Nelson David B, Martin Robert, Twickler Diane M, Santiago-Munoz Patricia C, McIntire Donald D, Dashe Jodi S
Departments of Obstetrics and Gynecology (D.B.N., R.M., D.M.T., P.C.S.-M., D.D.M., J.S.D.) and Radiology (D.M.T.), University of Texas Southwestern Medical Center, Dallas, Texas USA.
J Ultrasound Med. 2015 Dec;34(12):2217-23. doi: 10.7863/ultra.15.01026. Epub 2015 Oct 30.
The purpose of this study was to estimate the utility of sonography to detect small-for-gestational-age (SGA) neonates in pregnancies with gastroschisis and to evaluate neonatal outcomes according to birth weight percentile.
We conducted a retrospective cohort study of singleton pregnancies with fetal gastroschisis delivered at our hospital between August 1997 and December 2012. Diagnosis of growth restriction was based on estimated fetal weight below the 10th percentile using the nomogram of Hadlock et al (Am J Obstet Gynecol 1985; 151:333-337), evaluated at 4-week intervals throughout gestation and compared with subsequent birth weight, to evaluate the accuracy of sonography to detect and exclude SGA neonates. Pregnancy and neonatal outcomes were evaluated according to birth weight percentile.
There were 111 births with gastroschisis (6 per 10,000), and one-third (n = 37) had birth weight below the 10th percentile. The sensitivity and negative predictive value of sonography for an SGA neonate both approached 90% by 32 weeks and were approximately 95% thereafter. Detection increased with advancing gestational age (P = .02). The birth weight percentile was not associated with preterm birth, infection, bowel complications requiring surgery, duration of hospitalization, or perinatal mortality. Delayed closure of the gastroschisis defect was more frequent with birth weights at or below the 3rd percentile (P = .03).
Sonography reliably identified SGA neonates with gastroschisis in our series, and its utility improved with advancing gestation. Apart from delayed closure of the defect, a low birth weight percentile was not associated with an increased risk of morbidity or mortality in the immediate neonatal period.
本研究旨在评估超声检查在腹裂妊娠中检测小于胎龄（SGA）新生儿的效用，并根据出生体重百分位数评估新生儿结局。
我们对1997年8月至2012年12月在我院分娩的单胎腹裂妊娠进行了一项回顾性队列研究。生长受限的诊断基于使用Hadlock等人的图表（《美国妇产科杂志》1985年；151:333 - 337）估计胎儿体重低于第10百分位数，在整个孕期每隔4周进行评估，并与随后的出生体重进行比较，以评估超声检查检测和排除SGA新生儿的准确性。根据出生体重百分位数评估妊娠和新生儿结局。
共有111例腹裂分娩（每10000例中有6例），三分之一（n = 37）的出生体重低于第10百分位数。超声检查对SGA新生儿的敏感性和阴性预测值在32周时均接近90%，此后约为95%。随着孕周增加，检测率上升（P = 0.02）。出生体重百分位数与早产、感染、需要手术的肠道并发症、住院时间或围产期死亡率无关。腹裂缺损延迟闭合在出生体重处于或低于第3百分位数时更为常见（P = 0.03）。
在我们的系列研究中，超声检查能够可靠地识别腹裂SGA新生儿，其效用随着孕周增加而提高。除了缺损延迟闭合外，低出生体重百分位数与新生儿早期发病或死亡风险增加无关。
