Bastek Jamie A, Paré Emmanuelle, Wang Eileen, Elovitz Michal A, Srinivas Sindhu K
Department of Obstetrics and Gynecology, Maternal and Child Health Research Program, University of Pennsylvania, Philadelphia, Pennsylvania 19104, USA.
J Matern Fetal Neonatal Med. 2009 Nov;22(11):1039-44. doi: 10.3109/14767050903029584.
The objective of this study was to determine test characteristics of ultrasound in detecting intrauterine growth restriction (IUGR) in severe preeclampsia (S-PEC).
We performed a prospective study (2005-2007) to evaluate risk factors for PEC. Women with severe PEC and an ultrasound <or=3 weeks of delivery were enrolled. Chi square analysis determined associations between diagnosis of IUGR and small for gestational age (SGA) birth weight. Multivariable logistic regression was used to control for confounders. Fetal growth rate and test characteristics of ultrasound were calculated.
Ninety-three patients were enrolled. There was a significant association between IUGR and SGA, but no association between maternal demographic factors and IUGR. Test characteristics of ultrasound to diagnose IUGR in severe PEC were: sensitivity 56.7%, specificity 93.7%, PPV 81.0%, NPV 81.9%. The positive likelihood ratio (+LR) for ultrasound to detect IUGR in severe PEC was 8.9.
Current ultrasound practice has moderately good positive and negative predictive values and a high specificity for the diagnosis of IUGR in women with severe PEC. However, the poor sensitivity and low + LR indicate that additional modalities are needed to improve the usefulness of ultrasound in detecting IUGR in severe PEC.
本研究的目的是确定超声检测重度子痫前期（S-PEC）患者宫内生长受限（IUGR）的检测特征。
我们进行了一项前瞻性研究（2005 - 2007年）以评估子痫前期的危险因素。纳入了患有重度子痫前期且超声检查在分娩前≤3周的女性。采用卡方分析确定IUGR诊断与小于胎龄（SGA）出生体重之间的关联。使用多变量逻辑回归来控制混杂因素。计算胎儿生长速率和超声的检测特征。
共纳入93例患者。IUGR与SGA之间存在显著关联，但母亲人口统计学因素与IUGR之间无关联。超声诊断重度子痫前期患者IUGR的检测特征为：敏感性56.7%，特异性93.7%，阳性预测值（PPV）81.0%，阴性预测值（NPV）81.9%。超声检测重度子痫前期患者IUGR的阳性似然比（+LR）为8.9。
目前的超声检查在诊断重度子痫前期患者的IUGR方面具有中等良好的阳性和阴性预测值以及高特异性。然而，敏感性差和低 +LR表明需要其他方法来提高超声在检测重度子痫前期患者IUGR中的实用性。
