Schmidt P, Staboulidou I, Soergel P, Hillemanns P, Scharf A
Department of Obstetrics and Gynecology, Medical University Hannover, Hannover, Germany.
Arch Gynecol Obstet. 2007 Oct;276(4):315-21. doi: 10.1007/s00404-007-0355-z. Epub 2007 Mar 21.
For monitoring pregnancies it is useful to reduce unnecessary examinations due to wrongfully assumed growth retardation in cases with a small fetal growth potential. It also makes sense to improve the detection of objectively retardated children in order to a disproportionately high growth potential. It was the aim of this study to modify the standard growth charts for ultrasound parameters according to parental influences to better display the individual growth potential.
In a prospective trial 1,390 ultrasound measurements of 174 completed pregnancies were observed. For all patients a standard questionnaire was conducted in which possible predictors for fetal growth were collected. Customizing the growth charts had been achieved by (1) calculating the general impact of parental factors on the ultrasound measurement values, (2) plotting the individual growth charts for each pregnancy and (3) analyzing the difference of every observed measurement from either unchanged normal values or customized growth charts.
The obtained biparietal diameter measurements all in all are 291 mm closer to the individualized charts than to the unmodified charts. The total improvement of all thoracal diameter measurements was found to be 294 mm, the summarized advancement of all abdomen circumference values was 1,005 mm and the femur length measurements are 296 mm nearer to customized charts. All results were statistically significant.
This is the first time the impact of several predictors on ultrasound growth charts had been analyzed. While other working groups have demonstrated the benefit of customizing the fetal weight and length, this concept had never been carried forward onto the growth charts for ultrasound values. The method to adjust the common mean values by so called 'modifiers' is derived from the mathematical concept of the sequential first-trimester screening for Down's syndrome. For customizing growth charts this approach seems to be useful as well. The feasability and the statistical benefit of customizing ultrasound growth charts has been demonstrated in this work. A larger study seems to be promising and should be performed. Further improvements could be obtained by using normal growth charts which were derived from the examined cohort.
对于孕期监测而言，减少因胎儿生长潜力小却被错误假定为生长迟缓而进行的不必要检查很有必要。提高对客观生长迟缓胎儿的检测率也很有意义，因为这类胎儿有极高的生长潜力。本研究的目的是根据父母的影响因素修改超声参数的标准生长图表，以更好地显示个体生长潜力。
在一项前瞻性试验中，对174例足月妊娠进行了1390次超声测量。对所有患者进行了标准问卷调查，收集可能影响胎儿生长的预测因素。通过以下方式实现生长图表的定制：（1）计算父母因素对超声测量值的总体影响；（2）为每次妊娠绘制个体生长图表；（3）分析每次观察测量值与未修改的正常值或定制生长图表之间的差异。
总体而言，获得的双顶径测量值与个性化图表的差距比与未修改图表的差距小291毫米。所有胸径测量值的总体改善为294毫米，所有腹围值的总进步为1005毫米，股骨长度测量值与定制图表的差距近296毫米。所有结果均具有统计学意义。
这是首次分析多种预测因素对超声生长图表的影响。虽然其他研究小组已经证明了定制胎儿体重和身长的益处，但这一概念从未应用于超声值的生长图表。通过所谓的“修正因子”调整共同平均值的方法源自孕早期唐氏综合征序贯筛查的数学概念。对于定制生长图表，这种方法似乎也很有用。本研究证明了定制超声生长图表的可行性和统计学益处。一项更大规模的研究似乎很有前景，应该进行。通过使用来自研究队列的正常生长图表，可能会获得进一步的改进。
