Ağaoğlu Recep Taha, Bayrak Ayşe Çiğdem, Akbulut Özgür Volkan, Kindan Aziz, Tüfekçioğlu Eda, Kaya Mehmet, Özgürlük İzzet, Vural Yilmaz Zehra, Yakut Yücel Kadriye
Department of Perinatology, Ministry of Health, Etlik City Hospital, Ankara, Turkey.
Department of Neonatology, Ministry of Health, Etlik City Hospital, Ankara, Turkey.
J Ultrasound Med. 2025 Oct;44(10):1893-1901. doi: 10.1002/jum.70025. Epub 2025 Aug 2.
We aimed to investigate diaphragm functions via ultrasonography in fetuses with late-onset fetal growth restriction (LO-FGR) and to examine the relationship of these parameters with composite adverse perinatal outcomes (CAPO).
This prospective cohort study included 40 fetuses with LO-FGR and 40 healthy controls matched for gestational age. Diaphragmatic functions were evaluated using ultrasonography by measuring diaphragm thickness (DT) during inspiration and expiration, diaphragm thickness fraction (DTF), diaphragm excursion (DE), and costophrenic angle (CPA). CAPO was defined as a 5-minute Apgar score of less than 7 and/or infant respiratory complications or admission to the neonatal intensive care unit (NICU). The LO-FGR group was categorized into 2 subgroups: those with CAPO and those without. Statistical analyses evaluated the association between sonographic measurements of the diaphragm and CAPO.
In the LO-FGR group, DT (both inspiratory and expiratory), DTF, DE, and expiratory CPA were markedly reduced (P < .001). In LO-FGR cases that developed CAPO, DT (both inspiratory and expiratory), DTF, and DE were significantly lower (P < .001). Inspiratory DT exhibited the best predictive value for CAPO (area under the curve [AUC]: 0.923), followed by expiratory DT (AUC: 0.865) and DE (AUC: 0.786). Additionally, DUS parameters exhibited better predictive capability relative to Doppler measurements.
Diaphragmatic ultrasonography-derived functional parameters serve as clinically relevant biomarkers for predicting unfavorable perinatal outcomes in LO-FGR. The incorporation of DUS into standard prenatal assessment procedures may enhance the monitoring and management of LO-FGR cases.
我们旨在通过超声检查来研究晚发性胎儿生长受限（LO-FGR）胎儿的膈肌功能，并探讨这些参数与围产期综合不良结局（CAPO）之间的关系。
这项前瞻性队列研究纳入了40例LO-FGR胎儿和40例孕周匹配的健康对照。通过超声检查测量吸气和呼气时的膈肌厚度（DT）、膈肌厚度分数（DTF）、膈肌移动度（DE）和肋膈角（CPA），以评估膈肌功能。CAPO定义为5分钟Apgar评分小于7和/或婴儿呼吸并发症或入住新生儿重症监护病房（NICU）。LO-FGR组分为两个亚组：发生CAPO的和未发生CAPO的。统计分析评估了膈肌超声测量值与CAPO之间的关联。
在LO-FGR组中，DT（吸气和呼气时）、DTF、DE和呼气时的CPA均显著降低（P < 0.001）。在发生CAPO的LO-FGR病例中，DT（吸气和呼气时）、DTF和DE显著更低（P < 0.001）。吸气时的DT对CAPO的预测价值最佳（曲线下面积[AUC]：0.923），其次是呼气时的DT（AUC：0.865）和DE（AUC：0.786）。此外，相对于多普勒测量，超声膈肌功能参数具有更好的预测能力。
超声检查得出的膈肌功能参数可作为预测LO-FGR不良围产期结局的临床相关生物标志物。将超声膈肌功能检查纳入标准产前评估程序可能会加强对LO-FGR病例的监测和管理。
