巨大兒產前超聲預測評估及分娩結局的臨床分析

The value of pre-delivery ultrasound measurements in estimation of macrosomia and delivery outcome

目的回顧性分析本院B超預測胎兒體重的準確性,提高B超診斷技術,降低剖宮產率,減少分娩不良事件發生。方法選取2016年1月~2017年4月本院分娩孕婦241例,其中巨大胎兒(體重大於等於4kg)52例(21.5%),選取同時間段分娩正常體重胎兒189例(78.5%),所有孕婦均於孕前1週測量胎兒雙頂徑、股骨長度、腹圍,計算估計體重及敏感性和特異性,進行相關性分析及回歸模型,比較分娩方式及母兒預後差異。結果巨大兒組剖宮產率、產後出血量大於對照組,有顯著差異。新生兒窒息發生率及鎖骨骨折發生率均為零。B超採用Hadlock系統預測胎兒體重敏感性為34.6%,特異性為94.2%。結論本院巨大兒產前B超診斷準確性有限使剖宮產率增加,建立結合多種測量值的預測標準,有助於提高超聲診斷水平,降低剖宮產率。

Objective To establish an estimation formula to improve the precision of diagnostic techniques and to reduce adverse events in labor,a retrospective analysis was made on the pre-delivery ultrasound measurements and the delivery outcome.Methods 241 pregnancies were selected,including 52macrosomia pregnancies with birth weight≥4kg(the experiment group)and 189 normal pregnancies with birth weight<4kg(the control group).The AC,BPD,FL measurements by ultrasound were performed 7days before delivery in both groups.The value of EFWs was calculated according to the Hadlock formula.After analyzing the sensibility,the specificity and the correlation rate,a predictive model formula was established to estimate the delivery mode,the delivery complication and the prognosis of the newborns.Results The cesarean rates and the bleeding amount were significantly higher in the experiment group than that in the control group.The occurrence rates of the neonatal asphyxia and clavicular fracture were not significantly different in the two groups.The sensitivity and specificity for macrosomia prediction were 34.6%and 94.2%respectively by the Hadlock formula.Conclusion The cesarean rate was increased in the experiment group.A formula based on multiple variables might be beneficial to improve the prediction accuracy of ultrasound measurements and to reduce the cesarean section rate.