利用产前和产后图表的不同组合检测胎儿大小与胎龄不相符。

Detection of small- and large-for-gestational age using different combinations of prenatal and postnatal charts.

机构信息

Fetal Medicine Unit, John Radcliffe Hospital, Oxford, UK.

出版信息

Ultrasound Obstet Gynecol. 2022 Sep;60(3):373-380. doi: 10.1002/uog.24971.

DOI:10.1002/uog.24971

PMID:35708532

Abstract

OBJECTIVE

To determine the extent to which the detection rate of small-for-gestational age (SGA) and large-for-gestational age (LGA) at birth is influenced by the use of different combinations of estimated-fetal-weight (EFW) and birth-weight (BW) charts.

METHODS

This was a cohort study of all pregnant women with a singleton term birth receiving care in a university hospital during a 3-year period. All participants underwent a universal 36-week ultrasound scan for EFW measurement and had BW recorded at delivery. Five different reference charts were used for EFW and BW centile calculation. Two-by-two contingency tables were constructed using EFW as the screening test variable and BW as the outcome variable in order to calculate sensitivity, specificity, positive predictive value (PPV) and negative predictive value for all possible chart combinations.

RESULTS

The cohort included 17 678 pregnancies. The sensitivity of EFW < 10 centile for the detection of BW < 10 centile ranged from 10.8% to 66.8% and the sensitivity of EFW < 3 centile for the detection of BW < 3 centile ranged from 4.1% to 66.8%, depending on the charts used. The sensitivity of EFW > 90 centile for BW > 90 centile ranged between 22.9% and 68.3%. When locally derived charts for EFW and BW were used, the sensitivity of detection of BW < 10 centile using EFW < 10 centile was 43.7% (PPV, 45.5%); for the detection of BW < 3 centile using EFW < 3 centile, the sensitivity was 25.6% (PPV, 26.7%) and, for the detection of BW > 90 centile using EFW > 90 centile, it was 49.6% (PPV, 49.0%).

CONCLUSIONS

Different combinations of EFW and BW charts can yield vastly different detection rates (sensitivity) in the same population cohort and time period. If SGA and LGA detection rates are to be used as a meaningful performance indicator, healthcare systems should follow a clear and predefined methodology that includes explicit definitions of common reference standards. © 2022 International Society of Ultrasound in Obstetrics and Gynecology.

摘要

目的

确定不同估计胎儿体重（EFW）和出生体重（BW）图表组合的使用对出生时小胎龄儿（SGA）和大胎龄儿（LGA）检出率的影响程度。

方法

这是一项队列研究，纳入了在 3 年内于一所大学医院接受单胎足月分娩护理的所有孕妇。所有参与者均在 36 周时行通用超声检查以测量 EFW，并在分娩时记录 BW。使用 5 种不同的参考图表计算 EFW 和 BW 百分位值。构建 EFW 作为筛查测试变量和 BW 作为结果变量的 2×2 列联表，以计算所有可能图表组合的灵敏度、特异性、阳性预测值（PPV）和阴性预测值。

结果

该队列包括 17 678 例妊娠。EFW < 10 百分位值对 BW < 10 百分位值的检出率的灵敏度范围为 10.8%至 66.8%，EFW < 3 百分位值对 BW < 3 百分位值的检出率的灵敏度范围为 4.1%至 66.8%，这取决于所使用的图表。EFW > 90 百分位值对 BW > 90 百分位值的检出率在 22.9%至 68.3%之间。当使用本地生成的 EFW 和 BW 图表时，EFW < 10 百分位值对 BW < 10 百分位值的检出率的灵敏度为 43.7%（PPV，45.5%）；EFW < 3 百分位值对 BW < 3 百分位值的检出率的灵敏度为 25.6%（PPV，26.7%）；EFW > 90 百分位值对 BW > 90 百分位值的检出率的灵敏度为 49.6%（PPV，49.0%）。