Gjessing H K, Grøttum P, Dreier J M, Eik-Nes S H
Centre for Fertility and Health, Norwegian Institute of Public Health, Oslo, Norway.
Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway.
Ultrasound Obstet Gynecol. 2024 Dec;64(6):739-745. doi: 10.1002/uog.29124. Epub 2024 Oct 24.
To compare the precision of biparietal diameter (BPD) and crown-rump length (CRL) as predictors of gestational age in the human fetus in the late first and early second trimesters, using a population-based approach.
We constructed term and gestational-age prediction curves for first-trimester dating, based on 11 041 pregnancies with 12 260 measurements of CRL and/or BPD from a population-based Norwegian clinical database. We used a population-based approach with local linear quantile regression, combined with a time-to-event strategy that compensates for induced births. Term prediction precision was assessed by estimating and comparing the prediction residual curves using a time-to-event analysis. Individual differences in gestational-age predictions from CRL and BPD were assessed using measurements performed on the same fetus on the same day. A sensitivity analysis was performed to evaluate the effect of not distinguishing between non-spontaneous and spontaneous births.
CRL and BPD provided almost identical term prediction precision judged from the residual distribution. In about 51% of examinations, the difference in predicted gestational age was 1 day or less; 24% of examinations had a difference of 2 days, 14% had a difference of 3 days, 7% had a difference of 4 days and only 5% of all examinations had a difference of 5 days or more. Incorrectly removing induced births from the analysis, or treating them as spontaneous, would cause a substantial systematic prediction bias of about 2 days.
Based on population data, using comparisons at an individual level, our study found that BPD is as precise as CRL when used for first-trimester dating. BPD has advantages from a clinical point of view, since it is technically less challenging and less time-consuming to measure compared with CRL, and can be measured and assessed throughout the entire pregnancy. © 2024 The Author(s). Ultrasound in Obstetrics & Gynecology published by John Wiley & Sons Ltd on behalf of International Society of Ultrasound in Obstetrics and Gynecology.
采用基于人群的方法，比较双顶径（BPD）和头臀长（CRL）作为孕早期末和孕中期初人类胎儿孕周预测指标的准确性。
我们基于挪威一个基于人群的临床数据库中11041例妊娠的12260次CRL和/或BPD测量值，构建了孕早期预产期和孕周预测曲线。我们采用基于人群的局部线性分位数回归方法，并结合一种补偿引产的事件发生时间策略。通过使用事件发生时间分析估计和比较预测残差曲线来评估预产期预测精度。使用同一天对同一胎儿进行的测量评估CRL和BPD孕周预测的个体差异。进行敏感性分析以评估不区分非自然分娩和自然分娩的影响。
从残差分布判断，CRL和BPD提供了几乎相同的预产期预测精度。在约51%的检查中，预测孕周的差异为1天或更小；24%的检查差异为2天，14%的检查差异为3天，7%的检查差异为4天，所有检查中只有5%的差异为5天或更大。在分析中错误地去除引产病例或将其视为自然分娩会导致约2天的显著系统预测偏差。
基于人群数据，通过个体水平的比较，我们的研究发现，在孕早期用于确定孕周时，BPD与CRL一样精确。从临床角度来看，BPD具有优势，因为与CRL相比，其测量技术难度较小且耗时较少，并且在整个孕期都可以进行测量和评估。© 2024作者。《妇产科超声》由约翰·威利父子有限公司代表国际妇产科超声学会出版。
