Smith G C S, Shah I, White I R, Pell J P, Crossley J A, Dobbie R
Department of Obstetrics and Gynaecology, Cambridge University, Rosie Maternity Hospital, Cambridge, UK.
BJOG. 2007 Jun;114(6):705-14. doi: 10.1111/j.1471-0528.2007.01343.x.
To determine whether maternal serum levels of alphafetoprotein (alpha-FP) and human chorionic gonadotrophin (hCG) at 15-21 weeks provided clinically useful prediction of stillbirth in first pregnancies.
Retrospective study of record linkage of a regional serum screening laboratory to national registries of pregnancy outcome and perinatal death.
West of Scotland, 1992-2001.
A total of 84,769 eligible primigravid women delivering an infant at or beyond 24 weeks of gestation.
The risk of stillbirth between 24 and 43 weeks was assessed using the Cox proportional hazards model. Logistic regression models within gestational windows were then used to estimate predicted probability. Screening performance was assessed as area under the receiver operating characteristic (ROC) curve.
Antepartum stillbirth unrelated to congenital abnormality.
The odds ratio (95% CI) for stillbirth at 24-28 weeks for women in the top 1% were 11.97 (5.34-26.83) for alpha-FP and 5.80 (2.19-15.40) for hCG. The corresponding odds ratios for stillbirth at or after 37 weeks were 2.44 (0.74-8.10) and 0.79 (0.11-5.86), respectively. Adding biochemical to maternal data increased the area under the ROC curve from 0.66 to 0.75 for stillbirth between 24 and 28 weeks but only increased it from 0.64 to 0.65 for stillbirth at term and post-term. Women in the top 5% of predicted risk had a positive likelihood ratio of 7.8 at 24-28 weeks, 3.7 at 29-32 weeks, 5.1 at 33-36 weeks and 3.4 at 37-43 weeks, and the corresponding positive predictive values were 0.97, 0.33, 0.47 and 0.63%, respectively.
Maternal serum levels of alpha-FP and hCG were statistically associated with stillbirth risk. However, the predictive ability was generally poor except for losses at extreme preterm gestations, where prevention may be difficult and interventions have the potential to cause significant harm.
确定孕15 - 21周时孕妇血清甲胎蛋白（α-FP）和人绒毛膜促性腺激素（hCG）水平是否能为初产妇死产提供临床有用的预测。
对区域血清筛查实验室与国家妊娠结局和围产期死亡登记处的记录链接进行回顾性研究。
1992 - 2001年苏格兰西部。
共有84769名符合条件的初产妇在妊娠24周及以后分娩。
使用Cox比例风险模型评估24至43周之间的死产风险。然后在妊娠窗口内使用逻辑回归模型估计预测概率。筛查性能通过受试者操作特征（ROC）曲线下面积进行评估。
与先天性异常无关的产前死产。
处于前1%的女性在24 - 28周时α-FP导致死产的优势比（95%CI）为11.97（5.34 - 26.83），hCG导致死产的优势比为5.80（2.19 - 15.40）。37周及以后死产的相应优势比分别为2.44（0.74 - 8.10）和0.79（0.11 - 5.86）。将生化指标添加到产妇数据中，使24至28周死产的ROC曲线下面积从0.66增加到0.75，但足月和过期妊娠死产的该面积仅从0.64增加到0.65。处于预测风险前5%的女性在24 - 28周时的阳性似然比为7.8，29 - 32周时为3.7，33 - 36周时为5.1，37 - 43周时为3.4，相应的阳性预测值分别为0.97%、0.33%、0.47%和0.63%。
孕妇血清α-FP和hCG水平与死产风险存在统计学关联。然而，除了极早产时的死产外，预测能力总体较差，因为极早产时预防可能困难且干预可能会造成重大伤害。
