Department of Obstetrics and Gynecology, University of British Columbia, C420-4500 Oak Street, BC Women's Hospital, Vancouver, BC, V6H 3N1, Canada.
Women's Health Research Institute, BC Women's Hospital and Health Centre, Room H214-F - 4500 Oak Street (Box 42), Vancouver, BC, V6H 3N1, Canada.
BMC Pregnancy Childbirth. 2022 Jan 10;22(1):25. doi: 10.1186/s12884-021-04324-0.
To determine how various centile cut points on the INTERGROWTH-21st (INTERGROWTH), World Health Organization (WHO), and Hadlock fetal growth charts predict perinatal morbidity/mortality, and how this relates to choosing a fetal growth chart for clinical use.
We linked antenatal ultrasound measurements for fetuses > 28 weeks' gestation from the British Columbia Women's hospital ultrasound unit with the provincial perinatal database. We estimated the risk of perinatal morbidity/mortality (decreased cord pH, neonatal seizures, hypoglycemia, and perinatal death) associated with select centiles on each fetal growth chart (the 3rd, 10th, the centile identifying 10% of the population, and the optimal cut-point by Youden's Index), and determined how well each centile predicted perinatal morbidity/mortality.
Among 10,366 pregnancies, the 10th centile cut-point had a sensitivity of 11% (95% CI 8, 14), 13% (95% CI 10, 16), and 12% (95% CI 10, 16), to detect fetuses with perinatal morbidity/mortality on the INTERGROWTH, WHO, and Hadlock charts, respectively. All charts performed similarly in predicting perinatal morbidity/mortality (area under the curve [AUC] =0.54 for all three charts). The statistically optimal cut-points were the 39th, 31st, and 32nd centiles on the INTERGROWTH, WHO, and Hadlock charts respectively.
The INTERGROWTH, WHO, and Hadlock fetal growth charts performed similarly in predicting perinatal morbidity/mortality, even when evaluating multiple cut points. Deciding which cut-point and chart to use may be guided by other considerations such as impact on workflow and how the chart was derived.
确定 INTERGROWTH-21 世（INTERGROWTH）、世界卫生组织（WHO）和 Hadlock 胎儿生长图表的各种百分位数切点如何预测围产儿发病率/死亡率，以及这与选择用于临床的胎儿生长图表有何关系。
我们将卑诗省妇女医院超声科 28 周以上胎儿的产前超声测量值与省级围产儿数据库联系起来。我们估计了每个胎儿生长图表（第 3 百分位、第 10 百分位、识别 10%人群的百分位和 Youden 指数确定的最佳切点）上选定百分位与围产儿发病率/死亡率（脐血 pH 值降低、新生儿癫痫发作、低血糖和围产儿死亡）相关的风险，并确定了每个百分位预测围产儿发病率/死亡率的效果如何。
在 10366 例妊娠中，第 10 百分位切点检测 INTERGROWTH、WHO 和 Hadlock 图表上具有围产儿发病率/死亡率的胎儿的灵敏度分别为 11%（95%CI 8，14）、13%（95%CI 10，16）和 12%（95%CI 10，16）。所有图表在预测围产儿发病率/死亡率方面表现相似（所有三张图表的曲线下面积[AUC]为 0.54）。统计学上最佳切点分别为 INTERGROWTH、WHO 和 Hadlock 图表上的第 39、31 和 32 百分位。
即使评估多个切点，INTERGROWTH、WHO 和 Hadlock 胎儿生长图表在预测围产儿发病率/死亡率方面表现相似。选择使用哪个切点和图表可能取决于其他因素，例如对工作流程的影响以及图表的来源。
