超声估计巨大儿体重准确性的影响因素分析

Analysis of influencing factors on the accuracy of ultrasound estimation of macrosomia weight

目的探求影响超声估计巨大儿体重准确性的母体、胎儿及超声因素,为临床实践提供指导。方法回顾性分析2020年1月至2022年3月在南京医科大学第一附属医院建卡并分娩巨大儿的435例孕妇的临床资料。所有孕妇分娩前3天内(包括3天)均进行超声检查并使用Hadlock公式得到超声估计的胎儿体重(SEFW),与新生儿的实际出生体重(ABW)比较并计算绝对百分比误差(APE)作为评价SEFW准确性的指标。若APE大于10%,则视为超声估计的体重不准确。通过单因素分析及多因素Logistic回归分析评价不同因素对SEFW准确性的影响。结果435例巨大儿中,有63例(14.48%)的APE大于10%,其中50例(79.37%)的体重被低估,13例(20.63%)被高估。单因素分析显示超声估计体重不准确组中股骨长/股围(FL/AC)值及母亲患有糖尿病、分娩时胎龄<40周、AC<360mm、FL<75mm的比例均高于准确组,差异具有统计学意义(χ^(2)/t值分别为-2.645、6.661、4.179、70.615、4.346,P<0.05);多因素Logistic回归分析显示母亲患有糖尿病、分娩时胎龄<40周、AC<360mm是超声估计巨大儿体重不准确的独立危险因素,其OR值及95%CI分别为2.109(1.076~4.134)、2.022(1.097~3.728)、10.530(5.704~19.441),P<0.05。结论部分超声估计的胎儿体重会低估巨大儿的实际体重,考虑母亲是否患有糖尿病、胎龄及胎儿腹围能够提高估计巨大儿体重的准确性。

Objective To explore the maternal,fetal and ultrasound factors that affect the accuracy of ultrasound estimation of macrosomia weight,so as to provide guidance for clinical practice.Methods The clinical data of 435 pregnant women who booked and delivered macrosomia in our hospital from January 2020 to March 2022 were analyzed retrospectively.All pregnant women were examined by ultrasound within 3 days(including 3 days)before delivery,and the sonographic estimated fetal weight(SEFW)was obtained by Hadlock formula.Compared with the actual birth weight(ABW)of newborns,the absolute percentage error(APE)was calculated as the indicator to evaluate the accuracy of SEFW.If APE was greater than 10%,it is considered that the estimated weight is inaccurate.The effects of different factors on the accuracy of SEFW were evaluated by univariate analysis and multivariate Logistic regression analysis.Results Among 435 cases of macrosomia,63 cases(14.48%)had APE greater than 10%,of which 50 cases(79.37%)were underestimated and 13 cases(20.63%)were overestimated.Univariate analysis showed that the femur length/abdominal circumference(FL/AC)value and the proportion of mothers with diabetes,gestational age<40 weeks at delivery,AC<360 mm and FL<75 mm in the group with inaccurate ultrasound estimation of birth weight were higher than those in the accurate group,and the differences were statistically significant(χ^(2)/t=-2.645,6.661,4.179,70.615 and 4.346,respectively,P<0.05).Multivariate Logistic regression analysis showed that mother with diabetes,gestational age at delivery<40 weeks and AC<360 mm were independent risk factors for inaccurate estimation of macrosomia weight by ultrasound.The OR value and 95%CI were 2.109(1.076-4.134),2.022(1.097-3.728),10.530(5.704-19.441),P<0.05,respectively.Conclusion Part of SEFW will underestimate the weight of macrosomia,Considering whether mother has diabetes,gestational age and fetal abdominal circumference can improve the accuracy of estimating the weight of macrosomia.