巨大胎儿预测方法探讨

目的 探讨巨大胎儿的预测方法。方法 测量408例足月孕妇的宫高,计算以不同的宫高作为截断值筛选巨大胎儿的灵敏度、特异度,选取最优截断值。宫高≥最优截断值者176例,行B超检查,测量胎儿腹围(AC)、小脑横径(CD)、双顶径(BPD),并与新生儿出生体重进行相关分析,经二元线性回归推导出以AC、CD预测胎儿体重(FW)的方程式。应用560例进行临床验证。结果 宫高37cm为筛选巨大胎儿的最优截断值,其灵敏度、特异度分别为88.9％、66.7％。宫高≥37cm者,AC与出生体重的相关性最好,CD次之,偏相关系数分别为0.684 54(P<0.001)、0.221 52(P<0.05);以AC、CD预测(FW=269.6×AC 438.4×CD-7642.8).r=0.67(P<0.001)。经560例临床验证,预测巨大胎儿的灵敏度、特异度分别为83.3％、92.2％。预测体重与实际体重的符合率为82.7％。结论 以宫高初步筛选、再以B超测量胎儿AC、CD预测巨大胎儿,方法简便,且较准确,具有临床使用价值。

Study on the estimation of fetal macroeamia

Objective To Study the estimation of fetal macrosomia. Methods (1) The height of fundus uteri was measured in 408 pregnancies and the best cut off value was studied for the screening regarding as the sensitivity and specificity of fetal macrosomia. (2) The fetal abdominal circumference (AC),transverse cerebellar diameter (CD) and biparietal diameter (BID) were measured by ultrasonography in 176 cases whose height of fundus uteri was not less than the best cut off value. The relationships between AC,CD and BPD with neonatal birth weight were studied. The equation of double factors for estimating fetal weight (FW) was generated by regression analysis. (3) Prospective study of the effect of the generated equation in estimation of fetal macrosomia was performed in 560 cases. Results The cut off value for the screening of fetal macrosomia by the height of fundus uteri was 37 centimeter with the sensitivity and specificity as 88.9% and 66.7% respectivily. The best correlation was between AC and birth weight,while CD was the second. The coefficients of partial corelation were 0.684 54 (P < 0.001) and 0.221 52 (P <0.05),respectively. The equation of estimation by using AC and CD was established (FW = 269.6 x AC 438.4 x CD-7642.8),the coefficients was 0.67 (P < 0.001) . The prospective study in 560 cases showed that the sensitivity and specificity for diagnosising fetal macrosomia were 83.3% and 92.2% ,respectively. The predictive value of the equation was 82.7% . Conclusions The measurement of height of fundus uteri combined with AC and CD is valuable for the estimation of fetal macrosomia.