Levine A B, Lockwood C J, Brown B, Lapinski R, Berkowitz R L
Department of Obstetrics, Gynecology, and Reproductive Science, Mount Sinai School of Medicine, New York, New York.
Obstet Gynecol. 1992 Jan;79(1):55-8.
We evaluated 406 women with late third-trimester ultrasound examinations to determine whether the sonographic diagnosis of a large for gestational age (LGA) fetus, defined as an estimated fetal weight at or above the 90th percentile, altered the management of labor and delivery. The sonographic prediction of LGA fetuses had a sensitivity, specificity, and positive predictive value of 50, 90, and 52%, respectively. Women without the sonographic diagnosis of an LGA fetus (N = 338) differed from those with the diagnosis (N = 68) in the frequency of diagnosed labor abnormalities (19 versus 30%, P = .03), use of epidural anesthesia (57 versus 74%, P = .01), and the incidence of cesarean deliveries (32 versus 53%, P = .004). To determine whether it was the sonographic prediction of an LGA fetus or the actual fetal weight that altered clinical management and perinatal outcomes, we stratified the study population into four groups and compared the true negatives with the false positives and the false negatives with the true positives. The incorrect sonographic diagnosis of an LGA fetus had a statistically significant effect on both the diagnosis of labor abnormalities (P = .04) and the incidence of elective cesareans (P = .04) in pregnancies with appropriate for gestational age birth weights.
我们对406名在孕晚期接受超声检查的女性进行了评估，以确定超声诊断为大于胎龄（LGA）胎儿（定义为估计胎儿体重处于或高于第90百分位数）是否会改变分娩管理。LGA胎儿的超声预测的敏感性、特异性和阳性预测值分别为50%、90%和52%。未被超声诊断为LGA胎儿的女性（N = 338）与被诊断为LGA胎儿的女性（N = 68）在诊断出的产程异常频率（19%对30%，P = .03）、硬膜外麻醉的使用（57%对74%，P = .01）以及剖宫产发生率（32%对53%，P = .004）方面存在差异。为了确定是LGA胎儿的超声预测还是实际胎儿体重改变了临床管理和围产期结局，我们将研究人群分为四组，并比较了真阴性与假阳性以及假阴性与真阳性。对于出生体重符合孕周的妊娠，LGA胎儿的超声诊断错误对产程异常的诊断（P = .04）和择期剖宫产的发生率（P = .04）均有统计学意义的影响。
