Ultrasound microvascular flow imaging: evaluating fetal mesenteric blood flow and predicting postnatal surgery in meconium peritonitis.

IF 1.7 4区 医学 Q3 OBSTETRICS & GYNECOLOGY Journal of Maternal-Fetal & Neonatal Medicine Pub Date : 2024-12-01 Epub Date: 2024-09-29 DOI:10.1080/14767058.2024.2408587
Xuelei Li, Meng Zhou, Shanshan Wang, Chaoxue Zhang
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Abstract

Objective: This study explored the characteristics of fetal mesenteric blood flow perfusion across various gestational weeks and evaluated the efficacy of Microvascular Flow (MV-Flow) imaging technology in assessing intestinal wall blood flow in fetuses with meconium peritonitis (MP).

Method: In this retrospective study, we analyzed 35 fetuses with MP and 160 healthy fetuses. We examined the correlation between the Vascular Index (VI) of mesenteric perfusion and gestational age, conducted an analysis comparing MP operative and non-operative groups, and developed a predictive model for surgical intervention.

Results: The VI value demonstrated no significant change with increasing gestational age (correlation coefficient = 0.005, p = 0.946). For healthy fetuses, VI ranged approximately from 34.66% to 67.26% using the automatic ellipse method. The MP operative group exhibited significantly more cesarean deliveries (100% vs. 52.9%, p = 0.003), shorter gestational periods (34.76 ± 2.16 weeks vs. 37.48 ± 1.55 weeks, p < 0.001), lower birth weights (2762.14 ± 452.76 g vs. 3225.88 ± 339.98 g, p = 0.003), more persistent ascites (92.9% vs. 52.9%, p = 0.021), more frequent intestinal wall echo reductions (57.1% vs. 5.9%, p = 0.004), and lower VI (18.57 ± 5.51% vs. 39.41 ± 7.02%, p < 0.001). A predictive model was established: Logit (P)=8.86 - (0.37* VI) + (1.49* ascites), yielding an area under the curve of 0.857, with 78.6% sensitivity and 88.2% specificity. The VI value was significantly associated with the need for postnatal surgery (OR = 0.689, 95% confidence interval: 0.511 - 0.929, p = 0.015). A Receiver Operating Characteristic curve analysis for VI in predicting postnatal surgery showed an area under the curve of 0.971, with an optimal cutoff value of 35%, achieving 91% sensitivity and 94.4% specificity.

Conclusion: MV-Flow imaging effectively quantified fetal bowel wall blood flow perfusion. There was no significant change in VI across different gestational weeks. Significantly lower VI values in MP fetuses indicated an increased risk of intestinal wall necrosis and the potential need for postnatal surgical intervention.

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超声微血管血流成像:评估胎儿肠系膜血流并预测胎粪腹膜炎的产后手术。
研究目的本研究探讨了不同孕周胎儿肠系膜血流灌注的特点,并评估了微血管血流(MV-Flow)成像技术在评估胎儿蜕膜性腹膜炎(MP)肠壁血流中的功效:在这项回顾性研究中,我们分析了 35 名患有腹膜炎的胎儿和 160 名健康胎儿。我们研究了肠系膜血流灌注血管指数(VI)与胎龄之间的相关性,分析比较了MP手术组和非手术组,并建立了手术干预的预测模型:结果:随着胎龄的增加,VI 值没有明显变化(相关系数 = 0.005,P = 0.946)。对于健康胎儿,采用自动椭圆法计算的VI值约为34.66%至67.26%。MP手术组的剖宫产率明显更高(100% vs. 52.9%,P = 0.003),孕周更短(34.76 ± 2.16周 vs. 37.48 ± 1.55周,P = 0.003)、腹水持续时间更长(92.9% vs. 52.9%,P = 0.021)、肠壁回声减弱更频繁(57.1% vs. 5.9%,P = 0.004)、VI 更低(18.57 ± 5.51% vs. 39.41 ± 7.02%,P = 0.015)。VI预测产后手术的接收者操作特征曲线分析显示,曲线下面积为0.971,最佳临界值为35%,敏感性为91%,特异性为94.4%:结论:MV-血流成像可有效量化胎儿肠壁血流灌注。不同孕周的VI无明显变化。MP胎儿的VI值显著降低,表明肠壁坏死的风险增加,可能需要产后手术干预。
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来源期刊
CiteScore
4.40
自引率
0.00%
发文量
217
审稿时长
2-3 weeks
期刊介绍: The official journal of The European Association of Perinatal Medicine, The Federation of Asia and Oceania Perinatal Societies and The International Society of Perinatal Obstetricians. The journal publishes a wide range of peer-reviewed research on the obstetric, medical, genetic, mental health and surgical complications of pregnancy and their effects on the mother, fetus and neonate. Research on audit, evaluation and clinical care in maternal-fetal and perinatal medicine is also featured.
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