Department of Obstetrics and Gynecology, Gangnam Severance Hospital, Institute of Women's Life Medical Science, Yonsei University College of Medicine, Seoul, Korea.
Department of Obstetrics and Gynecology, Severance Hospital, Institute of Women's Life Medical Science, Yonsei University College of Medicine, Seoul, Korea.
PLoS One. 2019 Apr 26;14(4):e0215737. doi: 10.1371/journal.pone.0215737. eCollection 2019.
Small-for-gestational age (SGA) infants should be identified before birth because of an increased risk of adverse perinatal outcomes. The objective of this study was to assess the impact of fetal growth rate by gestational age on the prediction of SGA and to identify the optimal time to initiate intensive fetal monitoring to detect SGA in low-risk women. We also sought to determine which the ultrasonographic parameters that contribute substantially to the birthweight determination.
This was a retrospective study of 442 healthy pregnant women with singleton pregnancies. There were 328 adequate-for-gestational age (AGA) neonates and 114 SGA infants delivered between 37+0 and 41+6 weeks of gestation. We compared the biparietal diameters (BPD), head circumferences (HC), abdominal circumferences (AC), femur lengths (FL), and estimated fetal weights (EFW) obtained on each ultrasound to determine which of these parameters was the best indicator of SGA. We created receiver operating characteristic curves, calculated the areas under the curves (AUCs), and analyzed the data using multivariable logistic regressions to assess the ultrasound screening performances and identify the best predictive factor.
Among the four ultrasonographic parameters, the AC measurement between 24+028+6 weeks achieved a sensitivity of 79.5% and a specificity of 71.7%, with an AUC of 0.806 in the prediction of SGA. AC showed consistently higher AUCs above 0.8 with 6480% sensitivities as gestational age progressed. EFW measurements from 33+035+6 gestational weeks achieved a sensitivity of 60.6% and a specificity of 87.6%, with an AUC of 0.826. In a conditional growth model developed from the linear mixed regression, the value differences between AC and EFW in the SGA and AGA groups became even more pronounced after 33+035+6 weeks.
Healthy low-risk women with a low fetal AC after 24 weeks' gestation need to be monitored carefully for fetal growth to identify SGA infants with a risk for adverse perinatal outcomes.
由于围产期不良结局的风险增加，应在出生前识别出小于胎龄儿（SGA）。本研究的目的是评估胎龄相关的胎儿生长速度对 SGA 预测的影响，并确定在低危孕妇中开始强化胎儿监测以发现 SGA 的最佳时间。我们还试图确定哪些超声参数对确定出生体重有重要贡献。
这是一项回顾性研究，纳入了 442 名单胎妊娠的健康孕妇。其中 328 名胎儿大小与胎龄相符（AGA），114 名 SGA 婴儿在 37+0 至 41+6 周之间分娩。我们比较了每个超声检查中获得的双顶径（BPD）、头围（HC）、腹围（AC）、股骨长（FL）和估计胎儿体重（EFW），以确定这些参数中哪一个是 SGA 的最佳指标。我们绘制了受试者工作特征曲线，计算了曲线下面积（AUC），并使用多变量逻辑回归分析数据，以评估超声筛查性能并确定最佳预测因素。
在四个超声参数中，24+028+6 周的 AC 测量在预测 SGA 方面具有 79.5%的敏感性和 71.7%的特异性，AUC 为 0.806。随着胎龄的增加，AC 的 AUC 始终高于 0.8，其敏感性为 64%80%。33+035+6 周的 EFW 测量具有 60.6%的敏感性和 87.6%的特异性，AUC 为 0.826。在从线性混合回归中建立的条件生长模型中，在 33+035+6 周之后，SGA 和 AGA 组中 AC 和 EFW 之间的差值变得更加明显。
在妊娠 24 周后，胎龄较小的健康低危孕妇需要仔细监测胎儿生长情况，以识别有不良围产期结局风险的 SGA 婴儿。
