Department of Obstetrics and Gynecology, Faculté de médecine, Université Paris Descartes, Sorbonne Paris Cite, Assistance Publique-Hôpitaux de Paris, Hôpital Necker Enfants Malades, 149 rue de Sèvres, 75015, Paris, France.
Prenat Diagn. 2012 Sep;32(9):869-74. doi: 10.1002/pd.3923. Epub 2012 Jun 13.
We examined the outcomes of pregnancies in which the fetal head circumference (HC) was below the 5(th) centile at the routine second-trimester scan.
We retrospectively analysed outcomes of 18,377 women according to HC Z scores at second-trimester ultrasound examination between 2001 and 2008. We collected all major malformations, intrauterine deaths and other abnormal outcomes.
Six hundred seventy-four fetuses (3.7%) had an HC below the 5(th) centile. Twenty-one major malformations were noted, consisting mainly of neurological abnormalities (3.1%). There were seven intra uterine fetal death (1.3%). Of all the fetuses, 26% were lost to follow-up. Outcome and neurological development was normal in 467 cases, based on neonatal examination and/or parent or general practitioner reports. Major abnormalities were noted in respectively 26.2%, 3.0% and 1.1% of fetuses with Z scores < -2.5, -2.5 to -2.0, and -2 to -1.645, compared with 0.3% of fetuses with normal HC (p < 10(-4)).
A head circumference below the 5(th) centile at second-trimester scan is associated with various abnormalities, especially neurological disorders. The outcome was worse when the HC was smaller. An HC Z score below -2.5 was strongly associated with neurological and chromosomal abnormalities. Conversely, an HC Z score below -1.645 but above -2, excluding cases with prenatally diagnosed malformations, seems to be reassuring for favorable neonatal outcome.
我们研究了在常规的孕中期超声检查中，胎儿头围（HC）低于第 5 百分位数的妊娠结局。
我们回顾性分析了 2001 年至 2008 年期间，18377 名女性在孕中期超声检查中 HC Z 评分的结果。我们收集了所有主要畸形、宫内胎儿死亡和其他异常结果。
674 例胎儿（3.7%）HC 低于第 5 百分位数。注意到 21 例主要畸形，主要为神经异常（3.1%）。有 7 例宫内胎儿死亡（1.3%）。所有胎儿中有 26%因失访而丢失。根据新生儿检查和/或父母或全科医生的报告，467 例胎儿的结局和神经发育正常。与 HC 正常的胎儿（0.3%）相比，Z 评分< -2.5、-2.5 至-2.0 和-2 至-1.645 的胎儿中，分别有 26.2%、3.0%和 1.1%有主要异常（p<10(-4)）。
孕中期超声检查时头围低于第 5 百分位数与各种异常有关，特别是神经障碍。当 HC 较小时，结果更差。HC Z 评分低于-2.5 与神经和染色体异常强烈相关。相反，HC Z 评分低于-1.645 但高于-2，排除产前诊断畸形的病例，似乎对新生儿良好结局有保证。
