Wang Bo, Zhang Chunhua
Bo Wang, Department of Gynecology, The Affiliated Huaian No.1 People's Hospital of Nanjing Medical University, Huaian 223300, Jiangsu Province, China.
Chunhua Zhang, Department of Gynecology, Maternal and Child Healthcare Hospital, Huaian 223001, Jiangsu Province, China.
Pak J Med Sci. 2020 Nov-Dec;36(7):1708-1713. doi: 10.12669/pjms.36.7.1988.
To assess risk of fetal growth restriction (FGR) by combined screening in early and mid-pregnancy.
Pregnant women who received prenatal examinations and delivered in our hospital from January 2015 to January 2019 were selected and retrospectively analyzed. All women completed two ultrasonographic examinations during pregnancy, i.e. Down's screening during early pregnancy (11-13 + 6 weeks) and prenatal color Doppler screening during mid-pregnancy (20-24 weeks). A total of 33 FGR cases were screened out, and there were 1,507 normal pregnant women. The clinical, ultrasonographic and serological indices in early and mid-pregnancy were recorded. When the false positive rate was 5%, logistic regression analysis and receiver operating characteristic (ROC) curve were used to evaluate the influencing factors and predictive values of individual and combined indices for FGR in corresponding gestational weeks. The sensitivity and specificity of the optimal cutoff value of each index as well as the combination of optimal predictive indices were found by the area under ROC curve (AUC).
When the false positive rate was 5% in the single-index screening during early pregnancy, the parity, BPD, AC, HC, and FL had statistical significances. Multivariate analysis showed that the parity and BPD had statistical significances. During mid-pregnancy, univariate analysis revealed that the parity, BMI, BPD, AC, HC, FL, UTA-PI, UTA-RI, UA-PI and UA-RI had statistical significances. BMI, AC, UTA-PI, UTA-RI, UA-PI and UA-RI had statistical significances in multivariate analysis. BMI, UTA-PI and UA-PI were risk factors for FGR, with UTA-PI being most dangerous. AUC for combined screening exceeded those for individual screenings. The best combined screening program was BPD in early pregnancy + BMI + AC + UTA-PI + UTA-RI + UA-PI + UA-RI in mid-pregnancy. The optimal cutoff value was 0.015, with the sensitivity of 83.1% and the specificity of 61.3%.
The predictive efficiency of combined FGR screening in early and mid-pregnancy surpasses that of simple mid-pregnancy screening. It is recommended to use the integrated screening program in early and mid-pregnancy to predict FGR.
通过早孕期和中孕期联合筛查评估胎儿生长受限（FGR）风险。
选取2015年1月至2019年1月在我院接受产前检查并分娩的孕妇进行回顾性分析。所有孕妇在孕期均完成两次超声检查，即早孕期（11 - 13⁺⁶周）唐氏筛查和中孕期（20 - 24周）产前彩色多普勒筛查。共筛查出33例FGR病例，正常孕妇1507例。记录早孕期和中孕期的临床、超声及血清学指标。当假阳性率为5%时，采用逻辑回归分析和受试者工作特征（ROC）曲线评估各孕周FGR的个体及联合指标的影响因素和预测价值。通过ROC曲线下面积（AUC）确定各指标最佳截断值以及最佳预测指标组合的敏感性和特异性。
早孕期单指标筛查假阳性率为5%时，产次、双顶径（BPD）、腹围（AC）、头围（HC）和股骨长（FL）有统计学意义。多因素分析显示产次和BPD有统计学意义。中孕期单因素分析显示产次、体重指数（BMI）、BPD、AC、HC、FL、子宫动脉搏动指数（UTA - PI）、子宫动脉阻力指数（UTA - RI）、脐动脉搏动指数（UA - PI）和脐动脉阻力指数（UA - RI）有统计学意义。多因素分析中BMI、AC、UTA - PI、UTA - RI、UA - PI和UA - RI有统计学意义。BMI、UTA - PI和UA - PI是FGR的危险因素，其中UTA - PI最危险。联合筛查的AUC超过单项筛查。最佳联合筛查方案为早孕期BPD + 中孕期BMI + AC + UTA - PI + UTA - RI + UA - PI + UA - RI。最佳截断值为0.015，敏感性为83.1%，特异性为61.3%。
早孕期和中孕期联合FGR筛查的预测效率超过单纯中孕期筛查。建议采用早孕期和中孕期联合筛查方案预测FGR。
