Lap Chiara C, Voskuilen Charlotte S, Pistorius Lourens R, Mulder Eduard J H, Visser Gerard H A, Manten Gwendolyn T R
Department of Obstetrics, University Medical Center Utrecht, Division Woman and Baby, Utrecht, The Netherlands.
Department of Obstetrics and Gynaecology, University of Stellenbosch, Stellenbosch, South Africa.
J Matern Fetal Neonatal Med. 2020 Feb;33(4):633-638. doi: 10.1080/14767058.2018.1498837. Epub 2019 Jan 6.
To establish reference curves of normal fetal small bowel and colon diameters and to assess the clinical applicability. Serial longitudinal ultrasound examinations at 4-week intervals between 20 to 41 weeks of gestation in 39 low-risk fetuses. The largest loop of the small bowel and colon was identified. The bowel lumen short axis was measured. Linear mixed modeling was used to determine individual developmental trajectories. Twenty-eight fetuses with suspected bowel dilatation were analyzed relative to the reference curves. Development of the small bowel and colon diameters was best described by a linear and cubic model, respectively. The intraobserver and interobserver concordance were >0.94. In cases with suspected bowel dilatation, normal fetal outcome occurred if the bowel dilatation was transient. Progressive increase of fetal bowel diameter was associated with pathology after birth. Cases with small bowel pathology had a -score >8 after 25 weeks of gestation. We provided the first ultrasound reference curves for normal fetal small bowel and colon diameters. Progressive increase in the fetal bowel diameter -score was highly predictive of intestinal abnormalities after birth. Longitudinal follow-up of dilated fetal bowel is important to distinguish normality from disease.
建立正常胎儿小肠和结肠直径的参考曲线并评估其临床适用性。对39例低风险胎儿在妊娠20至41周期间每隔4周进行系列纵向超声检查。确定小肠和结肠的最大肠袢。测量肠腔短轴。采用线性混合模型确定个体发育轨迹。相对于参考曲线分析了28例疑似肠扩张的胎儿。小肠和结肠直径的发育分别用线性模型和三次模型能得到最佳描述。观察者内和观察者间的一致性>0.94。在疑似肠扩张的病例中，如果肠扩张是短暂的，则胎儿预后正常。胎儿肠直径的逐渐增加与出生后的病变相关。妊娠25周后小肠病变的病例z评分>8。我们提供了首个正常胎儿小肠和结肠直径的超声参考曲线。胎儿肠直径z评分的逐渐增加对出生后肠道异常具有高度预测性。对扩张胎儿肠进行纵向随访对于区分正常与疾病很重要。
