Adjahou S, Syngelaki A, Nanda M, Papavasileiou D, Akolekar R, Nicolaides K H
Fetal Medicine Research Institute, King's College Hospital, London, UK.
Fetal Medicine Unit, Medway Maritime Hospital, Gillingham, UK.
Ultrasound Obstet Gynecol. 2025 Jan;65(1):20-29. doi: 10.1002/uog.29134. Epub 2024 Nov 25.
First, to compare the predictive performance of routine ultrasonographic estimated fetal weight (EFW) at 31 + 0 to 33 + 6 and 35 + 0 to 36 + 6 weeks' gestation for delivery of a small-for-gestational-age (SGA) neonate. Second, to compare the predictive performance of EFW at 36 weeks' gestation for SGA vs fetal growth restriction (FGR) at birth. Third, to compare the predictive performance for delivery of a SGA neonate of EFW < 10 percentile vs a model combining maternal demographic characteristics and elements of medical history with EFW.
This was a retrospective analysis of prospectively collected data in 21 676 women with a singleton pregnancy who had undergone routine ultrasound examination at 31 + 0 to 33 + 6 weeks' gestation and 107 875 women with a singleton pregnancy who had undergone routine ultrasound examination at 35 + 0 to 36 + 6 weeks. Measurements of fetal head circumference, abdominal circumference and femur length were used to calculate EFW according to the Hadlock formula and this was expressed as a percentile according to the Fetal Medicine Foundation fetal and neonatal population weight charts. The same charts were used to diagnose SGA neonates with birth weight < 10 or < 3 percentile. FGR was defined as birth weight < 10 percentile in addition to Doppler anomalies. For each gestational-age window at screening, the screen-positive rate and detection rate were calculated at different EFW cut-offs between the 10 and 50 percentiles for predicting the delivery of a SGA neonate with birth weight < 10 or < 3 percentile, either within 2 weeks or at any time after assessment. The areas under the receiver-operating-characteristics curves (AUC) of screening for a SGA neonate by EFW at 31 + 0 to 33 + 6 weeks and at 35 + 0 to 36 + 6 weeks were compared.
The predictive performance of routine ultrasonographic examination during the third trimester for delivery of a SGA neonate is higher if: first, the scan is carried out at 35 + 0 to 36 + 6 weeks' gestation rather than at 31 + 0 to 33 + 6 weeks; second, the outcome measure is birth weight < 3 rather than < 10 percentile; third, the outcome measure is FGR rather than SGA; fourth, if delivery occurs within 2 weeks after assessment rather than at any time after assessment; and fifth, prediction is performed using a model that combines maternal demographic characteristics and elements of medical history with EFW rather than EFW < 10 percentile alone. At 35 + 0 to 36 + 6 weeks' gestation, detection of ≥ 85% of SGA neonates with birth weight < 10 percentile born at any time after assessment necessitates the use of EFW < 40 percentile. Screening at this percentile cut-off predicted 95% and 98% of neonates with birth weight < 10 and < 3 percentile, respectively, born within 2 weeks after assessment, and the respective values for neonates born at any time after assessment were 85% and 93%.
Routine third-trimester ultrasonographic screening for a SGA neonate performs best when the scan is carried out at 35 + 0 to 36 + 6 weeks' gestation, rather than at 31 + 0 to 33 + 6 weeks, and when EFW is combined with maternal risk factors to estimate the patient-specific risk. © 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.
第一，比较孕31⁺⁰至33⁺⁶周和35⁺⁰至36⁺⁶周时常规超声估计胎儿体重（EFW）对小于胎龄（SGA）新生儿分娩的预测性能。第二，比较孕36周时EFW对出生时SGA与胎儿生长受限（FGR）的预测性能。第三，比较EFW＜第10百分位数与结合母亲人口统计学特征和病史因素的EFW模型对SGA新生儿分娩的预测性能。
这是一项对前瞻性收集数据的回顾性分析，数据来自21676名单胎妊娠妇女，她们在孕31⁺⁰至33⁺⁶周接受了常规超声检查，以及107875名单胎妊娠妇女，她们在孕35⁺⁰至36⁺⁶周接受了常规超声检查。根据哈德洛克公式，利用胎儿头围、腹围和股骨长度的测量值计算EFW，并根据胎儿医学基金会胎儿及新生儿群体体重图表将其表示为百分位数。使用相同图表诊断出生体重＜第10或＜第3百分位数的SGA新生儿。FGR定义为出生体重＜第10百分位数且伴有多普勒异常。对于筛查时的每个孕周窗口，计算在第10至50百分位数之间不同EFW临界值下的筛查阳性率和检出率，以预测出生体重＜第10或＜第3百分位数的SGA新生儿在评估后2周内或任何时间的分娩情况。比较孕31⁺⁰至33⁺⁶周和35⁺⁰至36⁺⁶周时EFW筛查SGA新生儿的受试者操作特征曲线（AUC）下面积。
如果满足以下条件，妊娠晚期常规超声检查对SGA新生儿分娩的预测性能更高：第一，扫描在孕35⁺⁰至36⁺⁶周进行，而非孕31⁺⁰至33⁺⁶周；第二，结局指标是出生体重＜第3百分位数而非＜第10百分位数；第三，结局指标是FGR而非SGA；第四，分娩在评估后2周内发生而非评估后的任何时间；第五，使用结合母亲人口统计学特征和病史因素与EFW的模型进行预测，而非仅使用EFW＜第10百分位数。在孕35⁺⁰至36⁺⁶周时，要检测出评估后任何时间出生的出生体重＜第10百分位数的SGA新生儿的≥85%，需要使用EFW＜第40百分位数。在此百分位数临界值下进行筛查，预测了评估后2周内出生的出生体重＜第10和＜第3百分位数的新生儿分别为95%和98%，评估后任何时间出生的新生儿相应值分别为85%和93%。
妊娠晚期常规超声筛查SGA新生儿时，当扫描在孕35⁺⁰至36⁺⁶周进行而非孕31⁺⁰至33⁺⁶周，且EFW与母亲风险因素相结合以估计患者特定风险时，效果最佳。© 2024作者。《超声妇产科》由John Wiley & Sons Ltd代表国际妇产科超声学会出版。
