Nuffield Department of Obstetrics & Gynaecology, University of Oxford, Oxford, UK.
Ultrasound Med Biol. 2013 Feb;39(2):253-60. doi: 10.1016/j.ultrasmedbio.2012.09.003. Epub 2012 Dec 4.
Fetal growth restriction is one of the greatest risk factors for stillbirth. This pilot cohort study examined whether rapid placental volume (PlaV) calculation at 11 to 13 + 6 weeks can predict the small for gestational age (cSGA) baby. Women with singleton pregnancies were recruited (N = 145), a static three-dimensional (3-D) volume was captured, and the placental volume was computed using a semi-automated technique. Regression analysis explored the relationships between customized birth weight, placental quotient (PQ), standardized placental volume (sPlaV), and other predictors of SGA (including pregnancy-associated protein and uterine artery pulsatility index (PI). The results were examined using receiver-operating characteristic (ROC) curve analysis in the total population and then in the 2 subgroups whose members were classified as low risk or high risk at booking. Both PQ and sPlaV were significantly different for cSGA pregnancies compared to appropriate for gestational age (AGA) babies (p = 0.003 and <0.001, respectively) but only sPlaV was normally distributed. The independent predictors of birth weight (sPlaV, pregnancy associated protein, and nuchal translucency) were combined to produce a predictive model for cSGA. The ROC curves for prediction of cSGA in all 143 women gave areas under the curve of 0.77 (0.66 to 0.87) for sPlaV alone and 0.80 (0.69 to 0.92) for the combined model. When this was applied to the low-risk group, the areas under the curve were 0.82 (0.69 to 0.94) and 0.84 (0.72 to 0.95), respectively. For the high-risk group, the areas under the curve were 0.67 (0.45 to 0.86) for sPlaV alone and 0.76 (0.55 to 0.96) for the combined model. The use of this rapid-image analysis technique and dimensionless index to correct for gestation brings the possibility of an early combined screening test for the cSGA baby a step closer.
胎儿生长受限是导致死产的最大风险因素之一。这项初步队列研究旨在探讨 11 至 13+6 周时快速胎盘容量（PlaV）计算能否预测胎儿生长受限（SGA）。招募了单胎妊娠的女性（N=145），采集了静态三维（3-D）容积，并使用半自动技术计算胎盘容量。回归分析探讨了定制出生体重、胎盘商数（PQ）、标准化胎盘体积（sPlaV）与 SGA 其他预测因素（包括妊娠相关蛋白和子宫动脉搏动指数（PI））之间的关系。在总人群中，使用接收者操作特征（ROC）曲线分析来检验结果，然后在登记时被归类为低风险或高风险的 2 个亚组中进行检验。与适于胎龄（AGA）婴儿相比，sPlaV 和 PQ 在 SGA 妊娠中差异显著（p=0.003 和<0.001），但仅 sPlaV 呈正态分布。出生体重的独立预测因子（sPlaV、妊娠相关蛋白和颈项透明层）结合在一起，为 SGA 建立了预测模型。对所有 143 名女性进行的 cSGA 预测 ROC 曲线分析显示，sPlaV 单独预测 cSGA 的曲线下面积为 0.77（0.66 至 0.87），联合模型为 0.80（0.69 至 0.92）。当将其应用于低危组时，曲线下面积分别为 0.82（0.69 至 0.94）和 0.84（0.72 至 0.95）。高危组中，sPlaV 单独预测的曲线下面积为 0.67（0.45 至 0.86），联合模型为 0.76（0.55 至 0.96）。这种快速图像分析技术和用于校正孕周的无维度指数的使用，使 SGA 婴儿的早期联合筛查试验更近了一步。
