Division of Obstetrics and Gynecology, ASST Spedali Civili and Department of Clinical and Experimental Sciences, University of Brescia, Brescia, Italy.
Int J Gynaecol Obstet. 2022 Sep;158(3):626-633. doi: 10.1002/ijgo.14047. Epub 2021 Dec 9.
To compare delivery outcomes between true-positive (TP) and false-positive (FP) large-for-gestational-age (LGA) fetuses, appropriate-for-gestational-age (AGA) fetuses, and false-negative (FN) LGA fetuses.
Retrospective cohort study of singleton pregnancies at risk for macrosomia without contraindication to vaginal delivery, receiving an ultrasound scan at 34-37 weeks of pregnancy.
In all, 430 pregnancies were included: 155 TP LGA, 87 FP LGA, 177 AGA and 11 FN LGA newborns. Cesarean section rate during labor was significantly higher in FP LGA than in AGA (19% vs. 8.7%) but not significantly different between FP LGA and TP LGA (19% vs. 32.4%). Median birth weight z score was significantly higher in TP LGA (1.9) compared with the FP LGA and AGA (0.91 and 0.84, respectively), whereas no significant differences were found between FP LGA and AGA. Admission to a neonatal intensive care unit was significantly more frequent in TP LGA than AGA, whereas shoulder dystocia, postpartum hemorrhage, and third- to fourth-degree perineal tears were similar between the different groups.
A false-positive diagnosis of LGA fetus is associated with a significant increase of cesarean section during labor. Therefore, a suspicious ultrasound may result in reduction of the clinical threshold for the diagnosis of abnormal labor.
比较真阳性（TP）、假阳性（FP）巨大儿、适当胎龄儿（AGA）和假阴性（FN）巨大儿的分娩结局。
对无阴道分娩禁忌证的单胎妊娠进行回顾性队列研究，这些孕妇在妊娠 34-37 周时接受超声检查。
共纳入 430 例妊娠：155 例 TP 巨大儿、87 例 FP 巨大儿、177 例 AGA 和 11 例 FN 巨大儿新生儿。FP LGA 组产妇在分娩时行剖宫产术的比例显著高于 AGA 组（19%比 8.7%），但与 TP LGA 组无显著差异（19%比 32.4%）。TP LGA 组新生儿出生体重 z 评分中位数显著高于 FP LGA 和 AGA 组（1.9 比 0.91 和 0.84），但 FP LGA 与 AGA 组之间无显著差异。TP LGA 组新生儿入住新生儿重症监护病房的比例显著高于 AGA 组，而肩难产、产后出血和 3-4 度会阴撕裂在不同组之间相似。
LGA 胎儿的假阳性诊断与分娩时剖宫产术显著增加相关。因此，可疑的超声检查可能会降低异常分娩的临床诊断阈值。
