Second Department of Obstetrics and Gynecology, Aristotle University Medical School, Thessaloniki, Greece.
BCNatal - Barcelona Center for Maternal-Fetal and Neonatal Medicine (Hospital Clinic and Hospital Sant Joan de Deu), IDIBAPS, University of Barcelona, and Center for Biomedical Research on Rare Diseases (CIBER-ER), Barcelona, Spain.
Ultrasound Obstet Gynecol. 2019 Jan;53(1):55-61. doi: 10.1002/uog.19055. Epub 2018 Nov 26.
To develop a first-trimester or combined first- and second-trimester screening algorithm for the prediction of small-for-gestational age (SGA) and late fetal growth restriction (FGR).
This was a retrospective study of women with singleton pregnancy, who underwent routine first-, second- and third-trimester ultrasound assessment. Late FGR was defined, at ≥ 32 weeks' gestation in the absence of congenital anomalies, as either (i) estimated fetal weight (EFW) or birth weight (BW) < 3 centile, or (ii) EFW < 10 centile and either uterine artery mean pulsatility index (UtA-PI) > 95 centile or cerebroplacental ratio (CPR) < 5 centile. Neonates with BW < 10 centile, regardless of prenatal parameters, were defined as SGA. The predictive effectiveness of maternal and first- and second-trimester factors was tested using logistic regression and receiver-operating characteristics curve analyses.
A total of 3520 fetuses were included (late FGR, n = 109 (3.1%); SGA, n = 292 (8.3%)). Of the late FGR cases, 56 (1.6%) fulfilled the antenatal criteria (EFW < 3 centile or EFW < 10 centile plus abnormal UtA-PI or CPR) and were defined as prenatally detected late FGR. A first-trimester screening model (comprising conception method, smoking status, maternal height, pregnancy-associated plasma protein-A (PAPP-A) and UtA-PI) could predict 50.0% of the prenatally diagnosed and 36.7% of the overall late FGR fetuses for a 10% false-positive rate (FPR). A model combining first- and second-trimester screening parameters (conception method, smoking status, PAPP-A, second- trimester EFW, head circumference/abdominal circumference ratio and UtA-PI) could predict 78.6% of the prenatally detected, and 59.6% of the overall late FGR fetuses, for a 10% FPR (area under the curve 0.901 (95% CI, 0.856-0.947) and 0.855 (95% CI, 0.818-0.891), respectively). The prediction of SGA was suboptimal for both first-trimester and combined screening.
A simple model combining maternal and first- and second-trimester predictors can detect 60% of fetuses that will develop late FGR, and 79% of those fetuses that will be classified prenatally as late FGR, for a 10% FPR. Copyright © 2018 ISUOG. Published by John Wiley & Sons Ltd.
开发一种用于预测胎儿生长受限（FGR）和晚期胎儿生长受限（FGR）的孕早期或早中孕期联合筛查算法。
这是一项回顾性研究，纳入了接受常规早、中、晚期超声评估的单胎妊娠妇女。晚期 FGR 定义为无先天畸形的孕妇在≥32 周妊娠时出现以下两种情况之一：（i）估计胎儿体重（EFW）或出生体重（BW）<第 3 百分位数，或（ii）EFW<第 10 百分位数，且子宫动脉平均搏动指数（UtA-PI）>第 95 百分位数或胎盘-胎儿比值（CPR）<第 5 百分位数。BW<第 10 百分位数的新生儿，无论产前参数如何，均定义为 SGA。使用逻辑回归和受试者工作特征曲线分析来测试母体和早、中孕期因素的预测效果。
共纳入 3520 例胎儿（晚期 FGR，n=109（3.1%）；SGA，n=292（8.3%））。晚期 FGR 病例中，56 例（1.6%）符合产前标准（EFW<第 3 百分位数或 EFW<第 10 百分位数加异常 UtA-PI 或 CPR），并被定义为产前诊断的晚期 FGR。早孕期筛查模型（包括受孕方式、吸烟状况、孕妇身高、妊娠相关血浆蛋白-A（PAPP-A）和 UtA-PI）可预测 50.0%的产前诊断和 36.7%的总体晚期 FGR 胎儿，假阳性率（FPR）为 10%。中孕期筛查参数（受孕方式、吸烟状况、PAPP-A、中孕期 EFW、头围/腹围比和 UtA-PI）联合模型可预测 78.6%的产前诊断和 59.6%的总体晚期 FGR 胎儿，FPR 为 10%（曲线下面积为 0.901（95%CI，0.856-0.947）和 0.855（95%CI，0.818-0.891））。早孕期和联合筛查对 SGA 的预测效果均不佳。
一个简单的模型，结合母体和早、中孕期预测因素，可检测出 60%的晚期 FGR 胎儿，79%的产前晚期 FGR 胎儿，FPR 为 10%。版权所有©2018 ISUOG。由 John Wiley & Sons Ltd 出版。
