的价值分析
|
摘要
目的:探讨应用脐动脉血流用于预测子痫前期新生儿和产妇结局的临床价值。方法:选择在我院产科建档分娩的120例孕产妇作为研究对象,根据子痫前期发病情况分为子痫前期组60例与对照组60例,记录和比较两组孕产妇的一般资料、血脂、血糖水平、分娩前脐动脉血流与新生儿体重、胎盘的重量及Apgar评分,并进行相关性与危险因素分析。结果:两组孕产妇的年龄、孕次、产次、流产次数、孕周等对比差异均无统计学意义(P>0.05)。子痫前期组的血清HDL-C水平低于对照组(P<0.05),血清TC、TG、LDL-C、FBG水平高于对照组(P<0.05)。与对照组比较,子痫前期组脐动脉S/D、RI与PI值显著升高(P<0.05)。所有孕产妇都顺利完成分娩,孕产妇与新生儿都存活,子痫前期组的新生儿出生体重及Apgar评分和胎盘的重量均显著低于对照组(P<0.05)。在子痫前期组中,脐动脉S/D、RI、PI值与新生儿出生体重呈现显著负相关性(P<0.05)。多重线性回归分析显示子痫前期孕产妇的脐动脉S/D、RI、PI值为影响新生儿出生体重的独立危险因素(P<0.05)。结论:脐动脉血流与子痫前期新生儿出生体重显著相关,脐动脉S/D、RI、PI值为影响新生儿出生体重的独立危险因素,子痫前期脐动脉血流监测可为预测新生儿和产妇结局以及预后提供参考。
Objective: To investigate the clinical value of umbilical arterial blood flow for predicting the preeclampsia neonatal and maternal outcomes. Methods: 120 cases of pregnant women who gave birth in the obstetrics department of our hospital were selected and divided into 60 cases of the preeclampsia group and 60 cases of the control group according to the pre-eclampsia incidence. The general data, blood lipids and blood glucose level, umbilical arterial blood flow and neonatal birth weight and placental weight and Apgar score during the cesarean section were recorded and compared between two groups, and the correlative and risk factors analysis were performed. Results: There was no significant difference in the maternal age, pregnancy, birth, abortion, and gestational age between the two groups(P>0.05). The level of serum HDL-C in the preeclampsia group was lower than that in the control group(P<0.05), and the levels of serum TC, TG, LDL-C and FBG were higher than those in the non-eclamptic group(P<0.05). Compared with the control group, the umbilical artery S/D, RI and PI values were significantly increased in the preeclampsia group(P<0.05). All pregnant women successfully completed the delivery, both the maternal and the newborn survived. The birth weight and placental weight and Apgar score of the newborn in the preeclampsia group were significantly lower than those of the non-eclamptic group(P<0.05). In the preeclampsia group, the Pearson correlation coefficient showed significant negative correlation between the umbilical artery S/D, RI, and PI values and neonatal birth weight(P<0.05). Multiple linear regression analysis showed that the umbilical artery S/D, RI and PI values of preeclampsia were the independent risk factors for neonatal birth weight(P<0.05). Conclusion: Umbilical artery blood flow was closely related to the birth weight of preeclampsia. Umbilical artery S/D, RI and PI values are independent risk factors for neonatal birth weight. Preeclampsia umbilical artery blood flow monitoring can be used to provide references for predicting the prognosis of neonatal and maternal outcomes.
Objective: To investigate the clinical value of umbilical arterial blood flow for predicting the preeclampsia neonatal and maternal outcomes. Methods: 120 cases of pregnant women who gave birth in the obstetrics department of our hospital were selected and divided into 60 cases of the preeclampsia group and 60 cases of the control group according to the pre-eclampsia incidence. The general data, blood lipids and blood glucose level, umbilical arterial blood flow and neonatal birth weight and placental weight and Apgar score during the cesarean section were recorded and compared between two groups, and the correlative and risk factors analysis were performed. Results: There was no significant difference in the maternal age, pregnancy, birth, abortion, and gestational age between the two groups(P>0.05). The level of serum HDL-C in the preeclampsia group was lower than that in the control group(P<0.05), and the levels of serum TC, TG, LDL-C and FBG were higher than those in the non-eclamptic group(P<0.05). Compared with the control group, the umbilical artery S/D, RI and PI values were significantly increased in the preeclampsia group(P<0.05). All pregnant women successfully completed the delivery, both the maternal and the newborn survived. The birth weight and placental weight and Apgar score of the newborn in the preeclampsia group were significantly lower than those of the non-eclamptic group(P<0.05). In the preeclampsia group, the Pearson correlation coefficient showed significant negative correlation between the umbilical artery S/D, RI, and PI values and neonatal birth weight(P<0.05). Multiple linear regression analysis showed that the umbilical artery S/D, RI and PI values of preeclampsia were the independent risk factors for neonatal birth weight(P<0.05). Conclusion: Umbilical artery blood flow was closely related to the birth weight of preeclampsia. Umbilical artery S/D, RI and PI values are independent risk factors for neonatal birth weight. Preeclampsia umbilical artery blood flow monitoring can be used to provide references for predicting the prognosis of neonatal and maternal outcomes.
引文
[1]Zarean E,Shabaninia S.The Assessment of Association between Uterine Artery Pulsatility Index at 30-34 Week's Gestation and Adverse Perinatal Outcome[J].Adv Biomed Res,2018,20(7):111-137
[2]Fedorova OV,Ishkaraeva VV,Grigorova YN,et al.Antibody to Marinobufagenin Reverses Placenta-Induced Fibrosis of Umbilical Arteries in Preeclampsia[J].Int J Mol Sci,2018,19(8):E2377
[3]Yin G,Chen M,Li J,et al.Vascular corrosion casting of normal and pre-eclamptic placentas[J].Exp Ther Med,2017,14(6):5535-5539
[4]Salavati N,Gordijn SJ,Sovio U,et al.Birth weight to placenta weight ratio and its relationship to ultrasonic measurements,maternal and neonatal morbidity:A prospective cohort study of nulliparous women[J].Placenta,2018,3(63):45-52
[5]Hromadnikova I,Kotlabova K,Ivankova K,et al.Profiling of cardiovascular and cerebrovascular disease associated micro RNA expression in umbilical cord blood in gestational hypertension,preeclampsia and fetal growth restriction[J].Int J Cardiol,2017,15(249):402-409
[6]Wu J,Zhou W,Li Q,et al.Combined use of serum gamma glutamyl transferase level and ultrasonography improves prediction of perinatal outcomes associated with preeclamptic pregnancy[J].Clin Chim Acta,2017,12(475):97-101
[7]Zhao Y,Yang N,Li H,et al.Systemic Evaluation of Vascular Dysfunction by High-Resolution Sonography in an N(ω)-Nitro-l-Arginine Methyl Ester Hydrochloride-Induced Mouse Model of Preeclampsia-Like Symptoms[J].J Ultrasound Med,2018,37(3):657-666
[8]Higgins N,Fitzgerald PC,van Dyk D,et al.The Effect of Prophylactic Phenylephrine and Ephedrine Infusions on Umbilical Artery Blood p H in Women With Preeclampsia Undergoing Cesarean Delivery with Spinal Anesthesia:A Randomized,Double-Blind Trial[J].Anesth Analg,2018,126(6):1999-2006
[9]Dyer RA,Emmanuel A,Adams SC,et al.A randomised comparison of bolus phenylephrine and ephedrine for the management of spinal hypotension in patients with severe preeclampsia and fe tal compromise[J].Int JObstet Anesth,2018,2(33):23-31
[10]Delibas IB,Ingec M,Yapca OE.Does antenatal betamethasone have negative effects on fetal activities and hemodynamics in cases of preeclampsia without severe features?A prospective,placebo-controlled,randomized study[J].J Matern Fetal Neonatal Med,2017,30(22):2671-2678
[11]Stalzer A,Seybold D,Hossino D,et al.Doppler screening and predictors of adverse outcomes in high risk pregnancies affected by tobacco[J].Reprod Toxicol,2017,1(67):10-14
[12]Beukers F,Aarnoudse-Moens CSH,van Weissenbruch MM,et al.Fetal Growth Restriction with Brain Sparing:Neurocognitive and Behavioral Outcomes at 12 Years of Age[J].J Pediatr,2017,9(188):103-109
[13]Zhang D,Fu L,Wang L,et al.Therapeutic benefit of mesenchymal stem cells in pregnant rats with angiotensin receptor agonistic autoantibody-induced hypertension:Implications for immunomodulation andcytoprotection[J].Hypertens Pregnancy,2017,36(3):247-258
[14]Altorjay魣T,Surányi A,Nyári T,et al.Use of placental vascularization indices and uterine artery peak systolic velocity in early detection of pregnancies complicated by gestational diabetes,chronic or gestationalhypertension,and preeclampsia at risk[J].Croat Med J,2017,58(2):161-169
[15]Truong G,Guanzon D,Kinhal V,et al.Oxygen tension regulates the mi RNA profile and bioactivity of exosomes released from extravillous trophoblast cells-Liquid biopsies for monitoring complications of pregnancy[J].PLo S One,2017,12(3):e0174514
[16]Shen L,Diao Z,Sun HX,et al.Up-regulation of CD81 in hibits cytotrophoblast invasion and mediates maternal endothelial cell dysfunction in preeclampsia[J].Proc Natl Acad Sci U S A,2017,114(8):1940-1945
[17]Panaitescu AM,Wright D,Militello A,et al.Proposed clinical management of pregnancies after combined screening for pre-eclampsia at35-37 weeks'gestation[J].Ultrasound Obstet Gynecol,2017,50(3):383-387
[18]Martínez-Sánchez N,Pérez-Pinto S,Robles-Marhuendaá,et al.Obstetric and perinatal outcome in anti-Ro/SSA-positive pregnant women:a prospective cohort study[J].Immunol Res,2017,65(2):487-494
[19]Herzog EM,Eggink AJ,Reijnierse A,et al.Impact of early-and late-onset preeclampsia on features of placental and newborn vascular health[J].Placenta,2017,1(49):72-79
[20]Nystad M,Sitras V,Flo K,et al.Longitudinal reference ranges for maternal plasma laeverin,and its role as apotential biomarker of preeclampsia[J].BMC Pregnancy Childbirth,2016,16(1):377-384
[21]Paredes V,Espinoza-Caicedo JA,Salazar-Pousada D,et al.Lower placental growth factor and higher freeβ-h CG and PAPP-A levels in the fetal circulation of near-term pregnancies complicated with severe preeclampsia[J].Gynecol Endocrinol,2017,33(1):79-81
[22]Castelijn B,Hollander K,Hensbergen JF,et al.Peripartum fetal distress in diabetic women:a retrospective case-cohort study[J].BMCPregnancy Childbirth,2018,18(1):228-236
[23]Burton GJ,Jauniaux E.Development of the Human Placenta and Fetal Heart:Synergic or Independent?[J].Front Physiol,2018,12(9):373-383
[24]Mohta M,Duggal S,Chilkoti GT.Randomised double-blind comparison of bolus phenylephrine or ephedrine for treatment of hypotension in women with pre-eclampsia undergoing caesarean section[J]Anaesthesia,2018,73(7):839-846
[25]Vicente Bertagnolli T,Souza Rangel Machado M,et al.Safety of a physical therapy protocol for women withpreeclampsia:a randomized controlled feasibility trial[J].Hypertens Pregnancy,2018,37(2):59-67
[26]Collinot H,Marchiol C,Lagoutte I,et al.Preeclampsia induced by STOX1 overexpression in mice induces intrauterine growth restriction,abnormal ultrasonography and BOLD MRI signatures[J].J Hypertens,2018,36(6):1399-1406
[27]Güven D,Altunkaynak BZ,Altun G,et al.Histomorphomet ric changes in the placenta and umbilical cord during complica tions of pregnancy[J].Biotech Histochem,2018,93(3):198-210
[28]Mokhtar AM,Elsakka AI,Ali HM.Premedication with midazolam prior to cesarean delivery in preeclamptic parturients:A randomized controlled trial[J].Anesth Essays Res,2016,10(3):631-636
[29]Choudhary R,Desai K,Parekh H,et al.Sildenafil citrate for the management of fetal growth restriction and oligohydramnios[J].Int JWomens Health,2016,9(8):367-372
[30]Mc Laughlin K,Baczyk D,Potts A,et al.Low Molecular Weight Heparin Improves Endothelial Function in Pregnant Women at High Risk of Preeclampsia[J].Hypertension,2017,69(1):180-188
[31]Nielsen LH,Ovesen P,Hansen MR,et al.Changes in the renin-angiotensin-aldosterone system in response to dietary salt intake in normal and hypertensive pregnancy.A randomized trial[J].J Am Soc Hypertens,2016,10(11):881-890
[2]Fedorova OV,Ishkaraeva VV,Grigorova YN,et al.Antibody to Marinobufagenin Reverses Placenta-Induced Fibrosis of Umbilical Arteries in Preeclampsia[J].Int J Mol Sci,2018,19(8):E2377
[3]Yin G,Chen M,Li J,et al.Vascular corrosion casting of normal and pre-eclamptic placentas[J].Exp Ther Med,2017,14(6):5535-5539
[4]Salavati N,Gordijn SJ,Sovio U,et al.Birth weight to placenta weight ratio and its relationship to ultrasonic measurements,maternal and neonatal morbidity:A prospective cohort study of nulliparous women[J].Placenta,2018,3(63):45-52
[5]Hromadnikova I,Kotlabova K,Ivankova K,et al.Profiling of cardiovascular and cerebrovascular disease associated micro RNA expression in umbilical cord blood in gestational hypertension,preeclampsia and fetal growth restriction[J].Int J Cardiol,2017,15(249):402-409
[6]Wu J,Zhou W,Li Q,et al.Combined use of serum gamma glutamyl transferase level and ultrasonography improves prediction of perinatal outcomes associated with preeclamptic pregnancy[J].Clin Chim Acta,2017,12(475):97-101
[7]Zhao Y,Yang N,Li H,et al.Systemic Evaluation of Vascular Dysfunction by High-Resolution Sonography in an N(ω)-Nitro-l-Arginine Methyl Ester Hydrochloride-Induced Mouse Model of Preeclampsia-Like Symptoms[J].J Ultrasound Med,2018,37(3):657-666
[8]Higgins N,Fitzgerald PC,van Dyk D,et al.The Effect of Prophylactic Phenylephrine and Ephedrine Infusions on Umbilical Artery Blood p H in Women With Preeclampsia Undergoing Cesarean Delivery with Spinal Anesthesia:A Randomized,Double-Blind Trial[J].Anesth Analg,2018,126(6):1999-2006
[9]Dyer RA,Emmanuel A,Adams SC,et al.A randomised comparison of bolus phenylephrine and ephedrine for the management of spinal hypotension in patients with severe preeclampsia and fe tal compromise[J].Int JObstet Anesth,2018,2(33):23-31
[10]Delibas IB,Ingec M,Yapca OE.Does antenatal betamethasone have negative effects on fetal activities and hemodynamics in cases of preeclampsia without severe features?A prospective,placebo-controlled,randomized study[J].J Matern Fetal Neonatal Med,2017,30(22):2671-2678
[11]Stalzer A,Seybold D,Hossino D,et al.Doppler screening and predictors of adverse outcomes in high risk pregnancies affected by tobacco[J].Reprod Toxicol,2017,1(67):10-14
[12]Beukers F,Aarnoudse-Moens CSH,van Weissenbruch MM,et al.Fetal Growth Restriction with Brain Sparing:Neurocognitive and Behavioral Outcomes at 12 Years of Age[J].J Pediatr,2017,9(188):103-109
[13]Zhang D,Fu L,Wang L,et al.Therapeutic benefit of mesenchymal stem cells in pregnant rats with angiotensin receptor agonistic autoantibody-induced hypertension:Implications for immunomodulation andcytoprotection[J].Hypertens Pregnancy,2017,36(3):247-258
[14]Altorjay魣T,Surányi A,Nyári T,et al.Use of placental vascularization indices and uterine artery peak systolic velocity in early detection of pregnancies complicated by gestational diabetes,chronic or gestationalhypertension,and preeclampsia at risk[J].Croat Med J,2017,58(2):161-169
[15]Truong G,Guanzon D,Kinhal V,et al.Oxygen tension regulates the mi RNA profile and bioactivity of exosomes released from extravillous trophoblast cells-Liquid biopsies for monitoring complications of pregnancy[J].PLo S One,2017,12(3):e0174514
[16]Shen L,Diao Z,Sun HX,et al.Up-regulation of CD81 in hibits cytotrophoblast invasion and mediates maternal endothelial cell dysfunction in preeclampsia[J].Proc Natl Acad Sci U S A,2017,114(8):1940-1945
[17]Panaitescu AM,Wright D,Militello A,et al.Proposed clinical management of pregnancies after combined screening for pre-eclampsia at35-37 weeks'gestation[J].Ultrasound Obstet Gynecol,2017,50(3):383-387
[18]Martínez-Sánchez N,Pérez-Pinto S,Robles-Marhuendaá,et al.Obstetric and perinatal outcome in anti-Ro/SSA-positive pregnant women:a prospective cohort study[J].Immunol Res,2017,65(2):487-494
[19]Herzog EM,Eggink AJ,Reijnierse A,et al.Impact of early-and late-onset preeclampsia on features of placental and newborn vascular health[J].Placenta,2017,1(49):72-79
[20]Nystad M,Sitras V,Flo K,et al.Longitudinal reference ranges for maternal plasma laeverin,and its role as apotential biomarker of preeclampsia[J].BMC Pregnancy Childbirth,2016,16(1):377-384
[21]Paredes V,Espinoza-Caicedo JA,Salazar-Pousada D,et al.Lower placental growth factor and higher freeβ-h CG and PAPP-A levels in the fetal circulation of near-term pregnancies complicated with severe preeclampsia[J].Gynecol Endocrinol,2017,33(1):79-81
[22]Castelijn B,Hollander K,Hensbergen JF,et al.Peripartum fetal distress in diabetic women:a retrospective case-cohort study[J].BMCPregnancy Childbirth,2018,18(1):228-236
[23]Burton GJ,Jauniaux E.Development of the Human Placenta and Fetal Heart:Synergic or Independent?[J].Front Physiol,2018,12(9):373-383
[24]Mohta M,Duggal S,Chilkoti GT.Randomised double-blind comparison of bolus phenylephrine or ephedrine for treatment of hypotension in women with pre-eclampsia undergoing caesarean section[J]Anaesthesia,2018,73(7):839-846
[25]Vicente Bertagnolli T,Souza Rangel Machado M,et al.Safety of a physical therapy protocol for women withpreeclampsia:a randomized controlled feasibility trial[J].Hypertens Pregnancy,2018,37(2):59-67
[26]Collinot H,Marchiol C,Lagoutte I,et al.Preeclampsia induced by STOX1 overexpression in mice induces intrauterine growth restriction,abnormal ultrasonography and BOLD MRI signatures[J].J Hypertens,2018,36(6):1399-1406
[27]Güven D,Altunkaynak BZ,Altun G,et al.Histomorphomet ric changes in the placenta and umbilical cord during complica tions of pregnancy[J].Biotech Histochem,2018,93(3):198-210
[28]Mokhtar AM,Elsakka AI,Ali HM.Premedication with midazolam prior to cesarean delivery in preeclamptic parturients:A randomized controlled trial[J].Anesth Essays Res,2016,10(3):631-636
[29]Choudhary R,Desai K,Parekh H,et al.Sildenafil citrate for the management of fetal growth restriction and oligohydramnios[J].Int JWomens Health,2016,9(8):367-372
[30]Mc Laughlin K,Baczyk D,Potts A,et al.Low Molecular Weight Heparin Improves Endothelial Function in Pregnant Women at High Risk of Preeclampsia[J].Hypertension,2017,69(1):180-188
[31]Nielsen LH,Ovesen P,Hansen MR,et al.Changes in the renin-angiotensin-aldosterone system in response to dietary salt intake in normal and hypertensive pregnancy.A randomized trial[J].J Am Soc Hypertens,2016,10(11):881-890