Rotmensch S, Celentano C, Liberati M, Malinger G, Sadan O, Bellati U, Glezerman M
Department of Obstetrics and Gynecology, Edith Wolfson Medical Center, Holon, Israel.
Ultrasound Obstet Gynecol. 1999 May;13(5):340-4. doi: 10.1046/j.1469-0705.1999.13050340.x.
Antenatal weight estimations have limited sensitivity and specificity for the detection of macrosomia. The objective of our study was to examine the screening efficacy of the subcutaneous tissue width/femur length ratio for the intrapartum detection of fetal macrosomia in a non-diabetic population at term.
Intrapartum sonographic measurements were performed in 178 well-dated gravidas at 37-41 weeks' gestation with negative glucose tolerance screens. The biparietal diameter, femur length (FL), abdominal circumference and subcutaneous tissue width of the thigh (SCT) were determined. Subsequently, predictions for macrosomia (actual birth weights above the 90th centile) were made using varying cut-off points of the examined parameters or estimated fetal weights.
Macrosomia occurred in 27 newborns (15.1%). The SCT/FL ratio was independent of gestational age (r = -0.017). Maternal age, gravidity, parity, gestational age and the ratio of male-to-female infants were similar in pregnancies resulting in appropriate-for-gestational-age and macrosomic infants (NS). There was no difference in the SCT/FL ratio between these groups (p = 0.067; 99% power to detect 2 standard deviation differences). Comparison of screening efficacy by the univariate z score for the area under receiver operating characteristic (ROC) curves (theta) revealed that the abdominal circumference had the best sensitivity-specificity trade-off (theta = 0.8843; p < 0.0001 for comparison with SCT/FL ROC curve), followed by weight estimations based on the Hadlock formula (theta = 0.8773; p < 0.0005), the Shepard formula (theta = 0.8606; p < 0.0001), subcutaneous tissue thickness alone (theta = 0.6872; p < 0.01) and the SCT/FL ratio (theta = 0.6303).
We conclude that the SCT/FL ratio is a poor sonographic predictor of fetal macrosomia in the non-diabetic pregnancy and does not improve fetal weight estimations by conventional sonographic parameters.
产前体重估计对于巨大儿的检测，其敏感性和特异性有限。我们研究的目的是在足月非糖尿病人群中，检验皮下组织宽度/股骨长度比值在产时检测胎儿巨大儿的筛查效能。
对178例孕周准确、孕37 - 41周且葡萄糖耐量筛查阴性的孕妇进行产时超声测量。测量双顶径、股骨长度（FL）、腹围和大腿皮下组织宽度（SCT）。随后，使用所检查参数的不同切点或估计胎儿体重对巨大儿（实际出生体重高于第90百分位数）进行预测。
27例新生儿（15.1%）为巨大儿。SCT/FL比值与孕周无关（r = -0.017）。导致适于胎龄儿和巨大儿的妊娠中，产妇年龄、孕次、产次、孕周以及男女婴比例相似（无显著性差异）。这些组之间的SCT/FL比值无差异（p = 0.067；检测2个标准差差异的效能为99%）。通过单变量z分数对受试者操作特征（ROC）曲线下面积（theta）进行筛查效能比较，结果显示腹围具有最佳的敏感性 - 特异性权衡（theta = 0.8843；与SCT/FL ROC曲线比较，p < 0.0001），其次是基于哈德洛克公式的体重估计（theta = 0.8773；p < 0.0005）、谢泼德公式（theta = 0.8606；p < 0.0001）、单独的皮下组织厚度（theta = 0.6872；p < 0.01）以及SCT/FL比值（theta = 0.6303）。
我们得出结论，在非糖尿病妊娠中，SCT/FL比值是胎儿巨大儿的不良超声预测指标，并且不能通过传统超声参数改善胎儿体重估计。
