Department of Obstetrics and Gynaecology, São Paulo University Medical School, São Paulo, Brazil.
Fetal Diagn Ther. 2014;35(1):44-50. doi: 10.1159/000355936. Epub 2013 Nov 29.
To evaluate the fetal omphalocele diameter/abdominal circumference ratio (OD/AC) as a predictor of adverse perinatal outcome.
Analysis involving 47 singleton pregnancies with fetal omphalocele, normal karyotype and absence of other major abnormalities. The OD/AC ratio was determined antenatally by ultrasound and the best cutoff for the prediction of neonatal death was determined by receiver operating characteristic curve analysis. Additional secondary outcomes included need for oral intubation in the first 24 h of life, two-step surgery or use of synthetic mesh, reoperation, parenteral feeding and need for respiratory assistance >21 days, time to first oral feed, and time to hospital discharge.
Fetal OD/AC did not change significantly with gestational age. Postnatal death occurred in 10 (21.3%) cases and the best cutoff for prediction was an OD/AC ratio ≥0.26. In pregnancies with the first ultrasound evaluation performed before 31 weeks' gestation and an OD/AC ≥0.26, the likelihood ratio for needing intubation in the first 24 h of life was 2.6 (95% CI: 1.2-5.7), needing two-step surgery or use of mesh was 4.9 (95% CI: 1.9-14.4), and postnatal death was 4 (95% CI: 1.9-7.5).
A fetal ultrasound OD/AC ratio ≥0.26 is associated with increased postnatal morbidity and mortality.
评估胎儿脐膨出直径/腹围比值（OD/AC）作为预测不良围产结局的指标。
分析了 47 例胎儿脐膨出、正常核型和无其他主要异常的单胎妊娠。通过超声检查在产前确定 OD/AC 比值，并通过受试者工作特征曲线分析确定预测新生儿死亡的最佳截断值。其他次要结局包括生后 24 小时内需要经口插管、两步手术或使用合成网片、再次手术、肠外营养和需要呼吸支持>21 天、首次口服喂养时间和住院时间。
胎儿 OD/AC 与胎龄无显著变化。10 例（21.3%）发生新生儿死亡，最佳预测截断值为 OD/AC 比值≥0.26。对于在 31 周前进行首次超声评估且 OD/AC≥0.26 的妊娠，生后 24 小时内需要插管的可能性比为 2.6（95%CI：1.2-5.7），需要两步手术或使用网片的可能性比为 4.9（95%CI：1.9-14.4），新生儿死亡的可能性比为 4（95%CI：1.9-7.5）。
胎儿超声 OD/AC 比值≥0.26 与增加的新生儿发病率和死亡率相关。
