Nakamura Masamitsu, Hasegawa Junichi, Arakaki Tatsuya, Takita Hiroko, Hamada Shoko, Ichizuka Kiyotake, Sekizawa Akihiko
Department of Obstetrics and Gynecology, Showa University School of Medicine, Tokyo, Japan.
Fetal Diagn Ther. 2015;38(4):262-8. doi: 10.1159/000381803. Epub 2015 May 8.
To clarify whether ultrasonographic measurements of crown-rump length (CRL) at 11-13 weeks - based on the number of gestational days determined using the CRL at 9 weeks - can predict fetal prognosis.
A prospective cohort study was conducted to evaluate the association between fetal growth in the first trimester and fetal prognosis. Fetal growth in the first trimester was evaluated measuring CRLs at 11-13 weeks determined using the CRL at 9 weeks. The subjects were divided into short CRL (s-CRL) and normal CRL (n-CRL). The prognoses were compared between the two groups.
A total of 126 patients in the s-CRL group and 1,130 patients in the n-CRL group were enrolled. Abortion occurred in 7.1% of s-CRL and 0.9% of n-CRL subjects (p < 0.001). Among the patients with chromosomal abnormalities, the incidence of trisomy 18 was significantly greater in s-CRL (4.8 vs. 0.1%, p < 0.001). Without abortion, placental weight, frequency of small for gestational age (SGA) and birth weight in s-CRL were significantly higher than those in the n-CRL group (12.8 vs. 3.6%, p < 0.001).
Measuring CRL at 9 weeks is useful for determining gestational days prior to measuring CRL at 11-13 weeks. After reconfirming the gestational age at 9 weeks, measuring CRL at 11-13 weeks is useful for predicting the incidence of trisomy 18 as well as SGA later in pregnancy.
明确基于9周时头臀长（CRL）确定的妊娠天数，在11至13周时通过超声测量CRL是否能够预测胎儿预后。
进行一项前瞻性队列研究，以评估孕早期胎儿生长与胎儿预后之间的关联。通过测量9周时的CRL来确定11至13周时的CRL，以此评估孕早期胎儿生长情况。将研究对象分为CRL较短组（s-CRL）和CRL正常组（n-CRL）。比较两组的预后情况。
s-CRL组共纳入126例患者，n-CRL组共纳入1130例患者。s-CRL组的流产率为7.1%，n-CRL组为0.9%（p<0.001）。在染色体异常患者中，s-CRL组18三体的发生率显著高于n-CRL组（4.8%对0.1%，p<0.001）。在未发生流产的情况下，s-CRL组的胎盘重量以及小于胎龄儿（SGA）的发生率和出生体重均显著高于n-CRL组（12.8%对3.6%，p<0.001）。
在11至13周测量CRL之前，测量9周时的CRL有助于确定妊娠天数。在再次确认9周时的孕周后于11至13周测量CRL，有助于预测妊娠后期18三体以及SGA的发生率。
