多种公式预测巨大儿出生体重的效果评价

①目的对预测胎儿出生体重的7种公式进行比较分析,以找出一种较准确的公式。②方法对分娩巨大胎儿的104例孕妇测量宫高、腹围及B超检查胎儿双顶径、股骨长、腹围,分别用7种公式计算胎儿体重。预测公式如下:公式(一)EFW=187×FAC-3069;公式(二)EFW=514.3×BPD-1516.9;公式(三)EFW=2616.26 82.419×FFL;公式(四)EFW=(BPD FFL)FAC2/5.8;公式(五)EFW=2900 0.3×宫高×腹围;公式(六)EFW=宫高×腹围 500;公式(七)EFW=宫高×100±250。③结果结果与巨大儿实际出生体重比较,误差≤250g为符合。预测准确性最高的为公式(四)和公式(七),二者比较无显著性差异。④结论公式(四)和公式(七)值得在临床推广应用。     

超声测量估计巨大胎儿体重多项公式的临床验证

目的 :探讨超声测量估计巨大胎儿体重的精确性较高的公式。方法 :应用超声对 36 1例胎儿腹围、双顶径、股骨长、肱骨皮下脂肪厚度进行测量 ,并与新生儿出生体重进行多元线性回归推导出一个预测体重的公式 ;然后 ,应用此公式对 75例巨大儿进行临床验证 ,并与其它两个预测巨大胎儿精确性较高的公式进行比较。结果 :新公式巨大儿的检出率为 6 4 % ,均较单参数公式和另一个多参数公式高 (P <0 .0 5 )。结论 :应用腹围、头围、股骨长、肱骨皮下脂肪厚度预测巨大胎儿准确率较高 ,有较好的临床应用价值。     

超声多指标预测临产胎儿体重

OBJECTIVE: To evaluate the ultrasonic measurements of parturient fetal cerebellar diameter (CD), liver length(LL), kidney length (KL) and femur thigh soft tissue thickness(FSTT) for the estimation of fetal weight. METHODS: Ultrasonic measurements of the parturient fetal cerebellar diameter, liver length, kidney length and femur thigh soft tissue thickness were made in 115 cases. The data on these parameters were analyzed with statistical methods, and a multiple linear regressional equation for predicting the fetal body weight was derived. The calculated value of fetal body weight and the estimated parameters of the fetal body were compared with the actually measured values immediately after birth. The error of estimation was analyzed. RESULTS: CD, LL, KL and FSTT were significantly correlated with neonatal birth weight, the coefficient of multiple correlation R = 0.9425 (P < 0.001); among the 115 cases, 101 had absolute error less than +/- 200 g, with an agreement rate of 88%. The sensitivity and accuracy for detection of normal fetus were 98.13% and 94.78% respectively. The multiple linear regression equation derived was BW = -1009.914 + 356.1303FSTT + 354.0682KL + 236.8484 LL + 179.7384 CD. CONCLUSION: The equation is a simple, accurate and valuable equation for the estimation of fetal weight and can be used in clinical practice.     

胎儿体重的超声预测概况

随着超声诊断技术在产科的广泛应用,B型超声检查已成为胎儿体重预测的重要手段。准确预测胎儿体重对巨大儿、宫内生长受限的诊断以及分娩方式和分娩时机的选择都有重要意义。     

超声预测胎儿体重的临床应用

目的探讨超声预测胎儿体重的临床应用方法与效果。方法随机选取在该院进行检查的健康孕妇187例,进行超声预测胎儿体重检查,并对新生儿出生后30min内称重。结果测量后观察,新生儿出生前超声测量的BPD、FL、AC和出生后测量的BPD、FL、AC值对比,差异无统计学意义（P〉O.05）。单项指标中AC与新生儿出生体重的相关系数最高。结论超声预测胎儿体重的临床应用效果好,其中使用腹围多项指标较单项指标能更准确地估测胎儿体重。     

超声估计胎儿体重多项公式的临床验证

目的：研究B型超声预测胎儿体重的准确性的指标,探讨超声估计胎儿体重精确性较高的公式。方法：对287例孕妇在分娩前一周用超声测量双顶径、股骨长、头围、腹围,分别用7个公式预测得出胎儿体重,并与新生儿实际出生体重进行比较。结果：单项腹围预测胎儿体重与新生儿实际体重的符合率最高。倍论：超声测量胎儿腹围可以准确、方便地预测新生儿出生体重,多参数公式对胎儿体重的预测并不优于单项腹围预测。     

超声多指标预测临产胎儿体重

目的　探讨应用 B型超声测量胎儿小脑横径 (CD)、肝脏长度 (L L )、股骨中段软组织厚度(FSTT)和肾脏长径 (KL )以预测胎儿出生体重的临床价值。方法　应用 B型超声对 115例临产胎儿的小脑横径、肝脏长度、股骨中段软组织厚度和肾脏长径进行测量 ,将这些数据作统计学分析 ,得出估计胎儿体重的四元线形回归方程 ,以计算预测体重 ,并将预测体重与产后实测体重进行比较 ,分析其误差。结果　小脑横径、肝脏长度、股骨中段软组织厚度及肾脏长径与新生儿出生体重相关性好 ,其复相关系数 R=0 .942 5 (P<0 .0 0 1) ,115例中绝对误差值 <± 2 0 0 g的有 10 1例 ,占 88% ,对正常范围体重的胎儿诊断敏感性为 98.13% ,准确度为 94.78%。四元线形回归方程为 :BW=- 10 0 9.914+35 6 .130 3FSTT+35 4.0 6 82 KL +2 36 .8484L L +179.7384CD。结论　用上述预测胎儿出生体重 ,方法简单准确 ,具有较好的临床实用价值 ,值得在临床上推广。     

B超测量胎儿腹围、股骨长预测新生儿体重的临床研究

目的:探讨足月分娩前不同B超测量径线对新生儿出生体重和巨大儿的预测价值,为指导临床实践提供科学依据。方法:对3 971名孕妇,在分娩前3天内超声测量胎儿双顶径、头围、胸径、腹围、股骨长、肱骨长,追踪胎儿的出生体重,使用SPSS10.0软件包分析胎儿各径线长与出生体重的关系。结果:B超测量胎儿的双顶径、头围、胸径、腹围、股骨长、肱骨长与新生儿出生时体重相关性均有统计学意义(均P<0.001)。腹围和股骨长是巨大儿重要影响指标(P值均<0.001)。"新生儿出生体重(g)=13.6×腹围(mm)+41.4×股骨长(mm)-4 182"模型对预测新生儿出生体重具有一定价值,但对巨大儿预测价值相对较低(假阴性率为79.8%)。ROC曲线胎儿腹围、股骨长预测巨大儿的最佳临界值分别为357.5mm和71.5 mm,该界值预测巨大儿的灵敏度分别为67.4%和75.6%,特异度分别为83.0%和60.5%。结论:足月分娩前超测量胎儿胸围和股骨长是预测新生儿出生体重的较好指标,腹围大于357.5mm、股骨长大于71.5mm对预测巨大儿具有一定临床价值。     

多参数超声测量预测胎儿体重的临床应用

目的:探讨应用多参数超声测量指标预测胎儿出生体重的临床价值.方法:应用B型超声对919例孕妇的930例胎儿进行双顶径、股骨长、躯干前后径和横径测量,并根据其指标计算出所估计体重.把预测体重和出生体重进行对比分析,并依据性别和新生儿体重进行分组对比分析.结果:预测体重和新生儿出生体重相对误差在10%以内者占86.98%.相对误差和胎儿性别和新生儿的体重无明显关系.结论:应用多参数超声测量指标预测胎儿出生体重,适用范围广,有较好的临床使用价值.     

超声测量胎儿多项生物指标预测巨大儿的临床价值

目的 探讨B超测量胎儿多项生物学指标预测巨大儿的价值.方法 分析492例巨大儿B超测量的双顶径(BPD)、股骨长(FL)、头围(HC)、腹围(AC)、胸径(BD)等单因素与巨大儿体重的相关性,相关因素进行主成分回归分析得主成分回归方程,将此方程预测胎儿体重的结果及Hadlock3公式预测胎儿体重的结果与胎儿实际出生体重相比较.结果 单因素中BPD、BD、AC均有较高的相关性,相关系数分别为0.149、0.337、0.380(P＜0.05).主成分回归方程预测体重和新生儿出生体重相对误差在±200 g以内,占75.61%,Hadlock3公式预测体重和新生儿出生体重相对误差在±200 g以内,占20.73%.结论 单因素中BPD、BD、AC与体重均有较高的相关性,AC与体重的相关性高于BPD、BD;主成分回归分析得出的回归方程比Hadlock3公式预测巨大儿体重有更高的精确度.     

父母出生体重与巨大儿的相关性研究

了解父母亲出生体重与巨大儿发生的关系,探讨巨大儿发生的遗传倾向.采用病例对照研究的方法,将237例巨大儿和257例正常体重儿父母的出生体重及孕期情况等资料做回顾性分析.经多因素非条件logistic回归分析,随着母亲和父亲出生体重增加,巨大儿发生的风险分别为OR=1.707,95%CI：1.145～2.545;OR=1.979,95%CI：1.306～2.998,巨大儿发生的遗传度为74.48%.巨大儿是胎儿期的肥胖,属多基因遗传.母亲可能通过携带的肥胖基因和宫内的环境,父亲可能主要通过携带的肥胖基因影响巨大儿的发生.     

胎儿体重变化及其对分娩方式的影响

目的　探讨胎儿体重变化对分娩方式的影响。方法　调查 1986～ 2 0 0 0年住院的孕 37～ 4 2周单胎妊娠孕妇的分娩方式及其 13483例新生儿的出生体重。结果　 15年间胎儿平均出生体重及巨大儿发生率呈增高趋势 ( χ2 趋势=9 333,P <0 0 1) ,随着胎儿体重的增加 ,剖宫产率呈上升趋势 ( χ2 趋势 =2 8 6 5 3,P <0 0 1)。结论　胎儿出生体重增加及巨大儿发生率升高是剖宫产率上升的重要原因之一 ,期望通过合理均衡的孕期膳食及适当锻炼 ,控制孕妇及胎儿体重过度增加 ,而有利于正常分娩和产后恢复     

超声预测胎儿体重方法的选择

目的 对回归法和人工神经网络法预测胎儿体重作一比较,选择一种或几种准确性高、实用性强的方法供临床使用。方法分娩前７２小时内测量胎儿双顶径（ＢＰＤ）、头径（ＨＤ）、胸径ＴＨＤ）、腹径（ＡＤ）、股骨长度（ＦＬ）、肝脏长度（ＬＬ）、软组织厚度（ＳＴＴ）和皮下组织厚度（ＳＣＴ）,并记录新生儿出一体重,共３９０例,其中２５０例用地训练人工神经网络及建立体重预测的回归方程;１４０例用人工神经网络、回归方程和临     

近10年新生儿出生体重变化趋势的分析

目的 探讨新生儿出生体重（NBW）的变化趋势及其与剖宫产率之间的关系。方法 回顾性分析上海市普陀区妇婴保健院1989年至1998年10年间NBW的变化,及不同出生体重儿（低体重儿、正常体重儿和巨大儿）孕妇的分娩方式;并对初次产前检查≤20周至足月分娩的产妇,按NBW的不同分为3组,分析孕妇孕期体质指数（BMI）的增加与NBW之间的关系。结果 10年间NBW呈上升趋势,其中巨大儿的发生率明显增加（P＜0.05）、男婴多于女婴（P＜0.005）。随着NBW的增加,剖宫产率明显上升（P＜0.005）。巨大儿的孕妇其孕期BMI的增加与其它各组相比差异有显著性（P＜0.001）。结论 NBW和孕妇孕期BMI的过度增加是导致巨大儿发生率和剖宫产率上升的重要因素。加强孕妇孕期的膳食指导将是控制NBW、降低剖宫产率的有效手段。     

Determinants and outcome of fetal macrosomia in a Nigerian tertiary hospital

Background:

To determine the incidence and risk factors of fetal macrosomia and maternal and perinatal outcome.

Patients and Methods:

This was a 1-year prospective case–control study of singleton pregnancies in a Nigerian tertiary hospital. Only women who gave consent were recruited for the study. The maternal and perinatal outcomes in women who delivered macrosomic infants (birth weight ≥ 4000 g) were compared with the next consecutive delivery of normal birth weight (2500–3999 g) infants.

Results:

The total deliveries for the study period were 2437, of which 135 were macrosomic babies. The incidence of fetal macrosomia was 5.5%. The mean birth weights of macrosomic and nonmacrosomic babies were 4.26 ± 0.29 kg and 3.20 ± 0.38 kg, respectively, P = 0.000. Mothers with macrosomic babies were more likely to be older (P = 0.047), of higher parity (0.001), taller (P = 0.007), and weighed more at delivery (P = 0.000). Previous history of fetal macrosomia (P = 0.000) and maternal diabetes (P = 0.007) were factors strongly associated with the delivery of macrosomic infants. Pregnancies associated with fetal macrosomia had increased duration of labor (P = 0.007), interventional deliveries (P = 0.000), shoulder dystocia, and genital laceration (P = 0.000). There was no significant difference in the incidence of primary postpartum hemorrhage (P = 0.790), birth asphyxia, and perinatal mortality (P = 0.197).

Conclusion:

Fetal macrosomia is associated with maternal and fetal morbidities. The presence of the observed risk factors should elicit the suspicion of a macrosomic fetus and the need for appropriate management to reduce maternal and fetal morbidities.     

实施孕期体重管理的干预对胎儿出生体重的影响

目的探索孕期体重管理对胎儿出生体重的影响。方法选取在我院保健门诊建卡的单胎头位初产妇600例,以就诊时间将产妇随机分入干预组和对照组,每组各300例。干预组接受体重干预教育,对照组接受常规产科检查和教育。比较两组产妇自建卡起至分娩前BMI和体重的变化和低体重儿、巨大儿的发生率有无差异并评价其他妊娠并发症。结果干预组的分娩前BMI和体重的增幅、低体重儿、巨大儿、妊娠期糖尿病、妊娠高血压、剖宫产、早产的发生率均明显低于对照组（P〈0．05）。结论系统管理孕期体重可有效控制体重增加,降低低体重儿、巨大儿的发生率和其他妊娠并发症的发生率。     

The relationship between the weight of the placenta and birth weight of the neonate in a Nigerian Hospital

Background:

There have been several publications from different countries on the relationship between the placental weight and birth weight of the neonate. However, such reports from Nigeria are lacking in literature. The objective of this study was to determine the relationship between the placental weight and birth weight of the neonate at term pregnancy in a Nigerian hospital.

Materials and Methods:

It was a cross-sectional study conducted at Usmanu Danfodiyo University Teaching Hospital Sokoto between 1^st October 2008 and 31^st March 2009. Data gestational age at delivery (in weeks), parity, mode of delivery, fetal birth weight, placental weight, fetal gender, presence or absence of maternal medical diseases were obtained from 1009 singleton term deliveries who met the inclusion criteria for the study. The data was processed using EPI-INFO version 2005 and statistical analysis performed using one-way analysis of variance. A probability of 0.05 was set for statistical significance.

Results:

The placental birth weight ranged from 300 to 890 g with a mean of 590±82 g while the birth weight of the neonate ranged from 2030 to 5020 g with an average of 3275±469 g. The mean gestational age at delivery was 38.8±1.1 weeks while the mean placental birth weight ratio was 18.2±2.4 Increase in birth weight of the neonate was associated with corresponding increase in placental weight. However, as the gestational age at term advances the proportion of increase in the former was greater than that of the latter.

Conclusions:

There is a positive correlation between placental weight and birth weight of the neonate. However, the ratio of the placental and neonatal birth weights at term decreases with advancing gestational age. Thus, prolongation of pregnancy at term may adversely affect the fetus.     

孕前体重指数及孕期体重变化与新生儿出生体重的关系

目的 探讨孕妇孕前体重指数(BMI)、孕期总增重、孕中晚期增重速度的现状及对新生儿出生体重的影响.方法 收集了部分于2014年9月至2015年7月于首都医科大学宣武医院正常产检并分娩的孕妇进行前瞻性纵向研究.结果 ①孕中晚期增重速度及孕期总增重超出IOM标准组大于胎龄儿发生率高于低于IOM标准组.②孕中期增重速度与新生儿出生体重(r=0.439,P＜ 0.001)呈正相关.孕晚期增重速度与新生儿出生体重(r=0.224,P＜0.001)呈正相关.结论 孕中晚期增重速度与新生儿出生体重呈正相关.建议首都医科大学宣武医院加强孕妇孕期营养知识的宣教及孕期体重的监测及干预.