Chauhan S P, West D J, Scardo J A, Boyd J M, Joiner J, Hendrix N W
Spartanburg Regional Medical Center, Spartanburg, South Carolina, USA.
Obstet Gynecol. 2000 May;95(5):639-42. doi: 10.1016/s0029-7844(99)00606-7.
To compare clinical and sonographic estimates of birth weights with five new estimation techniques that involve measurements of soft tissue, for identifying newborns with birth weights of at least 4000 g.
Over 1 year, each woman at or after 36 weeks' gestation and suspected of having a macrosomic fetus had clinical and sonographic estimates of fetal weight (EFW) based on femur length (FL) and head and abdominal circumference, followed by five additional ways to identify excessive growth: cheek-to-cheek diameter, thigh soft tissue, ratio of thigh soft tissue to FL, upper arm subcutaneous tissue, and EFW derived from it. Areas (+/- standard error) of receiver operating characteristic (ROC) curves were calculated and compared with the area under the nondiagnostic line. P <.05 was considered statistically significant.
Among 100 women recruited, 28 newborns weighed 4000 g or more. The areas under the ROC curves with clinical (0.72 +/- 0.06) and sonographic predictions using biometric characteristics (0.73 +/- 0.06) had the highest but similar accuracies (P.05). Three of the five newer methods (upper arm or thigh subcutaneous tissue and ratio of thigh subcutaneous tissue to FL) were poor diagnostic tests (range of areas under ROC 0.52 +/- 0.06 to 0.58 +/- 0.07). Estimated fetal weight based on upper arm soft tissue thickness and cheek-to-cheek diameter (areas 0.70 +/- 0.06 and 0.67 +/- 0.06, respectively) were not significantly better than clinical predictions (P.05) for detecting macrosomic fetuses. About 110 macrosomic and nonmacrosomic infants combined would be needed to have 80% power to detect a difference between ROC curves with areas of 0.58 (thigh subcutaneous tissue) and 0.72 (clinical estimate).
ROC curves indicated that measurements of soft tissue are not superior to clinical or sonographic predictions in identifying fetuses with weights of at least 4000 g.
比较临床和超声对出生体重的估计值与五种涉及软组织测量的新估计技术，以识别出生体重至少为4000克的新生儿。
在1年多的时间里，对每一位妊娠36周及以后且疑似怀有巨大胎儿的孕妇，基于股骨长度（FL）、头围和腹围进行临床和超声胎儿体重（EFW）估计，随后采用另外五种方法来识别过度生长：双颊直径、大腿软组织、大腿软组织与FL的比值、上臂皮下组织以及由此得出的EFW。计算受试者操作特征（ROC）曲线的面积（±标准误差），并与非诊断线下方的面积进行比较。P<0.05被认为具有统计学意义。
在招募的100名女性中，有28名新生儿体重达到或超过4000克。临床估计（0.72±0.06）和使用生物特征的超声预测（0.73±0.06）的ROC曲线下面积具有最高但相似的准确性（P>0.05）。五种新方法中的三种（上臂或大腿皮下组织以及大腿皮下组织与FL的比值）诊断效果不佳（ROC曲线下面积范围为0.52±0.06至0.58±0.07）。基于上臂软组织厚度和双颊直径的估计胎儿体重（面积分别为0.70±0.06和0.67±0.06）在检测巨大胎儿方面并不比临床预测显著更好（P>0.05）。大约需要110名巨大儿和非巨大儿组合起来，才有80%的把握检测出ROC曲线下面积为0.58（大腿皮下组织）和0.72（临床估计）之间的差异。
ROC曲线表明，在识别体重至少为4000克的胎儿方面，软组织测量并不优于临床或超声预测。
