改良的生物物理相评分预测围生儿结局的应用

Application of modified biophysical score in predicting perinatal outcome

目的研究改良的生物物理相评分与围生儿结局的关系,寻求能准确评估胎儿的健康状况,以降低围生儿的不良结局发生的产前监护方法。方法对我院2001—2004年含高危妊娠因素的1 671例孕妇行改良的生物物理相评分(MBPS),即无负荷试验(NST)联合B超测定羊水指数(AFI)。结果因胎儿宫内窘迫行剖宫产术,羊水污染,Apgar评分≤7分,小于孕龄儿和围生儿病死率,MBPS异常的孕妇围生儿发生率分别为11.30%,24.82%,8.84%,6.14%和1.47%,而评分正常孕妇的上述围生儿不良结局的发生率分别为4.43%,7.67%,2.69%,2.85%和0.32%。NST,AFI和MBPS对围生儿不良结局预测评价的敏感度、特异度、阳性预测值、阴性预测值分别为NST 35.29%,90.48%,50.20%,83.73%;AFI 24.93%,92.85%,48.63%,81.99%;MBPS 55.00%,85.29%,54.05%,85.76%。结论MBPS是易于操作,无创伤,且可以广泛开展的方法,能降低围生儿不良结局预测的假阴性率的发生,在妊娠晚期可以作为常规的筛查方法。

Objective It is to study the relationship between modified biophysical score and perinatal outcome, and to explore an antepartum monitoring method with which fetal health can be exactly evaluated to debase adverse perinatal outcome. Methods 1671 pregnant women with high risk pregnancy factor were received modified biophysical estimation （MBPS） namely nonstress test （NST） combined with aminotic fluid index （AFI） measured by B ultrasound during 2001 to 2004. Results The incidence of adopting caesarean section for fetal distress in uterus, amniofic fluid contamination, Apgar score ≤7, less than gestational age infants and perinatal death in abnormal MBPS gravida were 11.30%, 24.82%, 8.84%, 6.14% and 1.47 % respectively, and that in normal MBPS gravida were 4.43 %, 7.67 %, 2.69 %, 2.85 % and 0.32 % respectively. The sensitivity, specificity, positive predictive value and negative predictive value of NST, AFI and MBPS predicting adverse perinatal outcome were 35.29 % , 90.48, 50.20 % and 83.73 % for NST, 24.93 % , 92.85 % , 48.63 % , 81.99 % for AFI and 55.00 %, 85.29 %, 54.05 %, 85.76 % for MBPS respectively. Conclusion The MBPS is an easily operated, non wounded and widely used method. It can decrease false negative rate in predicting adverse perinatal outcome and can be used for routine screening method in late pregnancy.