Department of Obstetrics, Gynecology, and Reproductive Science, Icahn School of Medicine at Mount Sinai, and Maternal-Fetal Medicine Associates, PLLC, New York, New York.
Obstet Gynecol. 2018 Oct;132(4):1033-1039. doi: 10.1097/AOG.0000000000002811.
To report the utility of the ultrasonographic biophysical profile, which includes all the components of a biophysical profile minus the nonstress test, in women with maternal indications for antepartum surveillance.
We conducted a case series reviewing the records of all women at 32 weeks of gestation or greater with at least one indication for antenatal testing (per the American College of Obstetricians and Gynecologists) delivered by a single maternal-fetal medicine practice between 2006 and 2018. Indications included diabetes, hypertension, lupus, antiphospholipid syndrome, sickle cell disease, renal disease, heart disease, hyperthyroidism, isoimmunization, inherited thrombophilia, and prior intrauterine fetal demise. Weekly ultrasonographic biophysical profiles were initiated at 32 weeks of gestation. We calculated the test-positive rate, the percentage of women delivered for an abnormal ultrasonography biophysical profile, and the intrauterine fetal demise rate (false-negative rate).
Nine hundred eighty-five women underwent 3,981 ultrasonographic biophysical profiles (four per woman; range 1-11). Sixteen women had an abnormal ultrasonographic biophysical profile, for a test positive rate of 1.6% (95% CI 1.0-2.6%) per woman, or 0.4% (95% CI 0.3-0.7%) per ultrasonographic biophysical profile. Of the 16 women with abnormal ultrasonographic biophysical profiles, 13 were delivered with good outcomes and three women had normal follow-up testing and uncomplicated deliveries at a later date. There were three women with intrauterine fetal demise (false-negative rate of 0.3%, 95% CI 0.1-0.9%). One woman with intrauterine fetal demise had a factor V Leiden mutation, fetal ventriculomegaly, and fetal growth restriction. The second woman with intrauterine fetal demise had advanced maternal age, a factor V Leiden mutation, and fetal growth restriction. The third woman with intrauterine fetal demise had class B diabetes. All three intrauterine fetal demises were diagnosed antepartum with an interval from normal ultrasonographic biophysical profile to intrauterine fetal demise of 7, 7, and 6 days, respectively.
The use of ultrasonographic biophysical profile in a high-risk cohort is associated with a very low test-positive rate and a very low incidence of intrauterine fetal demise. In women with preexisting medical conditions that place them at higher risk for intrauterine fetal demise, ultrasonographic biophysical profile can be used for antenatal testing.
报告超声生物物理评分的实用性，该评分包括生物物理评分的所有组成部分，但不包括非应激试验，适用于有产前监测指征的孕妇。
我们进行了一项病例系列研究，回顾了 2006 年至 2018 年间在一家母胎医学实践中心分娩的至少有一项产前检查指征（根据美国妇产科医师学会）的所有 32 周及以上孕妇的记录。这些指征包括糖尿病、高血压、狼疮、抗磷脂综合征、镰状细胞病、肾脏疾病、心脏病、甲状腺功能亢进、同种免疫、遗传性血栓形成倾向和宫内胎儿死亡。每周进行超声生物物理评分，于 32 周时开始。我们计算了阳性检出率、因异常超声生物物理评分而分娩的妇女百分比以及宫内胎儿死亡率（假阴性率）。
985 名妇女接受了 3981 次超声生物物理评分（每位妇女 4 次；范围 1-11 次）。16 名妇女的超声生物物理评分异常，阳性检出率为每位妇女 1.6%（95%置信区间 1.0-2.6%），或每次超声生物物理评分 0.4%（95%置信区间 0.3-0.7%）。在 16 名超声生物物理评分异常的妇女中，13 名分娩结局良好，3 名妇女在随后的随访检查中结果正常且分娩顺利。有 3 名妇女发生宫内胎儿死亡（假阴性率为 0.3%，95%置信区间 0.1-0.9%）。1 名宫内胎儿死亡的妇女存在因子 V Leiden 突变、胎儿脑室扩大和胎儿生长受限。第 2 名宫内胎儿死亡的妇女存在高龄、因子 V Leiden 突变和胎儿生长受限。第 3 名宫内胎儿死亡的妇女患有 B 类糖尿病。这 3 例宫内胎儿死亡均在产前通过超声生物物理评分诊断，从正常超声生物物理评分到宫内胎儿死亡的间隔分别为 7、7 和 6 天。
在高危孕妇中使用超声生物物理评分，其阳性检出率和宫内胎儿死亡发生率均非常低。对于有更高宫内胎儿死亡风险的孕妇，可使用超声生物物理评分进行产前检查。
