妊娠23-24周三维容积超声部分肢体体积预测胎儿晚发型生长受限的应用价值

目的 测量妊娠23-24周胎儿三维容积超声部分肢体体积,和常规二维超声参数比较,探讨对预测晚发型生长受限(fetal growth restriction,FGR)的应用价值。方法 选取2018年1月至2019年12月在我院行产前检查并最终确诊为晚发型FGR的74例孕妇,定义为病例组,另选取同期正常孕妇200例为对照组。在超声诊断仪规范化测量妊娠23-24周胎儿二维超声参数：双顶径、头围、腹围、股骨长度,记录二维超声参数生成的胎儿体重(estimated fetal weight,EFW)。三维容积超声测量部分肢体体积：上臂中段50%的体积(fractional arm volume, AVol)和大腿中段50%的体积(fractional thigh volume,TVol)。比较二组各个数值差异,应用ROC曲线下面积AUC比较各个参数预测晚发型FGR的价值。结果 病例组和对照组的双顶径、头围、腹围、股骨长度及EFW无统计学差异。两组间的AVol和TVol比较差异有统计学意义。ROC曲线分析显示,AVol和TVol预测晚发型FGR的曲线下面积(AUC)为0.70和0.74,二者差异无统计学意义,最佳截断值分别为4.5 mL和9.4 mL,,预测晚发型FGR的敏感性、特异性、准确性分别为63.5%和69.4%、89.4%和88.1%、81.4%和83.2%。二者联合预测晚发型FGR敏感性、特异性和准确率分别为79.0%、94.8%和90.1%。     

超声预测晚发型胎儿宫内生长受限的临床价值

目的 探讨超声对晚发型胎儿宫内生长受限的预测价值。方法 选取在我院行产前超声检查的孕妇99例,依据不同妊娠结局分为正常组66例（胎儿宫内发育正常）和迟发组33例（晚发型胎儿宫内生长受限）,获取两组心肌做功指数（MPI）、脑胎盘率（CPR）、肝静脉血流阻力指数（HVI）、静脉脉搏传递时间（VPTT）及心输出量（CO）,比较两组上述参数的差异。相关性分析采用Spearman相关分析法;绘制受试者工作特征（ROC）曲线分析各参数预测晚发型胎儿宫内生长受限的效能。结果 正常组CPR、VPTT、CO均高于迟发组,MPI、HVI均低于迟发组,差异均有统计学意义（均P<0.05）。CO与VPTT呈正相关（r=0.783,P<0.001）,CPR与HVI呈负相关（r=-0.374,P=0.037）,MPI与HVI呈正相关（r=0.639,P<0.001）。ROC曲线分析显示,MPI、CPR、HVI、VPTT、CO预测晚发型胎儿宫内生长受限的曲线下面积分别为0.809、0.836、0.987、0.897、0.989,敏感性分别为0.886、0.545、0.894、0.894、0.924...     

子宫动脉和脐动脉血流动力学参数对晚发型胎儿宫内生长受限的预测价值

目的 探讨子宫动脉和脐动脉彩超血流动力学检测指标对晚发型胎儿宫内生长受限(FGR)的预测价值.方法 选取198例孕晚期孕妇,其中晚发型FGR 60例(观察组),正常138例(对照组).FGR患者根据子宫动脉及脐动脉血流动力学检测结果分为4个亚组:Ⅰ组(子宫动脉、脐动脉均异常)、Ⅱ组(子宫动脉正常、脐动脉异常)、Ⅲ组(子...     

彩色多普勒超声对晚发型胎儿宫内生长受限血流动力学变化及妊娠结局的评估价值探讨

目的:探讨彩色多普勒超声对晚发型胎儿宫内生长受限血流动力学变化及妊娠结局的评估价值.方法:选取2019年7月—2020年7月在我院产检并生产的孕晚期孕妇114例为研究对象.经临床及常规超声确诊为胎儿生长受限(fetal growth restriction,FGR)的54例孕妇作为病例组,60例宫内胎儿正常发育孕妇作为...     

胎儿静脉导管超声检查在预测宫内生长受限胎儿出生结局中的应用价值

目的探讨胎儿静脉导管超声检查在预测宫内生长受限胎儿不良出生结局中的应用价值。方法选取我院确诊存在宫内生长受限胎儿的孕妇53例,依据新生儿出生不同结局分为正常组23例、轻微异常组15例和明显异常组15例。检测比较各组胎儿静脉导管多普勒血流参数变化情况。结果胎儿静脉导管的心室收缩期峰值流速/最大心房期回流速度(DVS/A)、静脉导管的阻力指数(DVRI)及静脉导管血流量/脐静脉血流量(QDV/QUV)均可以对FGR胎儿的明显异常出生结局作出预测,其中DVS/A曲线下面积最大,为91%,其次为DVRI,曲线下面积为90%,QDV/QUV曲线下面积为74%。结论 DVS/A、DVRI及QDV/QUV均可以作为预测宫内生长受限胎儿明显异常出生结局的指标,其中DVS/A、DVRI预测价值较高。     

小于胎龄儿与晚发型宫内生长受限胎儿右室心肌做功指数的研究

目的 比较小于胎龄儿(SGA)与晚发型宫内生长受限(LO-IUGR)胎儿右室心肌做功指数的差异性.方法 选取我院产检发现的晚发型宫内生长受限胎儿50例(孕32～37周)及同孕龄的小于胎龄儿50例,并选取孕龄相匹配的50例正常胎儿作为对照组,运用组织多普勒分别检测三组胎儿的右室心肌做功指数(MPI).结果 与对照组相比,...     

彩色多普勒超声检测子宫动脉及脐动脉在晚发型宫内生长受限中的价值

目的：彩色多普勒超声检测母体子宫动脉和胎儿脐动脉在晚发型宫内生长受限的血流动力学价值及预测不良围产儿结局。 方法：分析晚发型宫内生长受限的孕妇169例和58例同期分娩正常孕妇,于妊娠期产前超声多普勒分别检测子宫动脉和脐动脉的搏动指数(PI),比较各组动脉血流异常及妊娠结局不良发生率。 结果：晚发型FGR孕妇中胎儿宫内窘迫所致急诊剖宫产、早产、新生儿1min Apgar评分评分、转入NICU、子宫动脉血流异常及脐动脉血流异常例数发生率分别为48.5%、39.6%、31.4%、35.5%、31.4%和21.9%,均高于对照组(P <0.05);在晚发型宫内生长受限孕妇中妊娠结局不良发生率,D组(子宫动脉和脐动脉血流均异常)明显高于A组(子宫动脉和脐动脉血流均正常),而除了胎儿宫内窘迫所致急诊剖宫产外,B组(子宫动脉异常,脐动脉正常)妊娠结局不良发生率高于C组(子宫动脉正常,脐动脉异常)。 结论：超声多普勒检测检测晚发型胎儿生长受限孕妇的子宫动脉和脐动脉的血流动力学,是了解围产儿预后的有效监护手段,在晚发型胎儿生长受限孕妇中,子宫动脉和脐动脉均异常,提示妊娠合并症增加和围产儿结局不良。     

胎儿生长发育受限的超声诊断与监测

胎儿生长受限指因胎盘功能不全导致胎儿生长未能达到其生物学潜能。目前临床最大困惑是如何鉴别胎儿生长受限与健康小于胎龄儿。超声为诊断胎儿生长受限的金标准,主要诊断指标包括估重、腹围及脐动脉血流频谱。超声监测有助于预测胎儿不良结局,协助判断分娩时机。目前已被证明可帮助评估患儿预后的监测指标包括估重、腹围等生长径线、脐动脉血流阻力指数、静脉导管血流频谱、大脑中动脉频谱、脑胎盘血流比率、子宫动脉血流阻力指数。     

彩色多普勒超声在宫内胎儿生长受限诊断中的应用价值分析

目的:探讨应用彩色多普勒超声诊断宫内胎儿生长受限(FGR)的价值.方法:选取本院2018年1月—2020年6月收治的42例FGR孕妇为观察组,40例胎儿宫内发育正常的孕妇为对照组,均采取彩色多普勒超声检查,观察两组胎儿脐动脉(UA)、大脑中动脉(MCA)及静脉导管(DV)的血流参数指标.结果:在UA血流参数上,观察组胎...     

彩色多普勒超声联合血清学检测预测晚发型胎儿生长受限的临床价值

目的 探讨超声脐血流收缩期最大血流峰值/舒张期最小血流峰值(S/D)、脑胎盘率(CPR)联合血清胎盘生长因子(PLGF)、可溶性血管内皮因子受体-1(sFlt-1)预测胎儿生长受限(FGR)的临床价值。方法 选取2021年5月-2023年5月在本院经超声确诊为FGR的孕晚期孕妇46例作为FGR组,并选取同期46例胎儿发育正常的孕晚期孕妇作为非FGR组。 收集两组临床相关资料、均完善超声检查,记录S/D、大脑中动脉和脐动脉搏动指数,计算CPR;抽取空腹静脉血,检测血清PLGF、sFlt-1,比较两组孕妇临床相关资料及指标水平差异,多因素Logistic回归分析影响FGR发生的因素,ROC曲线分析超声指标和血清指标单项及联合预测FGR的临床价值。结果 FGR组合并妊娠高血压占比高于非FGR组(P<0.05);FGR组超声指标S/D高于非FGR组、CPR低于非FGR组(P<0.05);血清指标PLGF水平低于非FGR组,sFlt-1水平高于非FGR组(P<0.05)。多因素Logistic回归分析结果显示,超声指标S/D、CPR和血清指标PLGF、sFlt-1均为影响FGR发生的独立因素(P<0.05)。ROC曲线分析显示,超声指标S/D、CPR和血清指标PLGF、sFlt-1单项预测FGR发生的AUC分别为0.783、0.835、0.874、0.841,多项指标联合预测FGR发生的AUC为0.990,高于单项预测价值。结论 超声指标S/D、CPR,血清指标PLGF、sFlt-1单项均具有较好的预测价值,而联合检测价值更高。     

Prenatal detection of fetal growth restriction by fetal femur volume: efficacy assessment using three-dimensional ultrasound

As fetal growth restriction (FGR) may have increased risks with perinatal morbidity and mortality, it is very important to detect FGR prenatally. Fetal femur dysplasia is associated with a variety of congenital syndromes and FGR as well. To date, no prenatal assessment of fetal FV in predicting FGR using three-dimensional (3D) ultrasound (US) has been reported. In this study, we used 3D US to test the efficacy of fetal femur volume (FV) measurement in predicting FGR. We calculated the sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV) and efficacy of fetal FV assessed by 3D US in detecting FGR according to the Bayes' theorem. All the fetuses were singletons and were followed up to delivery to determine whether they were complicated with FGR or not. In total, 304 fetuses without FGR and 42 fetuses with FGR were included for FV assessment in utero by 3D US. Our results showed fetal FV assessed by 3D US can differentiate fetuses with FGR from fetuses without FGR well. The best predicting threshold for FGR is at the 10th percentile of FV. Using the 10th percentile as the cutoff, the sensitivity of fetal FV in predicting FGR was 71.4%, specificity 94.1%, positive predictive value 62.5%, negative predictive value 96.0% and accuracy 91.3%. In addition, fetal FV is superior to fetal biparietal diameter and fetal abdominal circumference in predicting FGR. In conclusion, fetal FV assessed by 3D US can be applied to detect FGR well prenatally. We believe fetal FV assessment by 3D US would be a useful test in detecting fetuses with FGR.     

彩色多普勒超声定量参数预测胎儿生长受限的列线图模型

目的：探讨彩色多普勒超声定量参数预测胎儿生长受限(FGR)的应用价值,并构建定量列线图模型以指导临床应用。方法：前瞻性选择2019年03月至2022年03月于我院分娩的单胎孕妇共140例为研究对象,孕妇年龄21~44岁,分娩孕周28~40周。根据胎儿出生体重小于对应孕周第10百分位将其分为FGR组40例和无FGR组100例。采用彩色多普勒超声定量检测胎儿脐动脉 (UA)、大脑中动脉(MCA)和静脉导管(DV)的血流参数。结果：FGR组孕妇妊娠期并发症和剖宫产比无FGR组增多,分娩孕周减小,UA搏动指数(UA-PI)、阻力指数(UA-RI)、收缩期最大血流速度/舒张末期血流速度(UA-S/D)增加,UA舒张期缺失或者倒置增多,而MCA-PI、MCA-RI、MCA-S/D、DV-心房收缩谷流速(DV-a)和心室收缩峰流速(DV-S)降低,差异均有统计学意义(P＜0.05)。多因素Logistic回归分析显示,孕妇妊娠期并发症(OR=5.659,95%CI=4.235~6.675,P＜0.001)、分娩孕周＜37周(OR=5.001,95%CI=3.657~6.123,P＜0.001)、UA-PI≥第95百分位(OR=3.527,95%CI=2.532~5.021,P=0.001)、UA舒张期缺失或者倒置(OR=3.321,95%CI=2.127~4.528,P=0.006)和MCA-PI＜第5百分位(OR=2.857,95%CI=1.965~3.635,P=0.011)是影响FGR发生的独立危险因素。R软件建立定量列线图模型,总分220分。受试者工作曲线(ROC)显示,列线图预测FGR的曲线下面积(AUC)为0.876。结论：彩色多普勒超声是筛查和诊断FGR的首选方法,孕妇妊娠期并发症、分娩孕周＜37周、UA-PI≥第95百分位、UA舒张期缺失或者倒置和MCA-PI＜第5百分位是影响FGR发生的独立危险因素。通过建立定量列线图模型能够指导临床早期识别FGR高危患儿并辅助诊断,有重要的应用价值。     

彩色多普勒超声检测12～14孕周胎儿三尖瓣反流的应用价值

目的探讨彩色多普勒超声检测孕12—14周胎儿三尖瓣反流的临床价值。方法52例孕12-14周发现三尖瓣反流的胎儿为反流组,根据反流程度分为轻度反流和中重度反流;50例孕12-14周未见三尖瓣反流的胎儿为对照组。两组均于孕中晚期行彩色多普勒系统畸形筛查。结果反流组胎儿轻度反流46例,中重度反流6例;检出胎儿异常10例,检出率为19．2％。对照组检出胎儿异常2例,检出率为4．0％;反流组胎儿异常检出率高于对照组（P〈0．05）。结论孕12-14周三尖瓣反流的胎儿发生异常的风险高于正常胎儿,彩色多普勒超声检测孕早期胎儿三尖瓣反流有重要的临床价值。     

The efficacy assessment of thigh volume in predicting intrauterine fetal growth restriction by three-dimensional ultrasound

Intrauterine growth restriction (IUGR) is an important issue in perinatology. To assess the efficacy of fetal thigh volume (ThVol) in predicting IUGR, we undertook a prospective cross-sectional study using quantitative 3-D ultrasound (US). During the study period, 30 fetuses with IUGR and 282 fetuses with non-IUGR were included for the ThVol assessment in utero by 3-D US. All the fetuses were singletons and had follow-up to the delivery to determine whether they were complicated with IUGR or not. Our results showed fetal ThVol assessed by 3-D US can differentiate fetuses with IUGR from fetuses with non-IUGR well. Using the 10th percentile as the screening threshold, the sensitivity of fetal ThVol in predicting IUGR was 86.6%, with specificity 91.1%, predictive value of positive test 51.0%, predictive value of negative test 98.5% and accuracy 90.7%. In conclusion, fetal ThVol assessed by quantitative 3-D US can be used to predict fetuses with IUGR antenatally. We believe fetal ThVol assessment by 3-D US would be a useful test in detecting fetuses with IUGR.     

孕早期胎盘体积的三维超声测量研究

目的 利用三维彩色超声容积技术测量早孕胎盘体积,初步探讨胎盘体积与孕龄和胎儿生长发育指标——头臀长的关系.方法 对2011年6月至2012年7月我院超声诊断科就诊的孕11～13+6周孕妇的胎盘留取容积数据,应用4Dview软件进行离线分析,采用VOCAL法得出胎盘体积(PV),最大胎盘截面的直径(MPD)及厚度(MPT).结果 ①胎盘体积范围33.2～171.3 cma,平均(84.9±26.5)cm3;孕龄79～100 d,平均(87.6±3.9)d;头臀长4.6～8.3 cm,平均(6.2±0.8)cm.②胎盘体积与孕龄及胎儿头臀长呈线性正相关,回归方程为:胎盘体积=-190.6+3.1×孕龄(r=0.511,P＜0.01)及胎盘体积=-17.5+16.5×头臀长(r=0.513,P＜0.01).③胎盘体积可以由MPD及MPT估计,方程为:胎盘体积=-30.7+12.6×MPD+ 11.7×MPT(r=0.622,P＜0.01).结论 早孕期胎盘体积与孕龄及头臀长具有相关性,并可以由最大胎盘截面直径及厚度进行估测.     

动态三维超声对胎儿体表畸形的诊断价值

目的 探讨动态三维超声在胎儿体表畸形诊断中的应用价值.方法 二维和动态三维超声对150例中晚期妊娠胎儿进行产前筛查,并比较二者超声诊断与产后诊断符合率.结果 150例胎儿共发现胎儿畸形26例31处.二维超声诊断与产后诊断相符19处,符合率61.3%;动态三维超声诊断28处,符合率90.0%,二者比较差异有统计学意义(P...     

Screening for pre-eclampsia and fetal growth restriction in twin pregnancies at 23 weeks of gestation by transvaginal uterine artery Doppler.

OBJECTIVE: To assess the value of transvaginal uterine artery Doppler at 23 weeks of gestation in predicting the development of adverse perinatal outcomes in twin pregnancies. PATIENTS AND METHODS: Women with twin pregnancies attending for routine ultrasound examination at 23 weeks in any one of seven hospitals underwent Doppler assessment of the uterine arteries. The right and left uterine arteries were identified using color flow mapping and velocity waveforms were obtained using pulsed Doppler. The mean pulsatility index (PI) of the two arteries was determined and the presence of uterine artery notching noted. Results were compared between monochorionic and dichorionic twins, and with our previously reported data from singleton pregnancies. Screening characteristics in the prediction of pre-eclampsia, fetal growth restriction (FGR), placental abruption, fetal death and early preterm delivery were calculated. RESULTS: Uterine artery Doppler at 22-24 weeks of gestation was performed in 360 twin pregnancies, including 324 dichorionic and 36 monochorionic diamniotic twins. Complete outcome data were available in 351 (97.5%). The mean uterine artery PI did not change significantly with gestation and there was no significant difference in mean PI between the dichorionic and monochorionic groups. However, the mean PI was significantly lower in twin pregnancies than in singletons. The pregnancy was complicated by pre-eclampsia in 6.0% of cases, FGR below the 5th centile of both twins in 8.8%, abruption in 0.9%, intrauterine fetal death in 1.7% and early preterm delivery at less than 32 completed weeks of gestation in 5.7% of cases. The respective sensitivities of uterine artery mean PI above the 95th centile for these complications were 33.3%, 9.7%, 66.6%, 33.3% and 18.6%. CONCLUSIONS: In twin pregnancies PI in the uterine arteries is lower than that in singleton pregnancies, but there is no significant difference between dichorionic and monochorionic twins. Doppler assessment of the uterine arteries at 23 weeks identifies a large proportion of twin pregnancies destined to develop adverse outcomes related to uteroplacental insufficiency.     

胎儿脐动脉S/D比值及超声生长参数Z-评分评估妊娠期糖尿病孕妇胎儿生长受限的价值

目的探讨胎儿脐动脉S/D比值及超声生长参数Z-评分在评估妊娠期糖尿病（GDM）孕妇胎儿生长受限（FGR）中的临床价值。 方法选取2016年6月至2021年10月在金华市妇幼保健院进行常规产检并于本院分娩的3409例单胎GDM孕妇作为研究对象。将诊断为FGR者作为观察组（35例）,其余作为对照组（3374例）。对比2组孕28周和孕32周的胎儿生长参数、脐动脉S/D比值、腹围Z-评分、头围Z-评分、头围/腹围比值Z-评分,绘制ROC曲线并分析脐动脉S/D比值及超声生长参数Z-评分评价FGR的效能。 结果观察组胎儿28周和32周双顶径、头围、腹围和股骨长均明显低于对照组,头围/腹围比值明显高于对照组,差异均有统计学意义（P均＜0.05）。观察组胎儿28周和32周的脐动脉S/D比值、头围/腹围比值Z-评分明显高于对照组,腹围Z-评分明显低于对照组,差异均有统计学意义（P均＜0.05）。28周和32周胎儿脐动脉S/D比值、腹围Z-评分和头围/腹围比值Z-评分评价FGR的ROC曲线下面积分别为0.820、0.984、0.948和0.855、0.941、0.981。 结论胎儿脐动脉S/D比值、超声生长参数Z-评分能够较为准确可靠地对胎儿宫内生长发育状况进行定量评估,为GDM孕妇FGR的临床诊断提供重要信息。