Arakaki Tatsuya, Hasegawa Junichi, Nakamura Masamitsu, Takita Hiroko, Hamada Shoko, Oba Tomohiro, Matsuoka Ryu, Sekizawa Akihiko
Department of Obstetrics and Gynecology, Showa University School of Medicine, Tokyo, Japan.
Department of Obstetrics and Gynaecology, St. Marianna University School of Medicine, Kanagawa, Japan.
J Matern Fetal Neonatal Med. 2020 Feb;33(4):564-569. doi: 10.1080/14767058.2018.1497601. Epub 2018 Sep 19.
To clarify whether early-onset fetal growth restriction (EO-FGR) could be distinguished from late-onset (LO)-FGR using ultrasonographic evaluations of the uterine artery (UtA) Doppler indices and the three-dimensional (3D) ultrasound placental volume (PV) in the first trimester. Subjects with 1362 singleton pregnancies who underwent an ultrasound scan at 11-13 weeks were enrolled prospectively. The UtA Doppler and PV indices in cases with EO-FGR (<32 weeks at diagnosis) and LO-FGR (≥32 weeks at diagnosis) later in pregnancy were compared with the control group. Twenty-eight EO-FGR, 73 LO-FGR, and 1261 control groups were analyzed. The crown-rump length (CRL) and PV were smaller in both EO and LO-FGR groups than in the control group. The UtA resistance index (RI) -score was significantly higher in the EO-FGR group than in the control group (0.723 versus 0.086, < .001), but did not differ between LO-FGR and the control group. The area under the receiver operating characteristics curve for the prediction of EO-FGR by combining the uterine artery resistance index (UtA-RI) and CRL was 0.760 (95% CI: 0.654-0.865). The detection rate for EO-FGR was 45.8%, with a 10% false-positive rate. Both EO- and LO-FGR are associated with a small CRL in the first trimester. High UtA-RI is associated with EO-FGR, while a small maternal height and PV are associated with LO-FGR.
为了明确在孕早期通过子宫动脉（UtA）多普勒指数和三维（3D）超声胎盘体积（PV）的超声评估能否区分早发型胎儿生长受限（EO-FGR）和晚发型（LO）-FGR。前瞻性纳入了1362例在孕11 - 13周接受超声检查的单胎妊娠受试者。将妊娠后期诊断为EO-FGR（诊断时孕周<32周）和LO-FGR（诊断时孕周≥32周）的病例的UtA多普勒和PV指数与对照组进行比较。分析了28例EO-FGR、73例LO-FGR和1261例对照组。EO和LO-FGR组的头臀长（CRL）和PV均小于对照组。EO-FGR组的UtA阻力指数（RI）评分显著高于对照组（0.723对0.086，P<0.001），但LO-FGR组与对照组之间无差异。通过联合子宫动脉阻力指数（UtA-RI）和CRL预测EO-FGR的受试者工作特征曲线下面积为0.760（95%CI：0.654 - 0.865）。EO-FGR的检出率为45.8%，假阳性率为10%。早发型和晚发型FGR在孕早期均与较小的CRL相关。高UtA-RI与EO-FGR相关，而母亲身高矮小和PV小与LO-FGR相关。
