Drouin Olivier, Boutin Amélie, Paquette Kim, Gasse Cédric, Guerby Paul, Demers Suzanne, Bujold Emmanuel
Department of Gynecology, Obstetrics and Reproduction, Faculty of Medicine, Université Laval, Québec City, QC; Department of Obstetrics and Gynecology, Cumming School of Medicine, University of Calgary, Calgary, AB.
Reproduction, Mother and Child Health Unit, CHU de Québec - Université Laval Research Centre, Université Laval, Québec City, QC.
J Obstet Gynaecol Can. 2018 Dec;40(12):1592-1599. doi: 10.1016/j.jogc.2018.02.004. Epub 2018 Oct 10.
To estimate the role of first-trimester uterine artery pulsatility index (UtA-PI) for the prediction of small-for-gestational age (SGA).
We conducted a prospective cohort study of nulliparous women with singleton pregnancy (Great Obstetrical Syndromes study). UtA-PI was performed at 11 + 0 to 13 + 6 weeks and was reported in multiple of median (MoM). SGA was defined as birth weight below the 10th percentile and stratified as term or preterm SGA. Receiver operating characteristic curves analyses with their area under the curve (AUC) were used to estimate the predictive values of UtA-PI, alone and UtA-PI combined with maternal characteristics. We computed the detection rate and false-positive rate (FPR) of the SOGC SGA screening guidelines in our population.
Of 4610 participants, SGA was identified in 486 pregnancies (10.3%), including 15 (0.3%) associated with preterm delivery. Compared with unaffected pregnancies, the mean log UtA-PI was significantly higher in term SGA and preterm SGA. The difference between preterm SGA and unaffected pregnancies remains significant after exclusion of SGA without preeclampsia. First-trimester UtA-PI was more predictive of preterm (AUC: 0.89) than term (AUC: 0.60) SGA (P < 0.01). Combined with maternal characteristics, UtA-PI could have predicted 64% of preterm and 20% of term SGA (10% FPR). The SOGC guidelines criteria for early screening of SGA had a detection rate of 21% for a FPR of 21%.
First-trimester UtA-PI can be used to predict SGA, but mainly preterm SGA. The current SOGC guidelines criteria for SGA screening are not efficient in nulliparous women.
评估孕早期子宫动脉搏动指数（UtA-PI）在预测小于胎龄儿（SGA）方面的作用。
我们对单胎妊娠的初产妇进行了一项前瞻性队列研究（大产科综合征研究）。在孕11⁺⁰至13⁺⁶周测量UtA-PI，并以中位数倍数（MoM）报告。SGA定义为出生体重低于第10百分位数，并分为足月或早产SGA。采用受试者工作特征曲线分析及其曲线下面积（AUC）来评估UtA-PI单独以及UtA-PI与母体特征联合的预测价值。我们计算了人群中SOGC SGA筛查指南的检出率和假阳性率（FPR）。
在4610名参与者中，486例妊娠（10.3%）被诊断为SGA，其中15例（0.3%）与早产有关。与未受影响的妊娠相比，足月SGA和早产SGA的平均UtA-PI对数显著更高。排除无先兆子痫的SGA后，早产SGA与未受影响妊娠之间的差异仍然显著。孕早期UtA-PI对早产SGA（AUC：0.89）的预测性高于足月SGA（AUC：0.60）（P<0.01）。结合母体特征，UtA-PI可预测64%的早产SGA和20%的足月SGA（FPR为10%）。SOGC SGA早期筛查指南标准的检出率为21%，FPR为21%。
孕早期UtA-PI可用于预测SGA，但主要是早产SGA。目前SOGC SGA筛查指南标准在初产妇中效率不高。
