临产前预测巨大儿简易模型

A simple model to predict macrosomia

目的:分析临床及超声估计胎儿体重的参数及方法,建立临产前筛查巨大儿的简易模型。方法:比较分析106例巨大儿(研究组)与92例非巨大儿(对照组)的各项参数,用体重相关参数建立巨大儿预测评分模型,并分析该模型的临床价值。结果:(1)研究组胎儿的双顶径(BPD)、腹围(AC)、股骨长(FL),孕妇分娩前宫高、腹围,孕期体重指数(BMI)增加值均显著高于对照组(P<0.01);而两组的孕、产次及与胎儿体重相关的妊娠并发症无显著差异(P>0.05);(2)BPD、AC、FL,孕天数及孕妇的宫高、腹围、宫高+腹围、孕期BMI增加值均与巨大儿有相关性(P<0.01)。(3)模型评分预测巨大儿的ROC曲线下面积为0.94,最佳临界值≥4分,该临界值预测巨大儿的灵敏度为88.7%,特异度为83.7%,约登指数为0.72。结论:该巨大儿评分模型临产前预测巨大儿简易、有效。

Objective: To establish a simple model for screening macrosomia before labor,different parameters of clinical and ultrasonographic fetal weight estimation were analyzed. Methods: By comparing parameters of 106 cases of macrosomia( study group) and 92 cases of non macrosomia( control group),macrosomia prediction score model was established and its clinical value was determined. Results: Incremental growth of biparietal diameter( BPD),fetal abdomen circumference( AC),fetal femur length( FL),fundal height,AC of pregnant woman, body mass index( BMI) from study group were significantly higher than from control group( P <0.01). The maternal times and pregnancy complications associated with fetal weight between two groups were no significant statistical differences( P>0.05).Macrosomia was correlated to increments of BPD,AC,FL,gestational days,fundal height,AC of pregnant woman,fundal height plus pregnant woman's AC,BMI of pregnant woman( P<0.01).The area under receiver operator characteristic curve of the model to prediction macrosomia was 0. 94. The cut-off value of more than or equal to 4 was useful to predict macrosomic fetus.The sensitivity of the cut-off value of this model to predict macrosomia was 88.7%.The specificity was 83.7% and the Youden index was 0.72.Conclusion: Using this macrosomia prediction score model before labor to predict macrosomia is simple and effective.