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. 2021 Jul;3(4):100385. doi: 10.1016/j.ajogmf.2021.100385. Epub 2021 Apr 23.
Gastroschisis and omphalocele are congenital abdominal wall defects in which the bowel and other abdominal contents extrude from the fetal abdominal cavity. Standard formulas for estimated fetal weight using ultrasound include fetal abdominal circumference measurement and have a range of error of approximately 10%. It is unknown whether the accuracy of estimated fetal weight assessment is compromised in fetuses with abdominal wall defects because of the extrusion of abdominal contents.
This study aimed to assess the accuracy of standard estimated fetal weight assessment in fetuses with abdominal wall defects by comparing prenatal assessment of fetal weight with actual birthweight.
A retrospective cohort study of fetuses diagnosed with gastroschisis or omphalocele was performed at a single center from 2012 to 2018. Fetuses with additional 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 percent difference between projected estimated fetal weight at birth and actual birthweight was calculated. The Wilcoxon rank-sum test was used to examine the difference between projected estimated fetal weight and actual birthweight.
We had complete data for 112 fetuses with abdominal wall defects, including 85 with gastroschisis and 27 with omphalocele. The median (interquartile range) projected estimated fetal weight was similar to median birthweight, at 2283 g (interquartile range, 2000-2810) and 2306 g (interquartile range, 1991-264), respectively, which did not represent a statistically significant difference between projected estimated fetal weight and actual birthweight (P=.32). The median percent error was 6.8 (3.1-12.8). In addition, we did not find any statistical difference between projected estimated fetal weight and actual birthweight in patients with gastroschisis (P=.52) or omphalocele (P=.35) individually. Estimated fetal weight was underestimated in most cases (n=68 [60.7%]).
In fetuses with abdominal wall defects, standard measurement of fetal weight shows an 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 these fetuses.
先天性腹壁缺陷包括腹裂和脐膨出，肠管和其他腹腔内容物由此从胎儿腹腔中脱出。使用超声的胎儿体重估计标准公式包括胎儿腹围测量，其误差范围约为 10%。由于腹部内容物的脱出，腹壁缺陷胎儿的胎儿体重估计准确性是否会受到影响尚不清楚。
本研究旨在通过比较产前胎儿体重评估与实际出生体重，评估标准胎儿体重估计在腹壁缺陷胎儿中的准确性。
对 2012 年至 2018 年在单一中心诊断为腹裂或脐膨出的胎儿进行了回顾性队列研究。排除了有其他异常或证实有染色体异常的胎儿。使用 Hadlock 公式计算胎儿体重。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计胎儿体重，并计算出生时预计胎儿体重与实际出生体重的百分比差异。使用 Wilcoxon 秩和检验检验预测胎儿体重与实际出生体重之间的差异。
我们有 112 例腹壁缺陷胎儿的完整数据，包括 85 例腹裂和 27 例脐膨出。中位数（四分位距）预测胎儿体重与中位数出生体重相似，分别为 2283 g（四分位距，2000-2810）和 2306 g（四分位距，1991-264），预测胎儿体重与实际出生体重之间无统计学差异（P=.32）。中位数百分比误差为 6.8（3.1-12.8）。此外，我们分别在腹裂（P=.52）和脐膨出（P=.35）患者中均未发现预测胎儿体重与实际出生体重之间存在统计学差异。在大多数情况下（n=68[60.7%]），估计胎儿体重被低估。
在腹壁缺陷胎儿中，胎儿体重的标准测量具有与超声评估胎儿体重的先前确定的误差范围至少相当的准确性。标准胎儿体重估计仍然是这些胎儿估计胎儿体重的合适方法。
