妊娠30周超声预测巨大儿风险的研究

Research on ultrasound prognosis of the risks of macrosomia at the 30th week of gestation

目的:探讨妊娠30周时胎儿超声双顶径、头围、腹围、股骨长4项检测值在预测巨大儿发生可能的临床价值。方法:将2013年6月至11月间出生的703例足月新生儿按出生时实际体重分为巨大儿和非巨大儿两组,回顾性比较两组胎儿在妊娠30周时B超检测的双顶径、头围、腹围和股骨长,分析正常胎儿与巨大儿各径线之间差异性。结果:妊娠30周时,胎儿头围、腹围和股骨长在巨大儿发生的相关性有统计学意义(P<0.05),双顶径在预测巨大儿发生中意义不大(P>0.05);ROC曲线妊娠30周时胎儿头围、腹围和股骨长的临界值分别为282.50、268.50和57.50 mm,该值预测巨大儿的灵敏度分别为69.8%、52.8%和60.4%,特异度分别为60.4%、85.8%和65.1%。结论:妊娠30周时超声测量胎儿头围、腹围和股骨长是预测巨大儿的重要指标,当腹围大于268.50 mm和(或)头围大于282.50 mm和(或)股骨长大于57.50 mm对预测巨大儿有一定的临床价值。

Objective： To investigate the clinical values of fetal ultrasound biparietal diameter（ BPD）,head circumference（ HC）, abdominal circumference（ AC）, femur length（ FL） in predicting the occurrence of macrosomia at the 30 th week of gestation. Methods： 703 cases of full-term newborns delivered between June and November in 2013 were divided into huge newborn group and non-huge newborn group according to the actual birth weight. Fetal ultrasound BPD,HC,AC and FL at the 30 th week of gestation were compared retrospectively,and the differences of various diameters were analyzed. Results： Significant differences about fetal HC,AC and FL were found in diagnosis of macrosomia at the 30 th week of gestation（ P〈0. 05）,and did not make sense about BPD in predicting the occurrence of macrosomia（ P〉0. 05）. ROC curve showed that fetal HC,AC and FL were282. 50,268. 50,and 57. 50 mm,sensitivities were 69. 8%,52. 8% and 60. 4% in predicting macrosomia,and specificities were 60. 4%,85. 8% and 65. 1%,respectively. Conclusion： Fetal AC,HC and FL are important indicators to predict macrosomia at the 30 th week of gestation,and there are clinical values when AC is over268. 50 mm and（ or） HC is over 282. 50 mm and（ or） FL is over 57. 50 mm.