彩色多普勒超声联合胎心监护及母体高危因素评估晚发型胎儿宫内生长受限孕妇妊娠结局的价值

The value of Doppler ultrasound combined with fetal heart rate monitoring and maternal high-risk factors in evaluating the pregnancy outcome of pregnant women with late-onset fetal intrauterine growth restriction

摘要:

目的 探讨彩色多普勒超声检测联合胎心监护及母体高危因素评估晚发型胎儿宫内生长受限（LO-FGR）孕妇妊娠结局的价值。方法 回顾性分析2021年7月—2025年3月南京医科大学附属淮安第一医院90例LO-FGR孕妇的临床资料。新生儿出生前进行彩色多普勒超声检测和胎心监护，根据新生儿妊娠结局分为妊娠良好组与不良妊娠结局组。比较两组基础资料。采用多因素一般Logistic回归模型分析LO-FGR孕妇妊娠结局的影响因素。绘制受试者工作特征（ROC）曲线分析静脉导管PI、胎心监护、子痫前期史、子宫动脉有舒张早期切迹预测LO-FGR孕妇不良妊娠结局的价值。结果 90例LO-FGR孕妇中，有54例发生不良妊娠结局，不良妊娠结局率为60.00%。不良妊娠结局组子痫前期史率、静脉导管搏动指数（PI）、子宫动脉舒张早期切迹率均高于妊娠良好组（P <0.05），不良妊娠结局组胎心监护反应型占比低于妊娠良好组（P <0.05）。多因素一般Logistic回归分析结果显示：静脉导管PI高［O^R =3.202（95% CI：1.582，6.479）］、有子痫前期史［O^R =7.740（95% CI：1.700，35.250）］、子宫动脉有舒张早期切迹［O^R =11.279（95% CI：2.477，51.349）］、胎心监护结果无反应型+可疑型［O^R =11.784（95% CI：2.546，54.536）］均为LO-FGR孕妇不良妊娠结局的危险因素（P <0.05）。ROC曲线结果显示，静脉导管PI、胎心监护、子痫前期史、子宫动脉有舒张早期切迹联合预测LO-FGR孕妇不良妊娠结局的曲线下面积为0.877（95% CI：0.802，0.951），敏感性为81.5%（95% CI：0.686，0.907）、特异性为91.7%（95% CI：0.775，0.982）。结论 彩色多普勒超声检测联合胎心监护及母体高危因素，能够准确地判断胎儿在宫内的生长发育情况及健康状况，及时发现潜在风险因素。

Abstract:

Objective To analyze the relationship between hemodynamic indicators detected by color Doppler ultrasound combined with fetal heart rate monitoring, maternal high-risk factors, and pregnancy outcomes in pregnant women with late-onset fetal intrauterine growth restriction (LO-FGR).Methods A total of 90 pregnant women with LO-FGR who were admitted to the Affiliated Huaian NO.1 People's Hospital of Nanjing Medical University from July 2021 to March 2025 were selected. Color Doppler ultrasound detection and fetal heart rate monitoring were performed before the birth of the newborns. According to the pregnancy outcomes of the newborns, they were divided into the good pregnancy group and the poor pregnancy outcome group. The basic data of the two groups were compared. To analyze the factors influencing the pregnancy outcome of pregnant women with LO-FGR and the value of receiver operating characteristic (ROC) curve analysis for the pregnancy outcome of pregnant women with LO-FGR.Results Among the 90 pregnant women with LO-FGR, 54 experienced adverse pregnancy outcomes, with an adverse pregnancy outcome rate of 60.00%. The poor pregnancy outcome group had significantly higher rates of preeclampsia history, higher ductus venosus pulsatility index (PI) levels, and higher rates of early diastolic notch in the uterine artery compared to the good pregnancy outcome group (P < 0.05), while the proportion of reactive fetal heart rate patterns was significantly lower (P < 0.05). Multivariate general Logistic regression analysis revealed that high ductus venosus PI level [O^R = 3.202 (95% CI: 1.582, 6.479)], history of preeclampsia [O^R = 7.740 (95% CI: 1.700, 35.250) ], and presence of early diastolic notch in the uterine artery [O^R=11.279 (95% CI: 2.477, 51.349) ], and non-reactive or suspicious fetal heart rate monitoring patterns [O^R=11.784 (95% CI: 2.546, 54.536) ] were all risk factors for adverse pregnancy outcomes in LO-FGR women (P < 0.05). The combined model incorporating ductus venosus PI, fetal heart rate monitoring, history of preeclampsia, and presence of early diastolic notch in the uterine artery showed relatively high predictive value for adverse pregnancy outcomes in LO-FGR women, with an area under the curve of 0.877 (95% CI: 0.802, 0.951). The sensitivity and specificity were 81.5% (95% CI: 0.686, 0.907) and 91.7% (95% CI: 0.775, 0.982), respectively.Conclusion Color Doppler ultrasound detection of hemodynamic indicators combined with fetal heart rate monitoring and maternal high-risk factors can accurately determine the growth, development and health status of the fetus in the uterus, and promptly identify potential risk factors.