Fetal Thigh Circumference versus Fetal Abdominal Subcutaneous Tissue Thickness in Prediction of Fetal Weight in Term Pregnant Women

Background: Fetal weight estimation by ultrasound is an important factor in obstetrics;it is directly related to the gestational age which helps to plan the mode of delivery and labor management. Objective: to compare between fetal thigh circumference (TC) and abdominal subcutaneous tissue thickness (SCT) in estimating birthweight in term pregnant women. Patients and Methods: This prospective cohort study was conducted at outpatient clinic or emergency room, Obstetrics and Gynecology Department, Faculty of Medicine, Ain Shams University Maternity Hospitals from March 2022 until May 2023. During this study, 100 term pregnant females with gestational age 37 - 40 weeks attended El Demerdash Maternity Hospital and scheduled for delivery either at outpatient clinic or emergency room were enrolled, after consenting each of them. Basic fetal biometry was performed by an expert and professional medical personnel to ensure the accuracy of examination results. Fetal abdominal subcutaneous thickness and fetal thigh circumference were measured for assessment of gestational age and correlated with actual fetal body weight. In the current study, three formulas;Hadlock, Vintzileos’ and SCT formula were correlated with actual fetal body weight after birth. Results: The present study revealed that TC formula is closer to the actual birth weight, followed by Hadlock formula, while the SCT formula is the furthest from it. Conclusion: To increase the accuracy of birth estimations, regular ultrasound examinations should include fetal thigh circumference measurement.

Assessment of Used Formulae for Sonographic Estimation of Fetal Weight in Sudanese Population

The objective of this study is to assess commonly used formulae (Sheppard, Campbell, Hadlock I, II, III, and IV) for estimation of fetal weight in Sudanese population. A descriptive cross-sectional study was conducted at Saudi Hospital-Khartoum-Sudan;from December 2015 to April 2016. The study included 225 singleton pregnancies. The fetal biometry—Biparietal diameter (BPD), head circumference (HC), abdominal circumference (AC), femur length (FL) and actual birth weights (ABW) were taken. Statistical analysis showed significant results at p ≤ 0.005. Results showed that the significant highest positive correlation between the ABW and the EFW/Kg was seen in the Hadlock I, III and IV equations having an equal values (0.951) followed by Hadlock II (0.946), Sheppard (0.872) and lastly Campbell (-0.925) with significant high degree of negative correlation. The new established equation EFWFLHCAC is the best formula identified in our study to predict Sudanese babies weight ranged between 1.86 Kg to 3.987 Kg.

Ultrasound estimation of fetal weight in twins by artificial neural network

This study was undertaken to determine the accuracy of using Ultrasound (US) estimation of twin fetuses by use of Artificial Neural Network. At First, as the training group, we performed US examinations on 186 healthy singleton fetuses within 3 days of delivery. Three input variables were used to construct the ANN model: abdominal circumference (AC), ab-dominal diameter (AD), biparietal diameter (BPD). Then, a total of 121 twin fetuses were assessed sub-sequently as the validation group. In validation group, the mean absolute error and the mean absolute per-cent error between estimated fetal weight and actual fetal weight was 261.77 g and 7.81%, respectively. Results show that, twin estimation of birth weight by ultrasound correlates fairly well with the actual weights of twin fetuses.

Factors Influencing the Accuracy of Sonographyestimated Fetal Weight:A Retrospective Cohort Study in the Chinese Population

Objective:To evaluate the accuracy of sonography-estimated fetal weight(EFW)and to determine the potential factors influencing EFW accuracy in the Chinese population.Methods:Eleven widely used formulae were chosen to evaluate the accuracy of EFW in 7016 cases in a retrospective cohort study.Nine potential factors(prenatal body mass index[BMI],gestational age[GA],birth weight[BW],fetal sex,fetal presentation,amniotic fluid volume[AFV],seniority of sonographers,the time interval between ultrasonic measurement and delivery,and diabetes mellitus)were analyzed by binary logistic regression to determine whether they influenced sonography-EFW.Results:All 11 models had high correlation coefficients between EFW and BW(r=0.819–0.843).Model 3 was the most accurate formula for the Chinese population.Compared to fetuses with EFW of 2500–3999g,the accuracy of EFW decreased by 69.10%(P<0.001)for fetuses less than 2500g,and decreased by 54.10%(P<0.001)for fetuses larger than 4000g.The accuracy of EFW in female fetuses decreased by 12.70%compared with male fetuses(P=0.021).Compared to the EFW calculated 1-3 days before delivery,the accuracy of the EFW performed 4–7 days before delivery showed a significant decrease(P=0.014).The accuracy of EFW was influenced by the individual measurement accuracy of the sonographers.Maternal BMI,DM,GA,fetal presentation,and AFV did not influence the accuracy of EFW after adjustment.Conclusion:Model 3 was the most accurate model for the Chinese population.The BW,fetal sex,time interval,and technique of the sonographers had different influences on the accuracy of EFW.

Predicting fetal weight by three-dimensional limb volume ultrasound (AVol/TVol) and abdominal circumference

Background:Fetal weight is an important parameter to ensure maternal and child safety.The purpose of this study was to use three-dimensional(3D)limb volume ultrasound combined with fetal abdominal circumference(AC)measurement to establish a model to predict fetal weight and evaluate its efficiency.Methods:A total of 211 participants with single pregnancy(28-42 weeks)were selected between September 2017 and December 2018 in the Beijing Obstetrics and Gynecology Hospital of Capital Medical University.The upper arm(AVol)/thigh volume(TVol)of fetuses was measured by the 3D limb volume technique.Fetal AC was measured by two-dimensional ultrasound.Nine cases were excluded due to incomplete information or the interval between examination and delivery>7 days.The enrolled 202 participants were divided into a model group(134 cases,70%)and a verification group(68 cases,30%)by mechanical sampling method.The linear relationship between limb volume and fetal weight was evaluated using Pearson Chi-squared test.The prediction model formula was established by multivariate regression with data from the model group.Accuracy of the model formula was evaluated with verification group data and compared with traditional formulas(Hadlock,Lee2009,and INTERGROWTH-21st)by paired t-test and residual analysis.Receiver operating characteristic curves were generated to predict macrosomia.Results:AC,AVol,and TVol were linearly related to fetal weight.Pearson correlation coefficient was 0.866,0.862,and 0.910,respectively.The prediction model based on AVol/TVol and AC was established as follows:Y=-481.965+12.194TVol+15.358AVol+67.998AC,R2adj=0.868.The scatter plot showed that when birth weight fluctuated by 5%(i.e.,95%to 105%),the difference between the predicted fetal weight by the model and the actual weight was small.A paired t-test showed that there was no significant difference between the predicted fetal weight and the actual birth weight(t=-1.015,P=0.314).Moreover,the residual analysis showed that the model formula’s prediction efficiency was better than the traditional formulas with a mean residual of 35,360.170.The combined model of AVol/TVol and AC was superior to the Lee2009 and INTERGROWTH-21st formulas in the diagnosis of macrosomia.Its predictive sensitivity and specificity were 87.5%and 91.7%,respectively.Conclusion:Fetal weight prediction model established by semi-automatic 3D limb volume combined with AC is of high accuracy,sensitivity,and specificity.The prediction model formula shows higher predictive efficiency,especially for the diagnosis of macrosomia.

New Sudanese Reference Chart of Fetal Bi-ometry and Weight Using Ultrasonography

Background: Many centers in Sudan use the reference data for fetal biometry. The recently published population-based reference either overestimated or underestimated the weight of the fetuses. Objective: To establish a national reference for fetal biometry, and weight by gestational age for singleton fetuses in Sudan. Methods: Data were collected on all singleton live births documented in the data collection sheet done at Saudi Hospital from 2015 to 2016 (n = 225). Gestational age estimation was based on the last menstrual period and fetal ultrasound thereafter. Fetal biometry and weight and other 6 fetal weight formulae were assessed. Reference data for fetal growth by gestational age were created. Results: New charts and reference equations are reported in Sudanese population for fetal biparietal diameter, head circumference, abdominal circumference and femur length and fetal weight. Conclusion: We advocate that these reference charts and equations for fetal biometry and weight might be valuable in the clinical use for appropriate ethnic Sudanese.

Outcomes of Fetal Macrosomia and Associated Factors: A Case-Control Facility Based Study

Objective: To identify risk factors of perinatal complications among macrosomic babies in a third level health care facility. Method: We conducted a case-control institutional based study. Cases (macrosomic babies and mothers with perinatal complications) and controls (pairs free of perinatal complication) of singleton live births were extracted from the maternity registry from January 2017 to December 2019. Matching was done for sex and gestational age after exclusion of genetic cause of macrosomia. The main primary outcome was the risk factors for complications. Logistic regression was used to estimate the odds ratio and the magnitude of association between the primary endpoint and the different covariates of the study. Results: Out of 362 couples included, we had 186 cases and 176 controls. The main perinatal complications were the delivery by caesarean section (26.5%) and lesions of the genital canal, 20.2%. There were no maternal deaths. Among newborns, metabolic complications (19.6%) were a leading cause of harmful outcomes before respiratory complications (12.4%), dystocic presentations (6.3%) or traumatic injuries (1.7%). The neonatal case fatality rate was 2.8%. Maternal age ≥30 years (p = 0.024);non-screening for gestational diabetes (p = 0.027);history of caesarean section (p = 0.041);weight gain ≥16 kg (p 0.001);maternal HIV (p = 0.047);birth weight ≥4500 g (p = 0.015) and birth height ≥52.7 ± 1.7 cm (p = 0.026) were risk factors for perinatal adverse outcomes. Conclusion: The delivery of a macrosomic baby remains problematic in this setting, and emphasizes the need to improve routine screening of gestational diabetes within a quality of prenatal follow-up through a multidisciplinary perinatal team involving obstetricians, endocrinologists and neonatal pediatricians.

胎儿体质量估计对初产妇巨大儿分娩方式及围产结局的临床观察

目的观察胎儿体质量估计对初产妇巨大儿的分娩方式和围产结局的影响。方法选取2022年1月至2023年12月北京市海淀区妇幼保健院分娩的足月单胎初产妇206例,根据估计体质量分为甲组(估计胎儿体质量<4000 g,118例)和乙组(估计胎儿体质量≥4000 g,88例)。比较两组产妇及新生儿的分娩方式和分娩结局等。结果206例初产妇年龄21~39岁,平均(30.6±3.4)岁。与乙组相比,甲组阴道分娩比例较高(61.9%比40.9%)、剖宫产比例较低(32.2%比56.8%),两组分娩方式的差异有统计学意义(P<0.05)。甲组试产率明显高于乙组(90.7%比59.1%),差异有统计学意义(P<0.05)。甲组产后出血量(容积法)和校正产后出血量均高于乙组[350(300,500)ml比300(300,380)ml,440(230,720)ml比360(160,560)ml],差异有统计学意义(P<0.05)。两组胎儿窘迫、肩难产、新生儿窒息比例的差异无统计学意义(P>0.05)。结论低估胎儿体质量可增加初产妇巨大儿试产率及阴道分娩率,也增加了产后出血量,但并未增加胎儿窘迫、肩难产、新生儿窒息等分娩并发症。建议胎儿估计体质量<4500 g且有阴道分娩意愿的产妇,应该在充分告知的情况下,增加试产机会。

重度子痫前期患者孕晚期血清尿素氮/肌酐比值与胎儿体重的关系研究

目的探讨重度子痫前期(PE)患者孕晚期血清尿素氮(BUN)/肌酐(Cr)比值与胎儿体重的关系。方法采用病例对照研究,选取2021年1月至2022年12月宁波市医疗中心李惠利医院及宁波大学附属妇女儿童医院收治的孕晚期重度PE患者200例,另选取同期入院待产的非高血压孕妇200例作为对照。收集孕妇临床资料,抽取空腹静脉血5 mL检测BUN、Cr等生化指标,观察重度PE患者BUN/Cr比值变化及胎儿体重特点;重度PE患者中发生胎儿生长受限(FGR)58例作为FGR组,未发生FGR 142例作为非FGR组,比较两组间BUN/Cr比值等血清生化指标及临床特点差异,分析重度PE患者孕晚期血清BUN/Cr比值对FGR发生的影响,血清BUN/Cr比值与胎儿出生体重的相关性。结果与非高血压组比较,重度PE组BUN/Cr比值较高,胎儿FGR发生率较高,胎儿出生体重较小,差异均有统计学意义(均P<0.05);BUN/Cr比值是重度PE患者发生FGR的独立危险因素(OR=1.176,95%CI:1.100~1.258,P<0.001);孕前BMI、孕期增重、分娩孕周与胎儿出生体重均呈正相关(r=0.158、0.173、0.798,P=0.027、0.014、<0.001),BUN/Cr、尿酸水平与胎儿出生体重均呈负相关(r=-0.477、-0.226,P<0.001、0.001);排除孕前BMI、孕期增重、分娩孕周及尿酸水平对胎儿出生体重的影响外,BUN/Cr比值与胎儿出生体重呈负相关(r=-0.389,P<0.001)。结论重度PE患者血清BUN/Cr比值与胎儿出生体重呈负相关,是重度PE患者发生FGR的独立危险因素。

产时Ⅱ度及以上会阴裂伤风险预测模型的构建和验证

目的 构建产时Ⅱ度及以上会阴裂伤风险预测随机森林算法模型,并初步评价模型的预测性能。方法 采用方便抽样法,选取经阴道分娩的1 366例产妇为研究对象,将其按照7∶3的比例随机分为训练集和验证集。采用LASSO回归分析筛选产时Ⅱ度及以上会阴裂伤的风险因素,采用随机森林算法构建预测模型,计算ROC曲线下面积、预测准确率、灵敏度和特异度等评价模型的性能。结果 共计8个预测因子被纳入随机森林模型中,分别为孕前BMI、孕期体质量增加、初产妇、剖宫产史、硬膜外麻醉、催产、引产和胎儿估计体质量,其中胎儿估计体质量对产时Ⅱ度及以上会阴裂伤的影响最大,其次是初产妇和催产。随机森林模型在验证集中的ROC曲线下面积为0.698(95%CI:0.645~0.751),预测准确率为80.0%(95%CI:75.8%~83.8%),灵敏度和特异度分别为50.5%和89.1%。结论 基于随机森林算法构建的产时Ⅱ度及以上会阴裂伤风险预测模型具有一定的预测价值,但预测性能仍有待提高。

基于超声血流参数评估晚发型胎儿宫内生长受限的研究

目的分析超声血流参数对晚发型胎儿宫内生长受限(FGR)的预测价值。方法选取2020年6月至2022年6月青海大学附属医院收治的82例晚发型FGR孕产妇作为研究对象。根据新生儿妊娠结局分为结局良好组(51例)与结局不良组(31例)。另选取同期在青海大学附属医院产检且胎儿生长正常的32例孕产妇作为对照组。比较3组基线资料及分娩前最后1次超声的大脑中动脉搏动指数(MCA-PI)、脐动脉搏动指数(UA-PI)、脑-胎盘血流比(CPR)、心血管整体评分(CVPS)、Hadlock胎儿体质量估测(EFW),绘制受试者工作特征(ROC)曲线评估上述超声血流参数对晚发型FGR孕产妇不良妊娠结局的预测价值。结果结局不良组新生儿出生体质量均低于结局良好组及对照组,且结局良好组低于对照组,差异均有统计学意义(P<0.05)。结局不良组分娩孕周短于对照组和结局良好组,差异均有统计学意义(P<0.05)。结局不良组MCA-PI、CPR、CVPS、EFW均低于结局良好组及对照组,且结局良好组低于对照组,差异均有统计学意义(P<0.05)。结局不良组UA-PI高于结局良好组及对照组,且结局良好组高于对照组,差异均有统计学意义(P<0.05)。ROC曲线分析结果显示,MCA-PI、UA-PI、CPR、CVPS、EFW单独预测晚发型FGR孕产妇不良妊娠结局的曲线下面积分别为0.667、0.792、0.762、0.820、0.917。结论超声血流参数MCA-PI、UA-PI、CPR、CVPS、EFW均对晚发型FGR孕产妇不良妊娠结局有一定预测价值,其中CVPS及EFW预测价值较高,可为临床治疗及判断分娩时机提供重要依据。

早产儿桡动脉有创血压与无创血压测量结果比较

目的:探讨早产儿桡动脉有创动脉血压(IBP)和无创血压(NIBP)测量结果的一致性和差异性。方法:采用回顾性研究方法,选取2020年12月—2021年12月中山大学附属第一医院新生儿科行IBP测量的93例危重早产儿为研究对象,记录患儿的IBP和NIBP收缩压、舒张压和平均动脉压,分析IBP和NIBP相关性、一致性,并根据体重和胎龄进行亚组分析。结果:收集93例患儿的IBP和NIBP共1771对,排除无效血压,最终纳入IBP和NIBP为1455对。Pearson相关性分析结果显示,IBP收缩压和NIBP收缩压(r=0.754,P<0.001)、IBP舒张压和NIBP舒张压(r=0.747,P<0.001)、IBP平均动脉压和NIBP平均动脉压(r=0.791,P<0.001)均呈正相关。IBP收缩压和NIBP收缩压差值为(7.20±5.59)mmHg,95%一致性界限为-3.75~18.16 mmHg;IBP舒张压和NIBP舒张压差值为(0.09±4.34)mmHg,95%一致性界限为-8.41~8.60 mmHg;IBP平均动脉压和NIBP平均动脉压差值为(1.03±4.27)mmHg,95%一致性界限为-7.34~9.39 mmHg。体重>2.0 kg的患儿IBP收缩压和NIBP收缩压偏倚均值、IBP舒张压和NIBP舒张压偏倚均值、IBP平均动脉压和NIBP平均动脉压偏倚均值均小于体重≤1.0 kg的患儿和体重>1.0~2.0 kg的患儿。胎龄>32~<37周的患儿IBP收缩压和NIBP收缩压偏倚均值、IBP舒张压和NIBP舒张压偏倚均值、IBP平均动脉压和NIBP平均动脉压偏倚均值小于胎龄≤28周的患儿和胎龄>28~32周的患儿。结论:早产儿桡动脉IBP和NIBP呈正相关,且IBP和NIBP间具有良好的一致性。NIBP可用于血流动力学稳定的早产儿,血流动力学不稳定且需要使用血管活性药物的婴儿建议进行IBP测量。

分娩前超声检查对不同营养状况孕妇胎儿体质量估计效果

目的比较超声Hadlock法与临床公式法(袁东法)评估胎儿体质量的符合率。方法回顾分析2020年1—4月在青岛市妇女儿童医院产科住院分娩的1715例孕妇的临床资料,按孕前体质量指数(BMI)分为体质量过低(<18.5 kg/m 2)组177例、体质量正常(18.5~23.9 kg/m 2)组1118例、体质量超标(24.0~27.9 kg/m 2)组317例、肥胖(≥28.0 kg/m 2)组103例。分别应用超声Hadlock法与袁东法估测胎儿体质量,比较两种方法计算的估计胎儿体质量与实际出生体质量的差异。结果4组超声Hadlock法评估胎儿体质量的准确率均明显高于袁东法(χ2=25.212~435.840,P<0.01);Hadlock法评估胎儿体质量的准确率4组差异无统计学意义(χ2=1.392,P>0.05),袁东法评估胎儿体质量的准确率随BMI升高而降低,差异有统计学意义(χ2=59.34,P<0.01)。结论Hadlock法评估胎儿体质量的准确率明显高于袁东法,且不受孕妇孕前BMI影响。

正常孕妇妊娠期增重和糖脂代谢与巨大儿发生风险的关系

目的:分析妊娠期体质量和糖脂水平在分娩巨大儿的无妊娠合并症/并发症、非肥胖、非高龄的正常孕妇中的变化特点,探讨其对巨大儿发生风险的影响。方法:选取2020年9—12月在上海交通大学医学院附属国际和平妇幼保健院定期产检的正常孕妇,根据是否分娩巨大儿分为巨大儿组(104例)和对照组(258例),比较2组基本情况和妊娠期糖脂水平,并采用Logistic回归分析正常孕妇分娩巨大儿的影响因素。结果:相较于正常对照组,巨大儿组妊娠期空腹血糖、妊娠早晚期三酰甘油(triglyceride,TG)水平更高,妊娠早晚期高密度脂蛋白(high density lipoprotein,HDL)水平更低,且巨大儿组妊娠期TG变化差值更大、HDL变化差值更小(均P<0.05)。与妊娠期增重适宜的正常孕妇相比,增重过多的正常孕妇分娩巨大儿的风险升高142%(OR=2.42,95%CI:1.34~4.39),增重不足的正常孕妇分娩巨大儿的风险降低73%(OR=0.27,95%CI:0.10~0.77);妊娠晚期HDL每升高1 mmol/L,分娩巨大儿风险下降79%(OR=0.21,95%CI:0.08~0.57)。结论:正常孕妇群体仍需严格控制妊娠期体质量以降低巨大儿的发生风险,并且仍需关注血脂代谢,其中妊娠晚期HDL的水平及变化情况或可辅助筛查隐匿性巨大儿。

不同孕期血脂水平与胎盘重量和胎盘/出生体重比的相关性

目的:探讨不同孕期母体空腹血脂与胎盘重量(PW)和胎盘/出生体重比(PFR)的相关性。方法:收集规律产检及足月、顺产分娩的1172例单胎孕妇的基本信息、不同孕期空腹血脂及PW、PFR,分析母体不同孕期空腹血脂对PW、PFR的影响及其与PW和RFR的关系。结果:在排除孕前体质指数(BMI)、孕龄、产次、胎儿性别等混杂因素后,妊娠早期低密度脂蛋白C(LDL-C)每升高1个单位,PW增加9.396 g(95%CI:0.510~18.283,P=0.038);妊娠中期总胆固醇(TC)、甘油三脂(TG)每升高1个单位,PW分别增加8.582 g(95%CI:3.464~13.699,P=0.001)和7.565 g(95%CI:1.825~13.305,P=0.010);载脂蛋白a1(APOA1)每升高1个单位,PW减少31.422 g(95%CI:-49.139~-13.705,P=0.001);妊娠晚期TG每增加1个单位,PW增加5.618 g(95%CI:1.149~10.088,P=0.014);HDL-C每增加1个单位,PW减少18.622 g(95%CI:-30.047~-7.196,P=0.001)。PFR与妊娠晚期APOA1负相关(P<0.05),与妊娠晚期载脂蛋白b(APOB)正相关(P<0.05)。结论:妊娠期母体血脂异常可导致PW、PFR异常,影响胎盘功能及新生儿体重,临床需加强监测母体血脂指标变化并及时干预。

超声预测胎儿体质量方法比较及孕期增重对其准确性的影响研究

目的:比较分析11种超声参数预测胎儿体质量公式的准确性,探讨孕期体质量增加(GWG)对超声估测胎儿体质量准确性的影响。方法:收集2020年8月至2020年12月于复旦大学附属金山医院分娩的502例单胎,足月分娩产妇孕期增重、分娩前7天内胎儿超声测量指标及新生儿出生体质量,计算并分析多种超声预测公式的准确性。根据孕期体质量增长标准,即单胎妊娠孕前体质量指数(BMI)<18.5 kg/m^(2)者孕期合理增重为12.5~18.0 kg,BMI 18.5~24.9 kg/m^(2)者增重11.5~16.0 kg,BMI 25.0~29.9 kg/m^(2)者增重7.0~11.5 kg,BMI≥30.0 kg/m^(2)者增重5.0~9.0 kg,将病例分为GWG过少组(125例)、正常组(202例)和过多组(175例),分析不同GWG对于超声预测胎儿体质量准确性的影响。结果:11种超声参数预测胎儿体质量公式中,HadlockⅢ公式预测胎儿体质量的绝对误差为186.64±149.28 g,相对误差为(5.52±4.18)%,在11种预测公式中误差最小,差异有统计学意义(P<0.05),绝对误差和相对误差符合率分别为72.31%、86.25%,均为最高,差异有统计学意义(P<0.05)。GWG过少组、正常组和过多组利用HadlockⅢ公式预测胎儿体质量时,绝对误差分别为190.23±136.69 g、148.12±99.39 g、228.54±189.57 g,相对误差分别为(5.95±4.25)%、(4.40±2.78)%、(6.49±5.09)%,差异均具有统计学意义(P<0.05)。结论:HadlockⅢ公式预测胎儿体质量的准确性优于其他公式,但其准确性可受GWG的影响,临床中预测胎儿体质量时需多方面综合考量。

超声多参数Z-评分联合模型评估胎儿生长受限的价值研究

目的探讨超声多参数Z-评分联合预测模型评估胎儿生长受限(FGR)的价值。方法回顾性分析2017年1月~2020年12月我院收治的88例单胎、孕22~29周且婴儿出生后确诊为FGR的孕妇临床资料,并以同期年龄、产次、妊娠期合并症等一般资料基本匹配的108例非FGR孕妇资料作为对照。采用Logistic回归方程建立胎儿体质量测定(EFW)、脐动脉(UA)、大脑中动脉(MCA)、脑-胎盘比(CPR)、腹围(AC)和头-腹围比值(HC/AC)等参数的单参数模型和多参数联合模型,并绘制受试者工作特征曲线(ROC),通过与Hadlock-EFW百分位数(Hadlock-EFWc)比较,以评估不同模型预测FGR的价值。结果FGR组EFW、EFWc及CPR、AC、HC/AC的Z-评分均明显低于非FGR组,UA-PI、MCA-PI的Z-评分高于非FGR组(P<0.001)。联合模型预测FGR的灵敏度为82.95%、特异度为70.37%、约登指数为0.533、ROC曲线下面积(AUC)为0.897,95%CI为(0.795,0.956),其预测效能优于Hadlock-EFWc及各超声单参数(P<0.05)。结论超声多参数Z-评分联合模型预测FGR相较Hadlock-EFWc和超声单参数更为准确且诊断价值更高。

探索孕中晚期胎儿体重对子痫前期孕妇早产及母婴不良结局的风险预测模型

目的探索分析孕中晚期胎儿体重对子痫前期孕妇早产及母婴不良结局的风险因素,并以此构建风险预测模型。方法选择2020年1月—2023年8月本院收治的160例单胎子痫前期孕妇作为研究对象,于孕妇孕24+0至32+0周对胎儿体重进行估算,按胎儿胎龄以及预测体重的孕妇分为小于胎龄儿(SGA)组、适于胎龄儿(AGA)组和大于胎龄儿(LGA)组三组,SGA组66例AGA组75例LGA组19例。收集孕妇的一般资料,所有孕妇均追踪至分娩后1个月,观察比较三组孕妇早产情况、分娩方式、分娩孕周等发生情况,并根据早产及母婴不良结局是否发生分为发生组和未发生组,采用多因素Logistic回归分析建立风险预测模型预测相关风险因素。结果三组孕妇发生早产人数比较,差异有统计学意义(P<0.05);SGA组孕妇分娩孕周显著小于AGA组、LGA组,且AGA组孕妇分娩孕周显著小于LGA组,差异有统计学意义(P<0.05);三组孕妇自然分娩、剖腹产、人工诱导分娩方式比较,差异有统计学意义(P<0.05);三组孕妇母婴感染、宫内窘迫、其他分娩并发症比较,差异有统计学意义(P<0.05);三组孕妇产后新生儿性别、围产儿结局比较,差异无统计学意义(P>0.05);SGA组新生儿体重显著轻于AGA、LGA组,且AGA组新生儿体重显著轻于LGA组,差异有统计学意义(P<0.05);三组新生儿ICU入住率比较,差异有统计学意义(P<0.05);多因素结果显示,患者资料中孕前BMI(低体重、超重或肥胖)、产次(初产妇)、不良孕产史、孕晚中期胎儿体重(SGA)、吸烟或被动吸烟及合并妊娠高血压等为影响子痫前期孕妇发生早产及母婴不良结局的独立危险因素(P<0.05);模型以Hosmer Lemeshow检验:χ^(2)=11.252,P=0.188>0.05,即拟合度优。ROC曲线AUC为0.892(95%CI:0.826~0.958),灵敏度为78.8%,特异度为92.9%,最大约登指数为0.717,即模型区分度良好。结论本研究通过孕中晚期B超多参数预测胎儿体重,探索孕中晚期胎儿体重对子痫前期孕妇早产及母婴不良结局的预测效能,可为临床防治早产及母儿严重并发症提供预警和应对方案。

超声估测胎儿体质量的准确性、一致性及其对胎儿分娩方式的影响

目的探讨超声估测胎儿体质量的准确性、一致性及其对胎儿分娩方式选择的影响。方法选取妊娠满28周且在本院住院分娩的单活胎妊娠初产妇1258例,记录胎儿实际体质量,采用三维容积超声测量部分肢体体积上臂中段50%的体积(AVol)和大腿中段50%的体积(TVol)评估胎儿体质量,比较不同年份胎儿实际体质量、超声AVol评估胎儿体质量、超声TVol评估胎儿体质量、分娩方式,以及不同分娩方式胎儿实际体质量、超声AVol评估胎儿体质量、超声TVol评估胎儿体质量,并分析胎儿实际体质量与超声AVol评估胎儿体质量、超声TVol评估胎儿体质量的相关性,以及超声AVol与超声TVol评估胎儿体质量的准确性、Kappa一致性。结果常规二维评估胎儿体重量与实际胎儿体质量、超声AVol评估胎儿体质量、超声TVol评估胎儿体质量比较,差异有统计学意义(P<0.05)。不同年份胎儿实际体质量、常规二维评估胎儿体质量、超声AVol评估胎儿体质量、超声TVol评估胎儿体质量比较,差异均无统计学意义(P>0.05)。不同年份胎儿剖宫产率比较,差异均无统计学意义(P>0.05)。剖宫产胎儿实际体质量、常规二维评估胎儿体质量、超声AVol评估胎儿体质量、超声TVol评估胎儿体质量高于顺产胎儿,差异有统计学意义(P<0.05)。经Pearson分析,实际体质量与超声AVol评估胎儿体质量、超声TVol评估胎儿体质量呈正相关(r=0.979、0.974,P<0.05)。超声AVol评估胎儿体质量的准确率为85.85%,超声TVol评估胎儿体质量的准确率为85.61%;超声AVol与超声TVol评估胎儿体质量的Kappa一致性为0.834。结论超声AVol、TVol评估胎儿体质量具有较高的准确性和一致性,控制胎儿体质量,有利于降低剖宫产率。

超声评估妊娠期糖尿病产妇胎儿体重的应用价值

目的:探讨超声评估妊娠期糖尿病(GDM)产妇胎儿体重中的应用价值.方法:选取2022年1月至2022年12月本院收治的108例GDM产妇作为研究对象,设为观察组,选取同期108例健康孕妇作为对照组.对两组产妇均给予超声检查,对比两组胎儿的生长情况,胎儿发育情况,新生儿中巨大儿出生率.结果:观察组胎儿肝脏长度和头围大于对照组,脐动脉搏动指数、阻力指数均高于对照组,新生儿中巨大儿出生率高于对照组,差异均有统计学意义(P<0.05).结论:对GDM产妇产前实施超声检查,可明显判断胎儿生长发育情况,以便临床采取相应的预防和治疗措施.