Epidemiology Branch, Division of Intramural Population Health Research, Eunice Kennedy Shriver National Institute of Child Health and Human Development, Bethesda, Maryland.
Biostatistics Research Branch, Division Clinical Research, National Institute of Allergy and Infectious Diseases, Fishers Lane, Rockville, Maryland.
Am J Perinatol. 2023 Jan;40(2):155-162. doi: 10.1055/s-0041-1728837. Epub 2021 May 3.
The objective of the study was to determine whether adding longitudinal measures of fundal height (FH) to the standard cross-sectional FH to trigger third trimester ultrasound estimated fetal weight (EFW) would improve small for gestational age (SGA) prediction.
We developed a longitudinal FH calculator in a secondary analysis of a prospective cohort study of 1,939 nonobese pregnant women who underwent serial FH evaluations at 12 U.S. clinical sites. We evaluated cross-sectional FH measurement ≤ -3 cm at visit 3 (mean: 32.0 ± 1.6 weeks) versus the addition of longitudinal FH up to and including visit 3 to trigger an ultrasound to diagnose SGA defined as birth weight <10th percentile. If the FH cut points were not met, the SGA screen was classified as negative. If FH cut points were met and EFW was <10th percentile, the SGA screen was considered positive. If EFW was ≥10th percentile, the SGA screen was also considered negative. Sensitivity, specificity, and positive predictive value (PPV) and negative predictive value (NPV) were computed.
In a comparison of methods, 5.8% of women were classified as at risk of SGA by both cross-sectional and longitudinal classification methods; cross-sectional FH identified an additional 4.0%, and longitudinal fundal height identified a separate, additional 4.5%.Using cross-sectional FH as an ultrasound trigger, EFW had a PPV and NPV for SGA of 69 and 92%, respectively. After adding longitudinal FH, PPV increased to 74%, whereas NPV of 92% remained unchanged; however, the number of women who underwent triggered EFW decreased from 9.7 to 5.7%.
An innovative approach for calculating longitudinal FH to the standard cross-sectional FH improved identification of SGA birth weight, while simultaneously reducing the number of triggered ultrasounds. As an essentially free-of-charge screening test, our novel method has potential to decrease costs as well as perinatal morbidity and mortality (through better prediction of SGA).
· We have developed an innovative calculator for fundal height trajectory.. · Longitudinal fundal height improves detection of SGA.. · As a low cost screening test, the fundal height calculator may decrease costs and morbidity through better prediction of SGA..
本研究旨在确定将标准的横断面宫底高度（FH）纵向测量添加到估计胎儿体重（EFW）的第三个三个月超声中，是否会改善对胎儿生长受限（SGA）的预测。
我们在一项前瞻性队列研究的二次分析中开发了一种纵向 FH 计算器，该研究纳入了 1939 名非肥胖孕妇，这些孕妇在美国 12 个临床地点接受了系列 FH 评估。我们评估了 3 次就诊时的横断面 FH 测量值≤-3cm（平均值：32.0±1.6 周）与添加直至包括 3 次就诊的纵向 FH 之间的关系，以触发超声诊断 SGA，定义为出生体重<第 10 个百分位数。如果未达到 FH 切点，则将 SGA 筛查归类为阴性。如果 FH 切点符合且 EFW<第 10 个百分位数，则将 SGA 筛查视为阳性。如果 EFW≥第 10 个百分位数，则 SGA 筛查也被视为阴性。计算了敏感性、特异性、阳性预测值（PPV）和阴性预测值（NPV）。
在方法比较中，5.8%的女性通过横断面和纵向分类方法被归类为 SGA 风险；横断面 FH 另外识别出 4.0%，纵向宫底高度另外识别出 4.5%。使用横断面 FH 作为超声触发因素，EFW 对 SGA 的 PPV 和 NPV 分别为 69%和 92%。添加纵向 FH 后，PPV 增加到 74%，而 NPV 保持在 92%不变；然而，接受触发 EFW 的女性数量从 9.7 减少到 5.7。
一种创新的计算标准横断面 FH 的纵向 FH 的方法，提高了对 SGA 出生体重的识别能力，同时减少了触发超声的数量。作为一种基本上免费的筛查试验，我们的新方法有可能通过更好地预测 SGA 来降低成本以及围产期发病率和死亡率。
·我们已经开发了一种用于宫底高度轨迹的创新计算器。·纵向宫底高度提高了 SGA 的检出率。·作为一种低成本的筛查试验，宫底高度计算器可以通过更好地预测 SGA 来降低成本和发病率。
