Maruotti Giuseppe Maria, Saccone Gabriele, Martinelli Pasquale
a Department of Neuroscience , Reproductive Sciences and Dentistry, School of Medicine, University of Naples Federico II , Naples , Italy.
J Matern Fetal Neonatal Med. 2017 Apr;30(8):972-976. doi: 10.1080/14767058.2016.1193144. Epub 2016 Jun 13.
To evaluate the accuracy of sonographic measurements of fetal soft tissue in the prediction of macrosomia.
Electronic databases were searched from their inception until September 2015 with no limit for language. We included only studies assessing the accuracy of sonographic measurements of fetal soft tissue in the abdomen or thigh in the prediction of macrosomia ≥34 weeks of gestation. The primary outcome was the accuracy of sonographic measurements of fetal soft tissue in the prediction of macrosomia. We generated the forest plot for the pooled sensitivity and specificity with 95% confidence interval (CI). Additionally, summary receiver-operating characteristics (ROC) curves were plotted and the area under the curve (AUC) was also computed to evaluate the overall performance of the diagnostic test accuracy.
Three studies, including 287 singleton gestations, were analyzed. The pooled sensitivity of sonographic measurements of abdominal or thigh fetal soft tissue in the prediction of macrosomia was 80% (95% CI: 66-89%) and the pooled specificity was 95% (95% CI: 91-97%). The AUC for diagnostic accuracy of sonographic measurements of fetal soft tissue in the prediction of macrosomia was 0.92 and suggested high diagnostic accuracy.
Third-trimester sonographic measurements of fetal soft tissue after 34 weeks may help to detect macrosomia with a high degree of accuracy. The pooled detection rate was 80%. A standardization of measurements criteria, reproducibility, building reference charts of fetal subcutaneous tissue and large studies to assess the optimal cutoff of fetal adipose thickness are necessary before the introduction of fetal soft-tissue markers in the clinical practice.
评估超声测量胎儿软组织预测巨大儿的准确性。
检索电子数据库，时间跨度从建库至2015年9月，无语言限制。我们仅纳入评估孕≥34周时超声测量腹部或大腿胎儿软组织预测巨大儿准确性的研究。主要结局是超声测量胎儿软组织预测巨大儿的准确性。我们绘制了合并敏感度和特异度及其95%置信区间（CI）的森林图。此外，绘制了汇总的受试者工作特征（ROC）曲线，并计算曲线下面积（AUC）以评估诊断试验准确性的整体表现。
分析了3项研究，包括287例单胎妊娠。超声测量腹部或大腿胎儿软组织预测巨大儿的合并敏感度为80%（95%CI：66 - 89%），合并特异度为95%（95%CI：91 - 97%）。超声测量胎儿软组织预测巨大儿诊断准确性的AUC为0.92，提示诊断准确性高。
孕34周后孕晚期超声测量胎儿软组织可能有助于高度准确地检测巨大儿。合并检出率为80%。在临床实践中引入胎儿软组织标志物之前，有必要对测量标准进行标准化、提高可重复性、建立胎儿皮下组织参考图表以及开展大型研究以评估胎儿脂肪厚度的最佳临界值。
