中孕期超声孤立性股骨短：胎儿生长受限及其他不良围产结局的一个标志物。
Isolated short femur length on second-trimester sonography: a marker for fetal growth restriction and other adverse perinatal outcomes.
机构信息
MSCI, Department of Obstetrics and Gynecology, Washington University School of Medicine, 4911 Barnes-Jewish Hospital Plaza, Campus Box 8064, St Louis, MO 63110, USA.
出版信息
J Ultrasound Med. 2012 Dec;31(12):1935-41. doi: 10.7863/jum.2012.31.12.1935.
OBJECTIVES
To estimate the association between isolated second-trimester short femur length and fetal growth restriction as well as other adverse perinatal outcomes.
METHODS
We conducted a retrospective cohort study of patients with singleton gestations presenting for sonography between 16 and 24 weeks' gestation from 1990 to 2009. Cases of aneuploidy, skeletal dysplasia, and major anomalies were excluded. Short femur length was defined as length below the 10th percentile for gestational age and was considered isolated when both the estimated fetal weight and abdominal circumference were above the 10th percentile for gestational age. Isolated short femur length below the 5th percentile was also evaluated. The primary outcome was fetal growth restriction, defined as birth weight below the 10th percentile. Secondary outcomes included preeclampsia and preterm birth before 37 and 34 weeks. Univariable and multivariable logistic regression analyses were used to estimate the risk of these outcomes in fetuses with isolated short femur length.
RESULTS
Of 73,884 patients, 569 (0.8%) had a fetus with a femur length below the 10th percentile, of which 268 (47.1%) were isolated; 210 patients (0.3%) had a fetus with a femur length below the 5th percentile, of which 34 (16.2%) were isolated. Isolated short femur lengths below the 10th and 5th percentiles were associated with an increased risk of fetal growth restriction (<10th: adjusted odds ratio [aOR], 3.4; 95% confidence interval [CI], 2.4-4.6; <5th: aOR, 4.6; 95% CI, 2.0-10.7) and also with an increased risk of preterm birth before 37 and 34 weeks. There was no significant association between isolated short femur length and preeclampsia.
CONCLUSIONS
Isolated short femur length on second-trimester sonography is associated with a greater than 3-fold increased risk of fetal growth restriction and an increased risk of preterm birth. Serial growth assessment may be warranted in these cases.
目的
评估孤立性中期股骨短与胎儿生长受限以及其他不良围产结局之间的关联。
方法
我们进行了一项回顾性队列研究，纳入了 1990 年至 2009 年间在 16 至 24 孕周进行超声检查的单胎妊娠患者。排除了染色体异常、骨骼发育不良和主要畸形的病例。股骨短定义为长度低于胎龄第 10 百分位数，当估计胎儿体重和腹围均高于胎龄第 10 百分位数时，则认为是孤立性的。我们还评估了第 5 百分位数以下的孤立性股骨短。主要结局为胎儿生长受限，定义为出生体重低于第 10 百分位数。次要结局包括子痫前期和 37 周和 34 周前的早产。采用单变量和多变量逻辑回归分析来评估孤立性股骨短胎儿发生这些结局的风险。
结果
在 73884 例患者中，569 例（0.8%）胎儿的股骨长度低于第 10 百分位数，其中 268 例（47.1%）为孤立性的；210 例（0.3%）胎儿的股骨长度低于第 5 百分位数，其中 34 例（16.2%）为孤立性的。第 10 百分位数和第 5 百分位数以下的孤立性股骨短与胎儿生长受限的风险增加相关（<10 百分位：调整后的优势比[aOR]，3.4；95%置信区间[CI]，2.4-4.6；<5 百分位：aOR，4.6；95%CI，2.0-10.7），并且还与 37 周和 34 周前早产的风险增加相关。孤立性股骨短与子痫前期之间无显著关联。
结论
中期超声检查发现孤立性股骨短与胎儿生长受限的风险增加 3 倍以上以及早产的风险增加相关。在这些情况下可能需要进行连续的生长评估。
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