应用超声定量分析评估未足月胎膜早破患者胎儿肺成熟度。

Medical Sciences Post Graduation, Universidade Federal Fluminense, Niterói, Brazil.

Department of Obstetrics, Universidade Federal do Estado do Rio de Janeiro, Rio de Janeiro, Brazil.

Fetal Diagn Ther. 2020;47(8):636-641. doi: 10.1159/000507550. Epub 2020 Jul 10.

INTRODUCTION

Prelabor rupture of membranes (PROM) is a frequent clinical situation, and the decision about the best time for delivery remains controversial, mainly due to the risk of neonatal respiratory morbidity (NRM). Assessment of fetal lung maturity using ultrasound, a safe method and widely used in current obstetrical practice, could change this scenario. This study was designed to evaluate the ability of quantitative ultrasound method QuantusFLM® to predict NRM in patients with PROM and whether maternal BMI, gestational age, occurrence of the disease, and presence of oligohydramnios influenced the performance.

METHODS

Patients with singleton gestations, diagnosis of PROM, and gestational age between 24 and 38 weeks and 6 days were included. Fetal lung image was acquired by ultrasound within 48 h prior to delivery and analyzed by QuantusFLM®. The results were then paired with neonatal outcomes to assess the program's ability to predict the NRM in this specific group. A logistic regression model was created to analyze factors that could affect the test results.

RESULTS

Fifty-four patients were included. Mean maternal BMI was 28.99 kg/m2, and in 25 patients (46.2%), oligohydramnios was observed at the time of examination. Mean gestational age at delivery was 35 weeks and 4 days, and the NRM prevalence was of 18.5%. QuantusFLM® predicted NRM with a 60% sensitivity, 79.5% specificity, 40% positive predictive value, 89.7% negative predictive value, and 75.6% accuracy. Maternal BMI, disease occurrence, presence of oligohydramnios, and gestational age did not interfere with the evaluation.

CONCLUSION

This study demonstrates a good accuracy of QuantusFLM® as a NRM predictor in patients with PROM, with particular reliability in identifying that pulmonary maturity has already occurred.

引言

胎膜早破（PROM）是一种常见的临床情况，关于最佳分娩时机的决策仍存在争议，主要是因为新生儿呼吸窘迫（NRM）的风险。使用超声评估胎儿肺成熟度是一种安全的方法，广泛应用于当前的产科实践中，可能会改变这种情况。本研究旨在评估定量超声方法 QuantusFLM®预测胎膜早破患者 NRM 的能力，以及母体 BMI、孕龄、疾病发生和羊水过少的存在是否影响该方法的性能。

方法

纳入单胎妊娠、胎膜早破诊断和 24 至 38 周零 6 天的患者。在分娩前 48 小时内通过超声获取胎儿肺图像，并由 QuantusFLM®进行分析。然后将结果与新生儿结局配对，以评估该方案在特定人群中预测 NRM 的能力。创建了一个逻辑回归模型来分析可能影响测试结果的因素。

结果

共纳入 54 例患者。平均母体 BMI 为 28.99kg/m2，25 例（46.2%）患者在检查时出现羊水过少。分娩时的平均孕龄为 35 周零 4 天，NRM 发生率为 18.5%。QuantusFLM®预测 NRM 的敏感性为 60%，特异性为 79.5%，阳性预测值为 40%，阴性预测值为 89.7%，准确率为 75.6%。母体 BMI、疾病发生、羊水过少的存在和孕龄均未影响评估。