B型超声测量胎儿股骨皮下组织厚度预测胎儿体重

目的探讨应用Ｂ型超声测量胎儿股骨皮下组织厚度预测胎儿出生体重的临床价值。方法应用Ｂ型超声对１７８例胎儿的双顶径、头围、腹围、股骨长、股骨皮下组织厚度进行测量并与新生儿出生体重的关系进行分析。结果股骨皮下组织厚度与新生儿出生体重相关性最好（ｒ＝０．８６０１）,对巨大儿诊断的敏感性为９１％,特异性为９４％,胎儿股骨皮下组织厚度与孕周呈正相关（ｒ＝０．７０７０）。结论应用Ｂ型超声测量胎儿股骨皮下组织厚度预测胎儿出生体重,方法简单、准确,有较好的临床应用价值。     

超声测量胎儿腹围预测巨大胎儿

目的　探讨产前预测新生儿出生体重的相关因素及超声测量胎儿腹围能否预测巨大胎儿。　方法　前瞻性选择 148例宫高 腹围≥ 135 cm的足月单胎已临产的孕妇 ,超声测量其胎儿双顶径、腹围、股骨长度 ,皮尺测量孕妇宫高、腹围 ,核对孕龄 ,分析这些因素与新生儿出生体重的相关性 ;按新生儿体重将这些孕妇分为巨大儿组和非巨大儿组 ,比较两组的资料 ;分析胎儿腹围与巨大儿的特定关系。　结果　多因素逐步回归分析显示单一胎儿腹围是预测胎儿体重的最好参数 ,优于胎儿腹围与股骨长的联合应用。其与胎儿体重呈直线正相关 ,r=0 .85。胎儿腹围≥ 36 cm可以预测 82 %的巨大儿 ,巨大儿组剖宫产率 70 .2 %。　结论　胎儿腹围与胎儿体重呈高度直线正相关 ,是预测胎儿体重的较好参数。在产前怀疑有巨大儿的可能时 ,超声测量胎儿腹围有助于其诊断。     

巨大儿产前预测指标分析

目的比较超声测量胎儿腹围、头围、双顶径、股骨长对预测巨大儿的临床价值。方法以218例巨大儿和218例体质量正常儿为研究对象,产前1周内行超声测量,记录腹围、头围、双顶径和股骨长度,出生后30 min内测量新生儿体质量。结果（1）巨大儿组产前1周腹围、头围、双顶径和股骨长度大于对照组,差异有统计学意义（P＜0．01）。（2）预测巨大儿腹围ROC曲线下面积大于头围、双顶径及股骨长度的面积,差异有统计学意义（P＜0．05）。（3）以腹围＞35．5 cm、头围＞33．5 cm、双顶径＞95．5 mm、股骨长度＞75．5 mm预测巨大儿的敏感性分别是83．95％、84．86％、72．48％和62．84％,特异性分别是66．06％、49．54％、61．93％和65．14％,一致率分别是75．00％、67．20％、67．20％和63．99％。结论腹围法预测巨大儿的准确性优于双顶径法、头围法及股骨长度法。     

超声测量胎儿腹部皮下组织厚度预测胎儿体重的临床观察

目的探讨应用超声测量胎儿腹部皮下组织厚度预测胎儿体重的临床价值。方法对2002年5月至2003年12月在朝阳市第二人民医院分娩的256例孕妇,应用超声测量胎儿双顶径（BPD）、头围（HC）、腹围（AC）、股骨长度（FL）、股骨皮下组织厚度（FSTT）及腹部皮下组织厚度（ASTT）,并且与新生儿出生体重进行直线回归分析。结果各项测量指标与出生体重均有一定的相关性（P均〈0.05）,以ASTT估计胎儿体重优于其他各项指标（r=0.868）。结论超声测量胎儿腹部皮下组织厚度预测胎儿体重相对准确,方法简便,有较好的临床应用价值。     

单项超声测量指标预测胎儿体重的临床应用

目的：探讨应用胎儿腹围单项超声测量指标预测胎儿出生体重的临床价值。方法：（１）应用Ｂ型超声对３００例胎儿的腹围、小脑横径、双顶径、股骨长进行测量，并与新生儿出生体重的关系进行分析。经单元线性回归得出腹围预测胎儿体重的单元方程式。（２）应用此方程对３３０例胎儿进行前瞻性验证。结果：腹围与新生儿体重的相关性最好，（ｒ＝０．８６６７９）。依据腹围可以初步预测胎儿出生的体重范围。其符合率达８０．０％。结论：应用超声测量胎儿腹围预测出生体重，方法简单，且较准确，有较好的临床实用价值。     

B超测量胎儿腹围预测新生儿体重的临床研究

目的:探讨超声测量胎儿腹围在预测新生儿出生体重和诊断巨大儿中的价值。方法:在孕妇分娩前3天内超声测量胎儿腹围,追踪胎儿的出生体重,分析胎儿腹围与出生体重的关系。结果:①共检测2167例单胎孕妇胎儿,胎儿腹围与出生体重呈直线正相关关系(r=0.97,P=0)。②胎儿腹围<34 cm者有7例巨大儿;胎儿腹围<35 cm有1436例,99%的新生儿出生体重<4000 g;胎儿腹围在35~35.9 cm有335例,新生儿平均出生体重为3525.0±249.7 g,巨大儿发生率为5.7%(19例),胎儿腹围在36~36.9 cm有224例,新生儿平均出生体重为3737.1±264.3 g,巨大儿发生率为21.4%(48例);胎儿腹围在37~37.9 cm有100例,平均出生体重3905.1±255.3g,巨大儿发生率为39%(39例),胎儿腹围≥38 cm有38例,新生儿平均出生体重4115.5±306.1g,巨大儿发生率71.1%(27例)。结论:超声测量胎儿腹围可以预测新生儿出生体重,胎儿腹围与胎儿体重呈高度直线正相关,胎儿腹围<35 cm提示发生巨大儿的可能性低;≥37.7 cm提示发生巨大儿的可能性大。     

超声测量胎儿股骨皮下组织厚度与预测出生体重的相关性探讨

目的为预测新生儿出生体重.方法应用超声对100例正常孕妇在分娩前1周内测量股骨皮下组织厚度(TSTT)、双顶径(BPD)、腹围(AC)、股骨长度(FL),并与新生儿出生体重的关系进行分析.结果股骨皮下组织厚度与体重的相关性最好(R=0.9027),逐步回归分析中FTSTT的F值最大(F=198.67).结论超声测量胎儿股骨皮下组织厚度预测出生体重的方法简单、准确,有较好的临床应用价值.     

超声测量胎儿腹围、小脑横径预测胎儿体重的研究

研究超声测量胎儿腹围 (AC)、小脑横径 (TCD)预测胎儿体重(FW)的可行性。方法 :应用B超测量 30 0例胎儿的AC、TCD、双顶径 (BPD)及股骨长度 (FL) ,并与新生儿出生体重进行相关分析 ,经二元线性回归导出AC、TCD预测FW的方程式。并对 4 0 0例胎儿用此方程式进行临床验证。结果 :AC与出生体重的相关性最好 ,TCD次之 ,其简单相关系数分别为 0 86435(P <0 0 0 1)、0 61718(P<0 0 0 1) ;偏相关系数分别为 0 78955(P <0 0 0 1)、0 162 90 (P <0 0 0 1)。以这二项指标预测FW的方程式为 :FW =190 .6×AC +332 8×TCD - 4 4 91 5,经 4 0 0例临床验证 ,符合率达 86 5% ,相对误差 <10 %者占 92 5%。结论 :超声测量胎儿AC、TCD预测FW ,方法简便 ,且较准确 ,有较好的临床实用价值。     

胎儿长骨超声测量筛查唐氏综合征的价值

目的 探讨胎儿短长骨与唐氏综合征的关系.方法 对5年来经细胞遗传学证实为唐氏综合征胎儿超声测量其股骨长度及肱骨长度与同孕龄正常胎儿股骨长度及肱骨长度进行比较.结果 唐氏综合征胎儿的长骨较同孕龄正常胎儿的长骨短,两者差异有显著性(P＜0.01).当胎儿股骨长度测量值与同孕龄正常胎儿股骨长度平均值的比值(MFL/PFL)及胎儿肱骨长度测量值与同孕龄正常胎儿肱骨长度平均值的比值(MHL/PHL)≤0.9的截断值时对检出唐氏综合征胎儿的敏感性分别为50%及66.7%,特异性分别为91.6%及91.7%,阳性预测值分别为8.7%及11.4%;当胎儿股骨长度及肱骨长度较同孕龄正常胎儿股骨长度及肱骨长度短,且＞1SD时对检出唐氏综合征胎儿的敏感性分别为75.0%及83.0%,特异性分别为76.5%及76.8%,阳性预测值分别为5.8%及6.5%.结论 产前B超测量胎儿股骨长度及肱骨长度对筛查唐氏综合征患儿有很重要的临床价值.     

巨大儿临床预测方法的局限性探讨

目的分析常用的几种巨大儿产前临床预测方法的应用价值。方法将2000年1月1日至2005年3月31日在北京大学第三医院妇产科进行产前检查并分娩巨大儿的273例孕妇临床资料与随机抽取的同期单胎分娩正常体重儿的135例孕妇临床资料作对比分析。采用统计学方法对临床常用巨大儿预测方法包括B超综合指标估算胎儿体重(estimated fetal weight,EFW)法、B超双指标估算法、胎儿双顶径(biparietal diameter,BPD)与股骨长(femur length,FL)之和]、B超单一指标估算法(胎儿腹围、股骨长)、临床宫高与腹围之和法以及经验性临床评估法进行评价。结果(1)巨大儿组与非巨大儿组孕妇年龄无统计学差异,但身高和终止妊娠孕周均有统计学意义[(163.0±5.47)cm和(160.0±4.7)cm;(39.7±1.2)周和(39.1±1.1)周,P<0.01]。(2)临床常用的巨大儿预测指标及不同界值的预测价值,EFW法灵敏度为38.1%,特异度为96.4%。B超双指标估算法(BPD+FL≥17 cm)灵敏度为54.0%,特异度为83.8%;当界值取16.5 cm时,灵敏度为88.8%,特异度为55.9%;B超双指标估算法的AC+FL≥42.5 cm时,灵敏度为90.8%,特异度为82.9%。B超单一指标法,以AC≥35 cm为界定值时其灵敏度为95.0%,特异度为71.0%;以38 cm为界定值时灵敏度为31.0%,特异度为99.1%。B超单一采用FL指标,以7.5 cm为界定值时灵敏度为49.8%和,特异度为82.0%。临床宫高与腹围之和法的界定值为≥140 cm时,其灵敏度为77.9%特异度为77.5%。经验性临床评估法灵敏度为46.3%特异度为96.6%。(3)各预测指标的ROC曲线下面积:EFW法0.906;B超双指标估算法中,BPD+FL之和0.795;AC+FL之和0.914;B超单一指标估算法中,AC 0.904,FL 0.752;临床宫高腹围之和0.862。(4)对于各个独立参数采用Logistic多因素回归分析,求得概率(P)方程及P的ROC曲线下面积为0.938。结论本研究显示了在某些病例中临床上预测巨大儿方面仍然有不可预测性。但各项指标单独应用时均有较大局限性至今尚无一种方法可以准确预测巨大儿。胎儿腹围与股骨长之和可能成为一个临床价值较好的预测指标。综合孕妇身高、终止孕周、胎儿腹围、宫高腹围和多参数分析可提高预测的准确性,降低漏诊率。     

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。     

B超测量胎儿双肩径及其它参数的临床应用

目的 探讨Ｂ超测量胎儿各径线的临床价值。方法 将１００例单胎孕３７￣４１周的孕妇产前３天内的Ｂ超测胎儿双顶径、股骨长、腹围、双肩径与生后３天内的新生儿各径线值比较,并进行其与新生儿体重的相关性的分析,应用双肩径预测巨大胎儿。结果 不同性别胎儿的各径线不同。Ｂ超测量胎儿各径线与生后测量值有良好的符合性,且与新生儿体重呈正相关。结论：双肩径为１１．０ｃｍ时巨大胎儿的诊断指数最好,对诊断巨大胎儿有帮助,     

Fetal biacromial diameter as a new ultrasound measure for prediction of macrosomia in term pregnancy: a prospective observational study

Objective: The current study aims to evaluate a simple method for sonographic measurement of the fetal biacromial diameter for prediction of fetal macrosomia in term pregnancy.

Materials and methods: The current study was a single center prospective observational study conducted in a tertiary University Hospital from January 2015 to May 2017. We included all consecutive term (37–42 weeks) pregnant women presented to the labor ward for delivery. Ultrasound parameters were measured as biparietal diameter, head circumference, transverse thoracic diameter, mid arm diameter, abdominal circumference, femur length, estimated fetal weight, and amniotic fluid index. The proposed ultrasound formula “Youssef’s formula” to measure the fetal biacromial diameter is: [Transverse thoracic diameter +2?×?midarm diameter]. The accuracy of proposed formula was compared to the actual biacromial diameter of the newborn after delivery. The primary outcome of the study was accuracy of sonographic measurement of fetal biacromial diameter in prediction of fetal macrosomia in terms of sensitivity and specificity

Results: The study included 600 participants; 49 (8.2%) of them delivered a macrosomic neonates and 551 (91.8%) delivered average weight neonates. There was no statistical significant difference between the proposed fetal biacromial diameter measured by ultrasound and the actual neonatal biacromial diameter measured after birth (p?=?.192). The area under the curve (AUC) for prediction of macrosomia at birth based on the fetal biacromial diameter and the abdominal circumference was 0.987 and 0.989, respectively, on receiver operating characteristic (ROC) curve analysis. Using the biacromial diameter cutoff of 15.4?cm has a PPV for prediction of macrosomia (88.4%) and 96.4% sensitivity with overall accuracy of 97%. Similarly, with the abdominal circumference (AC) cutoff of 35.5?cm, the PPV for prediction of macrosomia (87.7%) and 96.4% sensitivity with overall accuracy of 96.83%. No statistical significant difference between both of them was observed for prediction of fetal macrosomia (p?=?.841)

Conclusions: The sonographic measurement of fetal biacromial diameter seems to be a new simple and accurate method for prediction of fetal macrosomia and shoulder dystocia at birth.     

Macrosomia in postdates pregnancies: the accuracy of routine ultrasonographic screening.

OBJECTIVE: The purpose of this study was to assess the efficacy of routine ultrasonographic assessment of fetal weight in predicting fetal macrosomia in postdates pregnancies. STUDY DESIGN: A total of 519 pregnancies of > or = 41 weeks' duration were subjected to ultrasonographic estimation of fetal weight within 1 week of delivery. Estimated fetal weights were compared with birth weights. Linear regression analysis was performed and prediction limits for estimated fetal weights were generated. RESULTS: Twenty-three percent of infants had birth weights > or = 4000 gm and 4% had birth weights > or = 4500 gm. The mean percent absolute error was 7.7%. At a birth weight of > 3750 gm, the Hadlock model (which uses abdominal circumference and femur length) systematically overestimated the birth weight. The sensitivity, specificity, and positive and negative predictive values for the ultrasonographic diagnosis of macrosomia were 56%, 91%, 64%, and 87%, respectively. The prediction limits generated determine the range of birth weights predicted for a given estimated fetal weight. CONCLUSION: Routine ultrasonographic screening for macrosomia in postdates pregnancies is associated with a relatively low positive predictive value.     

Diabetic macrosomia: accuracy of third trimester ultrasound

Sonar biparietal diameter, head circumference, and abdominal circumference percentile values obtained late in the third trimester were compared with birth weight percentile (relative to dates) in 147 diabetic mothers and 40 control fetuses of nondiabetics. Estimates of fetal weight by the method of Shepard et al were also calculated from these sonar data and compared with birth weight percentile. Abdominal circumference values greater than the 90th percentile correctly predicted macrosomia (defined as birth weight greater than 90th percentile) in 78% of cases. Biparietal diameter and head circumference percentiles were significantly less predictive of macrosomia. When analyzed in a similar manner, estimated fetal weights greater than the 90th percentile correctly predicted macrosomia at birth in 74% of cases. However, when both the abdominal circumference and the estimated fetal weight exceeded the 90th percentile, macrosomia was correctly diagnosed in 88.8% of pregnant women with diabetes mellitus.