Bardin Ron, Aviram Amir, Hiersch Liran, Hadar Eran, Gabbay-Benziv Rinat
Helen Schneider Hospital for Women, Rabin Medical Center - Beilinson Hospital, Petach Tikva, Israel.
Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.
J Matern Fetal Neonatal Med. 2022 Apr;35(8):1539-1545. doi: 10.1080/14767058.2020.1762559. Epub 2020 May 19.
To investigate clinical and sonographic features associated with sonographic accuracy for the prediction of small for gestational age (SGA) and macrosomia at birth.
The database of a tertiary medical center was retrospectively searched for women who gave birth at term to a singleton healthy neonate in 2007-2014 and underwent sonographic estimated fetal weight (sEFW) evaluation within 3 d before delivery. Fetal growth restriction (FGR) and SGA were defined as sEFW or birth weight <10th percentile for gestational age; macrosomia was defined as birth weight >4000 grams. Data on maternal age, parity, gestational age, fetal gender, presentation, placental location, diabetes, hypertension, and oligo/polyhydramnios were compared between pregnancies with a false-negative and false-positive diagnosis of SGA or macrosomia.
Of the 5425 fetal weight evaluations, 254 (4.7%) deviated by >15% from the actual birth weight. Nulliparity, absence of diabetes, neonatal female gender, anterior placenta, lower birth weight, and oligohydramnios were associated with a high deviation. We identified 482 SGA neonates (8.9%) and 633 macrosomic neonates (11.7%). A false-positive diagnosis of FGR was associated with oligohydramnios, absence of diabetes, and posterior placenta, and a false-negative diagnosis, with older maternal age, nulliparity, and male gender. A false-positive diagnosis of macrosomia was associated with older maternal age, multiparity, polyhydramnios, anterior placenta, and lack of hypertensive complications, and a false-negative diagnosis, with diabetes, hypertension, oligohydramnios, and vertex presentation.
The accuracy of sEFW is affected by clinical and sonographic pregnancy characteristics. Further analyses should focus on improving accuracy especially at the fetal weight extremes.
探讨与超声预测出生时小于胎龄儿（SGA）及巨大儿准确性相关的临床和超声特征。
回顾性检索某三级医疗中心数据库，纳入2007 - 2014年足月分娩单胎健康新生儿且在分娩前3天内接受超声估计胎儿体重（sEFW）评估的妇女。胎儿生长受限（FGR）和SGA定义为sEFW或出生体重低于胎龄的第10百分位数；巨大儿定义为出生体重>4000克。比较SGA或巨大儿诊断为假阴性和假阳性的妊娠之间，关于产妇年龄、产次、孕周、胎儿性别、胎位、胎盘位置、糖尿病、高血压及羊水过少/过多的数据。
在5425次胎儿体重评估中，254次（4.7%）与实际出生体重偏差>15%。初产妇、无糖尿病、新生儿为女性、前置胎盘、低出生体重及羊水过少与高偏差相关。我们识别出482例SGA新生儿（8.9%）和633例巨大儿新生儿（11.7%）。FGR的假阳性诊断与羊水过少、无糖尿病及后置胎盘相关，假阴性诊断与产妇年龄较大、初产妇及男性胎儿性别相关。巨大儿的假阳性诊断与产妇年龄较大、经产妇、羊水过多、前置胎盘及无高血压并发症相关，假阴性诊断与糖尿病、高血压、羊水过少及头先露相关。
sEFW的准确性受临床和超声妊娠特征影响。进一步分析应聚焦于提高准确性，尤其是在胎儿体重极端值时。
