Abstract
Objective To explore the correlation between parturients' uterine artery blood flow spectra in the first and second trimesters of pregnancy and fetal growth restriction (FGR). Methods The data of parturients treated in our hospital from February 2018 to February 2020 were retrospectively analyzed, 50 parturients with FGR were selected as the FGR group, and other 50 healthy cases were selected as the control group. In the first trimester (11-12 weeks of gestation) and the second trimester of pregnancy (13–24 weeks of gestation), the parturients of the two groups accepted the color Doppler ultrasonography (CDS), their hemodynamics indicators of uterine artery were recorded, and the correlation between their uterine artery blood flow spectra in the two periods and FGR was analyzed with the Receiver Operating Characteristic (ROC) curve. Results No statistical differences in the parturients' general information including age, gestational weeks, gravidity, and parity between the two groups were observed (P > 0.05); the newborn's body weight, Apgar scores, number of preterm infants, and the number of infants transferring to the neonatal intensive care unit (NICU) were significantly different between the two groups (P < 0.05); in the first and second trimesters of pregnancy, the uterine artery pulsatility index (UtA-PI), uterine artery resistance index (UtA-RI), maximal systolic flow velocity, and systolic/diastolic (UtA-S/D) ratio were significantly higher in the FGR group than in the control group (P < 0.05), and the time-averaged maximal velocity (TAMX) was significantly lower in the FGR group than in the control group (P < 0.001); in early pregnancy, the incidence of early diastolic notch at bilateral uterine arteries between the two groups was not significantly different (P > 0.05), and the unilateral and total incidence in the first trimester as well as the unilateral, bilateral, and total incidence in the second trimester were significantly higher in the FGR group than in the control group (P < 0.05); in the first trimester, the sensitivity of detecting FGR with a uterine artery blood flow spectrum was 0.820, AUC (95% CI) = 0.840 (0.757–0.923), and in the second trimester, it was 0.860, AUC (95% CI) = 0.900 (0.832–0.968). Conclusion There is a correlation between uterine artery blood flow spectra in the first and second trimesters of pregnancy and FGR, and the sensitivity of spectrum in the first trimester is higher than that in the second trimester, presenting a better clinical application value.
Highlights
Fetal growth restriction (FGR) is one of the most common complications in the perinatal stage, and its diagnostic criteria are the failures of a fetus to achieve its due growth potential at a gestational age below the 10th percentile of the mean for that fetus of the same sex, or below 2,500 g after 37 weeks of gestation [1, 2]
Based on the different pathogenic causes, FGR has been clinically classified into two categories, namely, FGR of definite etiology due to maternal primary disease and pregnancy comorbidities and FGR of unknown etiology, known as idiopathic FGR (IFGR), which accounts for about 40% of the total incidence of FGR [3,4,5]
The incidence rates of early diastolic notch of bilateral uterine arteries between the two groups were not significantly different (P > 0.05), and compared with the control group, the unilateral and total incidences in early pregnancy and unilateral, bilateral, and total incidences in the pregnant metaphase were significantly higher in the FGR group (P < 0.05), see Figure 3
Summary
Fetal growth restriction (FGR) is one of the most common complications in the perinatal stage, and its diagnostic criteria are the failures of a fetus to achieve its due growth potential at a gestational age below the 10th percentile of the mean for that fetus of the same sex, or below 2,500 g after 37 weeks of gestation [1, 2]. FGR with a clear pathogenic cause can be eased after systemic treatment, while the effect of treating IFGR with measures such as nutritional support is limited, so most clinical studies focus on the prediction of IFGR [6,7,8]. Compared with the MCA and FUA, the uterine artery blood flow spectrum can represent the hemodynamic relationship between the mother, uterus, and fetus more accurately, while the presence or absence of an early diastolic notch can reflect the vascular resistance of the uterine artery [13, 14], which is associated with or higher than other arteries for FGR. The association between uterine artery blood flow spectra in the first and second trimesters of pregnancy and FGR was explored with the results reported as follows
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