Division of Maternal Fetal Medicine, Department of Obstetrics and Gynecology, Sidney Kimmel Medical College at Thomas Jefferson University, Philadelphia, PA, USA.
Department of Obstetrics and Gynecology, The George Washington University School of Medicine and Health Sciences, Washington, DC, USA.
Eur J Obstet Gynecol Reprod Biol. 2019 Sep;240:341-346. doi: 10.1016/j.ejogrb.2019.07.031. Epub 2019 Jul 27.
The objective of this study was to evaluate whether ultrasound measured fetal adrenal gland size can be a predictor of spontaneous term labor.
This study was a diagnostic test accuracy study using a prospective cohort design evaluating the ability of 2-dimensional ultrasound measurement of fetal adrenal gland total length, total width, fetal zone length and fetal zone width in women in the third trimester to predict the primary outcome of spontaneous term labor. Secondary outcomes were vaginal delivery, length of labor, and maternal and neonatal morbidities.
Of 43 patients recruited, 3 were excluded. 11 (25.6%) presented in spontaneous labor and 29 (67.4%) underwent induction of labor. Patient demographics were similar for all included except for admission cervical exam and oxytocin use. A receiver operative curve was created to assess test predictability. Weighted width of fetal adrenal gland was the best predictor of spontaneous labor amongst variables measured with an area under the curve of 0.674, p = 0.93. w/W ≥ 0.41 had a sensitivity of 91.0%, specificity of 44.8%, positive predictive value of 38.5% and a negative predictive value of 92.3%. Maternal and neonatal morbidities were not different between the spontaneous labor group and the induction of labor group.
Ultrasound measured fetal w/W was moderately predictive of spontaneous labor.
本研究旨在评估超声测量胎儿肾上腺大小是否可以预测自发性足月分娩。
这是一项使用前瞻性队列设计的诊断性测试准确性研究，评估了在孕晚期，二维超声测量胎儿肾上腺总长度、总宽度、胎儿区长度和胎儿区宽度，对自发性足月分娩这一主要结局的预测能力。次要结局为阴道分娩、产程长短以及母婴并发症。
在招募的 43 名患者中，有 3 名被排除。11 名（25.6%）患者自发性分娩，29 名（67.4%）患者行引产。所有纳入患者的人口统计学特征除入院时宫颈检查和催产素使用外，均相似。绘制受试者工作特征曲线以评估测试的预测能力。加权宽度是测量变量中预测自发性分娩的最佳指标，曲线下面积为 0.674，p=0.93。w/W≥0.41 的敏感性为 91.0%，特异性为 44.8%，阳性预测值为 38.5%，阴性预测值为 92.3%。自发性分娩组和引产组的母婴并发症无差异。
超声测量胎儿 w/W 对自发性分娩有一定的预测能力。
