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扩大胎儿生长限制定义识别了高比例的动脉多普勒异常

Angela Nakahra¹, Miranda Long¹, Ardem Elmayan²

¹Department of Obstetrics and Gynecology, Ochsner Health, New Orleans, Louisiana.

American journal of perinatology

|October 7, 2024

概括

扩大胎儿生长限制 (FGR) 的定义,包括腹周长 (AC) 和胎儿估计体重 (EFW),可以更好地检测异常的动脉多普勒 (UAD). 此更新的FGR定义有助于更早地识别有风险的怀孕.

科学领域:

围产科和孕产妇医学
胎儿超声波和多普勒研究
生殖内分泌学生殖内分泌学

背景情况:

胎儿生长限制 (FGR) 是产周期不良结果的重要风险因素.
孕产妇和胎儿医学协会扩大了FGR标准,包括腹周 (AC) <第10个百分点,独立于估计的胎儿体重 (EFW).
之前的研究证实了扩大定义的孕期新生儿小小的检测有所改善,但其对识别异常动脉多普勒 (UAD) 的影响尚不清楚.

研究的目的:

为了将符合扩大FGR定义 (正常EFW与受限制AC) 的胎儿中检测UAD异常的可能性与仅使用EFW识别的可能性进行比较.
通过使用不同的定义标准来评估UAD异常在识别FGR的诊断性能.

主要方法:

追溯队列研究,分析符合FGR标准的胎儿生长超声波 (EFW<10个百分点或AC<10个百分点与正常EFW).
仅根据AC标准识别的胎儿与EFW标准识别的胎儿之间的UAD异常患病率 (心缩/心缩比升高,缺席/逆转末端心缩速度) 的比较.
接收机操作员特征 (ROC) 曲线分析,以评估每个FGR定义的UAD异常的预测值.

主要成果:

在619个FGR扫描中,441 (71%) 符合EFW标准,178 (29%) 仅满足AC标准. 单靠AC的FGR在怀孕早期 (30.4 vs. 35.4周) 被诊断出来,并且在怀孕32周之前更频繁 (70% vs. 11%).
异常UAD的比例在各组之间是相似的 (15%对15%). 然而,仅使用EFW就会错过29%的异常UAD发现.
结合FGR的定义 (考虑EFW和AC) 显示了异常UAD的最高检测率 (曲线下的面积:0.78),超过单独的EFW (0.69) 和单独的AC (0.73).

结论:

结合EFW和AC的FGR定义显著提高了异常UAD的检测,而不是仅使用EFW标准.
限制AC的胎儿显示异常UAD指数的可能性与符合EFW的FGR标准的胎儿相似.
扩展的FGR定义促进了FGR的早期检测,并改善了相关异常多普勒发现的识别.

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