在未经选择的低危人群中联合母体因素和子宫动脉多普勒测速法建立先兆子痫预测模型

Objective: The purpose of this study was to develop a predictive model for preeclampsia. Study design: This was a prospective screening study for preeclampsia using uterine artery Doppler ultrasound in unselected low-risk singleton pregnancies at community hospitals in the UK (n = 32,157). Logistic regression models were developed and their predictive ability assessed using the area under the receiver operator curve (AROC). Results: Six hundred twelve (2.0% ) women developed preeclampsia, and 144 (0.5% ) required early delivery (< 34 weeks). A model using both maternal and ultrasound factors had an AROC of 0.798, which was higher than ultrasound alone (0.729, P < .0001) or maternal factors alone (0.712, P < .0001). In early onset disease, the AROC of ultrasound alone (0.922) was not significantly improved by adding maternal predictors (0.945, P = .27). In contrast, late onset disease was better predicted by the combined model (AROC 0.798) than ultrasound alone (AROC 0.729, P < .0001) or maternal factors alone (AROC 0.712, P < .0001). Conclusion: The combination of uterine artery Doppler ultrasound and maternal factors provided the

妊娠4～6个月母体血清α-甲胎蛋白水平与随后婴儿猝死综合征发生风险的相关性研究

BACKGROUND:Unexplained stillbirth and the sudden infant death syndrome (SIDS)share some features.A raised maternal serum level of alpha-fetoprotein during the second trimester of pregnancy is a marker of placental dysfunction and a strong predictor o f the risk of unexplained stillbirth.It is unknown whether alpha -fetoprotein levels also predict the risk of SIDS.METHODS:We linked a prenatal -screening database for wo men in western Scot-land with databases of maternity,perinatal death,and birth and death certifications to assess t he association between second -trimester levels of maternal serum alpha -feto-protein and the subsequent risk of SI DS.RESULTS:A-mong 214,532women with singleton bi rths,there were114cases of SIDS(incidence,2.7per 10,000births a-mong women with alpha -fetoprotein l evels in the lowest quintile and 7.5per 10,000births am ong those with levels in the highest quintile).When the lowest quintile was used as a referent,the unadjusted odds ra tios for SIDS for the second through fifth quintiles were1.7(95percent confi-dence interval,0.8to 3.5),1.8(95percent confidence interval,0.9to 3.7),2.5(95percent confidence inter-val,1.3to 4.8),and 2.8(95percent confidence inter-val,1.4to 5.4),respectively(P for trend =0.001).The risk of SIDS varied inversely with th e birth -weight per-centile and the gestational age at delivery;after adjustment for these factors,the odds ratios fo r SIDS were 1.7(95percent confidence interval,0.8to3.5),1.7(95percent confidence interval,0.8to 3.5),2.2(95percent confi-dence interval,1.1to 4.4),and 2.2(95percent confi-dence interval,1.1to 4.3),respectively(P for trend =0.01).CONCLUSIONS:There is a direct asso ciation be-tween second -trimester maternal se rumalpha -fetoprotein levels and the risk of SIDS,which may be mediated in part through impaired fetal growth and pr eterm birth.

妊娠中期母亲血清甲胎蛋白水平变化与产后婴儿猝死综合征之间的关系

背景:不明原因的死产和婴儿猝死综合征(SIDS)都有一些相同的特点,在妊娠中期,母亲血清甲胎蛋白水平增高,表明胎盘功能障碍,也是胎儿不明原因死产的一个重要提示。母亲血清甲胎蛋白水平增高是否也可以预示SIDS的发生,尚不清楚。方法:作者通过对苏格兰西部妇产医院提供的资料,包括产前信息、围生期胎儿死亡情况以及婴儿出生和死亡等情况进行评估。