To explore influences of fetal umbilical artery absent end-diastolic flow (AEDF) and/or decreased cerebral-placental ratio (CRP)<1 on pregnancy outcome and prognosis of survival children.

A total of 103 pregnant women who hospitalized in Women′s Hospital of Nanjing Medical University from January 2015 to December 2019, with fetal umbilical artery AEDF or CRP<1 and met inclusion and exclusion criteria of this study were selected as research subjects. According to clinical comprehensive evaluation results of pregnant women, they were divided into two groups: termination group (n=64) and continued pregnancy group (n=39). Data were collected concerning the age, height, weight of two groups of pregnant women, gestational age when fetal umbilical artery AEDF and/or CRP<1 occurred, pregnancy outcome of pregnant women and neonates, as well as early prognosis of surviving children. Using independent-samples t test or chi-square test, the above indicators were statistically compared. There were no statistically significant differences between two groups of pregnant women in terms of their age, height, weight and other general clinical data (P>0.05). The procedure followed in this study was approved by the Ethics Committee of the Women′s Hospital of Nanjing Medical University (Approval No.[2019]KY-046).

①The gestational age when fetal umbilical artery AEDF or CRP<1 occurred in pregnant women in termination group was (34.6±3.0) gestational weeks, which was significantly greater than (29.3±3.5) gestational weeks of continued pregnancy group, and the difference was statistically significant (t=8.286, P<0.001). ②There was no significant difference in gestational age of delivery between two groups (P>0.05). The neonatal birth weight in continued pregnancy group was (1 527.5±828.3) g, which was significantly lower than that of termination group (1 894.3± 696.5) g, and the difference was statistically significant (t=2.289, P=0.029). The incidence of neonatal asphyxia was 16.7% (5/30) in continued pregnancy group, which was significantly lower than 1.5% (1/65) in termination group, and the difference also was statistically significant (χ²=5.589, P=0.018). ③Among 39 pregnant women in continued pregnancy group, 9 cases (23.1%) had intrauterine fetal death, and the time of intrauterine fetal death was 4 to 33 days after the occurrence of fetal umbilical artery AEDF and/or CRP<1 (average 16.6 days). There was no intrauterine fetal death in pregnant women in termination group. Incidence of intrauterine fetal death of pregnant women in continued pregnancy group was significantly higher than that in termination group, and the difference was statistically significant (χ²=13.420, P<0.001). ④There were no statistically significant differences in incidence of malnutrition, autism spectrum disorder, motor development retardation, developmental delay, language disorders, visual disorders, and hearing disorders among surviving children in termination group and continued pregnancy group (P>0.05).

When fetal umbilical artery AEDF and/or CRP<1 occurs in pregnant women, it indicates that intrauterine hypoxia has been quite serious, and has even existed for a long time. Even if the pregnancy is terminated by emergency cesarean section, some children would still have symptoms of abnormal neuro-development. Expectant pregnancy treatment for such pregnant women will not only prolong the gestational age, but also may increase the incidence of intrauterine death and neonatal asphyxia. It is of particular importance to strengthen the antepartum fetal heart surveillance and adopt timely termination of pregnancy in treatment of expectant pregnancy.