Department of Obstetrics and Gynecology, Vanderbilt University Medical Center, Nashville, TN.
Department of Obstetrics and Gynecology, Vanderbilt University Medical Center, Nashville, TN.
Am J Obstet Gynecol MFM. 2020 Feb;2(1):100064. doi: 10.1016/j.ajogmf.2019.100064. Epub 2019 Nov 9.
Congenital diaphragmatic hernia is a congenital anomaly in which fetal abdominal organs herniate into the thoracic cavity through a diaphragmatic defect, which can impede fetal lung development. Standard formulas for estimated fetal weight include measurement of fetal abdominal circumference, which may be inaccurate in fetuses with congenital diaphragmatic hernia because of displacement of abdominal contents into the thorax.
This study aimed to assess the accuracy of standard estimated fetal weight assessment in fetuses with congenital diaphragmatic hernia by comparing prenatal assessment of fetal weight with actual birthweight.
A retrospective cohort study of fetuses diagnosed with congenital diaphragmatic hernia was performed at a single center from 2012 to 2018. Fetuses with multiple anomalies or confirmed chromosome abnormalities were excluded. Estimated fetal weight was calculated using the Hadlock formula. Published estimates of fetal growth rate were used to establish a projected estimated fetal weight at birth from the final growth ultrasound, and the percentage difference between projected estimated fetal weight at birth and actual birthweight was calculated. A Wilcoxan rank-sum test was used to examine the difference between projected estimated fetal weight and birthweight.
We had complete data for 77 fetuses with congenital diaphragmatic hernia. The majority (76.6%, 55 of 77) had left-sided congenital diaphragmatic hernia. The median [interquartile range] projected estimated fetal weight was similar to median birthweight, at 3177 g [2691-3568] and 3180 g [2630-3500], respectively, which did not represent a statistically significant difference between projected estimated fetal weight and birthweight (P = .66). The median absolute percentage difference between projected birthweight and actual birthweight was 6.3% [3.2-7.0]. Estimated fetal weight was overall underestimated in a minority of cases (44.2%, 34 of 77).
In fetuses with a congenital diaphragmatic hernia, standard measurements of fetal estimated fetal weight show accuracy that is at least comparable with previously established margins of error for ultrasound assessment of fetal weight. Standard estimated fetal weight assessment remains an appropriate method of estimating fetal weight in fetuses with congenital diaphragmatic hernia.
先天性膈疝是一种先天性异常，胎儿腹部器官通过膈肌缺陷疝入胸腔，从而阻碍胎儿肺的发育。估计胎儿体重的标准公式包括测量胎儿腹围，但在患有先天性膈疝的胎儿中，由于腹部内容物移位到胸腔，腹围的测量可能不准确。
本研究旨在通过比较产前胎儿体重评估与实际出生体重，评估先天性膈疝胎儿中标准估计胎儿体重评估的准确性。
对 2012 年至 2018 年在单一中心诊断为先天性膈疝的胎儿进行回顾性队列研究。排除了有多种异常或确诊染色体异常的胎儿。使用 Hadlock 公式计算估计胎儿体重。使用已发表的胎儿生长率估计值，根据最后一次生长超声建立出生时的预测估计胎儿体重，并计算预测出生时估计胎儿体重与实际出生体重之间的百分比差异。使用 Wilcoxan 秩和检验检验预测估计胎儿体重与出生体重之间的差异。
我们对 77 例先天性膈疝胎儿有完整的数据。大多数（76.6%，55/77）为左侧先天性膈疝。中位数[四分位距]预测估计胎儿体重与中位数出生体重相似，分别为 3177 g [2691-3568]和 3180 g [2630-3500]，两者之间无统计学差异（P=0.66）。预测出生体重与实际出生体重的中位数绝对百分比差异为 6.3% [3.2-7.0]。在少数情况下，估计胎儿体重总体低估（44.2%，34/77）。
在患有先天性膈疝的胎儿中，标准的胎儿估计体重测量值的准确性至少与超声评估胎儿体重的先前确定的误差范围相当。标准的估计胎儿体重评估仍然是评估先天性膈疝胎儿体重的一种合适方法。
