Wie Jeong Ha, Choe Suyearn, Kim Sa Jin, Shin Jong Chul, Kwon Ji Young, Park In Yang
Department of Obstetrics and Gynecology (J.H.W., S.J.K., J.C.S., J.Y.K., I.Y.P.) and Physiology Laboratory (S.C.), Catholic University of Korea, Seoul, Korea.
J Ultrasound Med. 2015 Oct;34(10):1777-84. doi: 10.7863/ultra.15.14.09012. Epub 2015 Aug 31.
To evaluate the value of volume measurement using 3-dimensional sonography for prediction of miscarriage.
We prospectively enrolled 188 singleton pregnant women at 5 to 9 weeks' gestation. The 3-dimensional sonographic gestational sac volume and yolk sac volume were measured together with the fetal heart rate, gestational sac diameter, and yolk sac diameter. For each sonographic parameter, nomograms were created; z scores were calculated for each measurement, and the values were compared between miscarriage and ongoing pregnancy groups. Sonographic parameters for prediction of miscarriage were evaluated by multivariate analysis, and the screening performance was assessed by a receiver operating characteristic curve.
Among the 188 pregnancies, 30 (16.0%) had miscarriage. Multivariate analysis showed that fetal heart rate below the 5th percentile (odds ratio, 6.43), gestational sac diameter below the 5th percentile (odds ratio, 4.87), gestational sac volume below the 5th percentile (odds ratio, 5.25), and yolk sac diameter below the 2.5th or above the 97.5th percentile (odds ratio, 15.86) were significant predictors of miscarriage (P = .018; P = .018; P = .033; and P < .001, respectively). At a false-positive rate of 30%, the detection rate for miscarriage in screening by a combination of fetal heart rate, gestational sac diameter, gestational sac volume, and yolk sac diameter was 77.8%.
A small-for-gestational-age gestational sac volume is a significant sonographic predictor of miscarriage, as are fetal bradycardia, a small gestational sac diameter, and a small or large yolk sac diameter.
评估三维超声测量容积在预测流产中的价值。
前瞻性纳入188例孕5至9周的单胎孕妇。测量三维超声下妊娠囊容积、卵黄囊容积，同时测量胎儿心率、妊娠囊直径和卵黄囊直径。针对每个超声参数绘制列线图；计算每次测量的z分数，并比较流产组和继续妊娠组的值。通过多因素分析评估预测流产的超声参数，并通过受试者工作特征曲线评估筛查性能。
188例妊娠中，30例（16.0%）发生流产。多因素分析显示，胎儿心率低于第5百分位数（比值比，6.43）、妊娠囊直径低于第5百分位数（比值比，4.87）、妊娠囊容积低于第5百分位数（比值比，5.25）以及卵黄囊直径低于第2.5百分位数或高于第97.5百分位数（比值比，15.86）是流产的显著预测因素（P = 0.018；P = 0.018；P = 0.033；P < 0.001）。在假阳性率为30%时，联合胎儿心率、妊娠囊直径、妊娠囊容积和卵黄囊直径进行筛查时，流产的检出率为77.8%。
孕周对应的妊娠囊容积小是流产的重要超声预测指标，胎儿心动过缓、妊娠囊直径小以及卵黄囊直径小或大也是如此。
