Roeckner Jared T, Odibo Linda, Odibo Anthony O
Departments of Obstetrics and Gynecology, Division of Maternal Fetal Medicine, Morsani College of Medicine, University of South Florida, Tampa, FL, USA.
J Matern Fetal Neonatal Med. 2022 Jun;35(11):2099-2104. doi: 10.1080/14767058.2020.1779214. Epub 2020 Jun 16.
The use of growth velocities derived from fetal biometrics have been suggested to improve prediction of large for gestational age (LGA). Our objective was to determine if ultrasonographic growth velocities (GV) for abdominal circumference (AC) and estimated fetal weight (EFW) improve the prediction of LGA infants when compared to Hadlock EFW.
This was a secondary analysis of data from a prospective study of women referred for growth ultrasounds during the 3rd trimester. Growth velocities (GV) for AC (AC - GV) and EFW (EFW - GV) were derived from the difference in Z-scores between measurements at the time of anatomy survey (18-24 week) and third trimester ultrasound (26-36 weeks). Change in AC - GV and EFW - GV >90th %ile alone or in combination with Hadlock EFW >90th%ile were compared for prediction of a LGA neonate. The primary outcome was the sensitivity and specificity of the (1) Hadlock EFW >90%ile, (2) AC - GV, (3) EFW - GV, (4) Hadlock EFW + AC - GV, and (5) Hadlock EFW + EFW - GV for the prediction of neonatal LGA. Test characteristics and area under the ROC curve (AUC) were determined. The association between the ultrasound predicted growth and adverse neonatal outcome was assessed using logistic regression.
Of 630 women meeting inclusion criteria, 85 (13.5%) had LGA neonates. Hadlock EFW showed a better NPV (98.0%) and sensitivity (71.1%) when compared to AC - GV (NPV 87.5%, sensitivity 17.7%) and EFW - GV (NPV 88.0%, sensitivity 22.6%). Combining Hadlock EFW and AC-GV or EFW - GV did little to improve the test characteristics for the prediction of LGA (AUC 0.65 and 0.64, respectively). All five measurements were unable to predict a composite of adverse neonatal outcome or need for maternal cesarean delivery. Adjustment of the growth velocities for gestational age at anatomy scan or 3rd trimester growth scan did not change these results.
AC and EFW growth velocities do not appear to improve the prediction of LGA infants when compared to using the third trimester Hadlock EFW.
有人提出使用基于胎儿生物测量得出的生长速度来改善对大于胎龄儿（LGA）的预测。我们的目的是确定与哈德洛克估计胎儿体重（EFW）相比，腹围（AC）和估计胎儿体重（EFW）的超声生长速度（GV）是否能改善对LGA婴儿的预测。
这是一项对在孕晚期因生长超声检查而转诊的女性进行的前瞻性研究数据的二次分析。AC（AC - GV）和EFW（EFW - GV）的生长速度是根据解剖学检查时（18 - 24周）和孕晚期超声检查（26 - 36周）测量值之间的Z评分差异得出的。将AC - GV和EFW - GV单独或与哈德洛克EFW>第90百分位数组合时>第90百分位数的变化用于预测LGA新生儿。主要结局是（1）哈德洛克EFW>第90百分位数、（2）AC - GV、（3）EFW - GV、（4）哈德洛克EFW + AC - GV和（5）哈德洛克EFW + EFW - GV预测新生儿LGA的敏感性和特异性。确定检验特征和ROC曲线下面积（AUC）。使用逻辑回归评估超声预测生长与不良新生儿结局之间的关联。
在630名符合纳入标准的女性中，85名（13.5%）有LGA新生儿。与AC - GV（阴性预测值87.5%，敏感性17.7%）和EFW - GV（阴性预测值88.0%，敏感性22.6%）相比，哈德洛克EFW显示出更好的阴性预测值（98.0%）和敏感性（71.1%）。将哈德洛克EFW与AC - GV或EFW - GV组合对预测LGA的检验特征改善不大（AUC分别为0.65和0.64）。所有五项测量均无法预测不良新生儿结局或产妇剖宫产需求的综合情况。对解剖扫描或孕晚期生长扫描时的胎龄生长速度进行调整并未改变这些结果。
与使用孕晚期哈德洛克EFW相比，AC和EFW生长速度似乎并未改善对LGA婴儿的预测。
