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。     

B超测量胎儿肝脏面积预测巨大儿的临床价值

目的 :研究应用B型超声测量胎儿肝脏面积预测巨大儿的临床价值。方法 :应用B型超声测量 36 0例足月妊娠胎儿的双顶径、头围、腹围、股骨长度、股骨皮下组织厚度、肝脏长度和肝脏面积 ,并分析各预测指标与新生儿出生体重的关系及用于预测巨大儿的敏感性和特异性。结果 :各项预测指标中胎儿肝脏面积与新生儿体重的相关性最好 (r =0 .80 6 ) ,对巨大儿诊断的敏感性为 88 89% ,特异性为 95 4 2 %。结论 :应用B型超声测量胎儿肝脏面积预测巨大儿的准确性较高 ,具有临床应用价值     

B超对500例正常足月妊娠胎儿体重的预测

目前,国内多通过宫高、腹围的外测值,经多元回归方程计算来估计胎儿体重,因受孕妇腹壁脂肪厚薄、单水多少、胎头高低等诸因素的影响,准确率只在50～70％左右。为此,我院应用B超测量胎头双顶径、腹部直径、股骨长度之值的方法,来预测胎儿的体重500例,将其结果报道如下。     

糖原贮积症Ⅱ型表现为胎儿宫内生长迟缓一例分析

孕妇26岁,孕1产0.既往月经规律,孕早期平顺,孕25周时产前检查发现宫高低于第10百分位数,未予处理,以后每周产前检查一次,均低于第10百分位数.孕32+5周时,B超检查双顶径7.3 cm,股骨长5.5 cm,腹围21.5 cm,诊断为"胎儿宫内生长迟缓(Infrauterine growth retardation IUGR)"收入院治疗.入院后给丹参、复方氨基酸、VitC、VitE、ATP、辅酶A等治疗一疗程后,复查B超双顶径7.8 cm,股骨长5.6 cm,腹围22.6 cm,增长仍不满意,遂行第二疗程治疗;治疗后双顶径、股骨长度、腹围均无增长,宫高25 cm,低于第10百分位数.     

应用人工神经网络预测胎儿体重的研究

目的:探讨人工神经网络预测新生儿出生体重的价值。方法:将226例足月、单胎、无妊娠合并症及并发症的初产妇分为训练组(100例,男女胎儿各50例)和验证组(126例,男女胎儿各63例),训练组分别选取不同参数构建3个神经网络,(1)联合参数法:用孕妇身高、体重、腹围、宫高及B超下胎儿双顶径、股骨长和羊水池最大深度作为输入节点;(2)孕妇参数法,用孕妇身高、体重、腹围和宫高作为输入节点;(3)胎儿参数法,用B超下胎儿双顶径、股骨长和羊水池最大深度作为输入节点。神经网络构建完成后以126例验证组来分别测试3种网络的准确性和误差。结果:联合参数法准确率最高为84.94%,母亲参数法为83.45%,胎儿参数法为80.80%。结论:人工神经网络预测胎儿体重有很好的应用前景。选取合适的孕妇及胎儿参数建立网络可提高预测的准确性。     

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。     

用肠外营养治疗胎儿宫内生长迟缓

目的：应用肠外营养治疗胎儿宫内生长迟缓（ＩＵＧＲ），并观察其疗效。方法：采用临床对照试验。将试验对象分为两组：试验组３０例（肠外营养组），对照组３０例（复方丹参组）。测定用药前、后孕妇的宫高、腹围、体重及胎儿的双顶径、头围、腹围、股骨长及新生儿体重。结果：肠外营养组孕妇的测定指标及胎儿、新生儿的各项生长指标均高于对照组，Ｐ〈０．０５。结论：增加孕妇全面均衡营养供给，能够有效地治疗ＩＵＧＲ。     

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。     

糖原贮积症型表现为胎儿宫内生长迟缓一例分析

孕妇 2 6岁 ,孕 1 产 0 。既往月经规律 ,孕早期平顺 ,孕 2 5周时产前检查发现宫高低于第 10百分位数 ,未予处理 ,以后每周产前检查一次 ,均低于第 10百分位数。孕 32 5周时 ,B超检查双顶径 7.3cm,股骨长 5 .5 cm,腹围 2 1.5 cm,诊断为“胎儿宫内生长迟缓 (Infrauterine growthretardation IUGR)”收入院治疗。入院后给丹参、复方氨基酸、Vit C、Vit E、ATP、辅酶 A等治疗一疗程后 ,复查 B超双顶径 7.8cm ,股骨长 5 .6 cm ,腹围 2 2 .6 cm ,增长仍不满意 ,遂行第二疗程治疗 ;治疗后双顶径、股骨长度、腹围均无增长 ,宫高 2 5 cm,低…     

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,     

Ultrasound biometry of Arabian fetuses.

OBJECTIVE: To establish fetal ultrasound biometry charts for Arabian fetuses between 14 and 40 weeks of gestation. METHOD: Cross-sectional fetal ultrasound data of normal singleton pregnancies, which had been performed over a period of 7 years, were retrieved. Only pregnant Arab women with certain last menstrual period dates and/or early ultrasound examinations were included. Each fetus contributed to only one set of data. Normal ranges for biparietal diameter (BPD), head circumference (HC), abdominal circumference (AC), and femur length (FL) were established. The mean and 5th and 95th percentiles at 18th, 28th, and 36 weeks of gestation were compared with similar ranges of published data from pregnancies of American and Anglo-Saxon population. RESULTS: Fetal ultrasound biometry has been established for our local population. Comparing our data with Western population emphasizes the presence of significant variation in fetal morphometric measurements, particularly in the later weeks of gestation and at the extremes of the range of fetal size. CONCLUSION: The clinical significance of this variation differs according to the primary objective of ultrasound fetal measurements. For estimation of fetal age, usually by head and femur measurements in early gestation, ethnic variation seems to have limited significance. Whereas for estimation of fetal growth and/or weight in the third trimester, based on abdominal circumference, the use of given points, e.g., 10th or 5th percentile derived from other population charts, has the potential of either over- or underdiagnosis of IUGR fetuses. The adoption of locally developed charts is recommended.     

Neck Circumference Measurements in Second Trimester Fetuses with Down's Syndrome

Ultrasound examinations were performed on 132 normal fetuses between 12 and 25 weeks of gestation to measure the fetal neck circumference (NC), biparietal diameter (BPD), head circumference (HC), abdominal circumference (AC), and femur length (FL). The relationships between the fetal neck circumference and gestational age, as well as between the fetal neck circumference and fetal biometric parameters (BPD, HC, AC, FL) were linear. Nomograms between the fetal neck circumference and all other parameters were established including the 5th, 50th, and 95th percentile lines. Only one of nine fetuses with Down's syndrome was found to have abnormally increased fetal neck circumference (above the 95th percentile), whereas the remaining eight cases were equally distributed above and below the 50th percentile of these nomograms. The positive predictive value of an abnormally increased fetal neck circumference was 1.6% in our tested population, where the prevalence of Down's syndrome was 1 in 132. Our observations suggest that the use of fetal neck circumference in second trimester fetuses does not add in the prenatal diagnosis of Down's syndrome.     

Gender- and parity-specific reference charts for fetal size in low risk singleton pregnancies at the onset of the third trimester

OBJECTIVES: To determine fetal growth in low risk pregnancies at the beginning of the third trimester and to assess the relative importance of fetal gender and maternal parity. SETTING: Dutch primary care midwifery practice. STUDY DESIGN: Retrospective cohort study on 3641 singleton pregnancies seen at a primary care midwifery center in the Netherlands. Parameters used for analysis were fetal abdominal circumference (AC), fetal head circumference (HC), gestational age, fetal gender and maternal parity. Regression analysis was applied to describe variation in AC and HC with gestational age. Means and standard deviations in the present population were compared with commonly used reference charts. Multiple regression analysis was applied to examine whether gender and parity should be taken into account. RESULTS: The fetal AC and HC increased significantly between the 27th and the 33rd week of pregnancy (AC r2=0.3652, P<0.0001; HC r2=0.3301, P<0.0001). Compared to some curves, our means and standard deviations were significantly smaller (at 30+0 weeks AC mean=258+/-13 mm; HC mean=281+/-14 mm), but corresponded well with other curves. Fetal gender was a significant determinant for both AC (P<0.0001) and HC (P<0.0001). Parity contributed significantly to AC only but the difference was small (beta=0.00464). CONCLUSION: At the beginning of the third trimester, fetal size is associated with fetal gender and, to a lesser extent, with parity. Some fetal growth charts (e.g., Chitty et al.) are more suitable for the low-risk population in the Netherlands than others.     

孕20～24周临床联合超声预测胎儿出生体重的研究

目的:探讨影响孕20～24周胎儿出生体重的相关因素,构建孕20～24周预测胎儿出生体重的公式。方法:前瞻性研究2011年3月至5月在江苏省产前诊断中心超声室行中期(孕龄20～24周)胎儿结构筛查的单胎孕妇235例,孕前月经规则。根据身份证记录孕妇年龄,询问并记录孕前体重;测量孕妇身高及超声检查时的体重,根据末次月经确定孕龄;超声测量胎儿生物学参数:双顶径、头围、腹围、股骨及肱骨;随访孕妇分娩前体重、新生儿出生体重、胎龄及性别。采用逐步多元回归分析方法,通过173例建立中孕期预估胎儿出生体重的公式。用已建立的回归方程前瞻性预测62例孕妇的胎儿出生体重,并验证其准确性。结果:单指标:孕妇孕前体重及BMI、行超声检查时体重及BMI、分娩前体重及BMI、中孕时胎儿腹围、股骨长、肱骨长、胎龄以及超声检查至分娩时的时间间隔与出生体重均有一定关系(P≤0.10),故纳入上述参数逐步多元回归分析,得出预测胎儿出生时体重的方程:预测的出生体重=-501.14+12.52×时间间隔+34.19×孕妇行超声检查时的BMI+8.61×超声检查时测量的胎儿腹围。通过验证,绝对误差值≤250g者56例,占90.32%,相对误差在10%以下者57例,占91.93%。结论:孕妇中孕期BMI、胎儿腹围超声测量值以及该次超声检查至分娩的间隔时间是预测胎儿出生体重的主要参数。     

Longitudinal reference charts for growth of the fetal head, abdomen and femur

OBJECTIVES: The aims of the present study were to establish improved reference charts for growth of the fetal head, abdomen and femur, and to determine the effect of fetal and maternal factors. STUDY DESIGN: This prospective longitudinal study included 650 low-risk pregnancies. Outer-outer biparietal diameter (BPD), head circumference (HC), mean abdominal diameter (MAD), abdominal circumference (AC) and femur length (FL) were measured by ultrasound, and the statistical analysis was based on regression analysis and multilevel modeling. RESULTS: Reference percentiles for the growth of MAD, AC and FL showed continuous growth in gestational week 10-40, while BPD and HC showed a slightly blunted growth toward the end of pregnancy. FL was the only variable that was not influenced by gender. There was a significant negative association between breech presentation and all five biometrical variables, while maternal weight was positively associated with all five variables. Cephalic index significantly influenced BPD and HC. Maternal height had a positive effect on BPD, HC, AC and FL, and parity had a positive effect on MAD and AC, while smoking influenced negatively HC, MAD, and FL. Terms for calculating conditional reference values and customisation for individualised growth assessment are presented. CONCLUSIONS: New reference charts for the growth of fetal head, abdomen and femur are suggested for assessing fetal size and growth, and can be adjusted for maternal and fetal factors to suite individual pregnancies.     

Fetal biometry: does patient ethnicity matter?

Abstract

Objective: To determine if fetal biometry varies according to race.

Methods: We performed a retrospective chart review of prenatal ultrasounds completed in our Perinatal Center from January 2009 to December 2010. Singleton pregnancies 17 to 22.9 weeks were included. Pregnancies complicated by IUGR, fetal anomalies, chronic maternal diseases, or dated by an ultrasound after the first trimester were excluded. Biparietal diameter (BPD), head circumference (HC), abdominal circumference (AC), femur length (FL), and humerus length (HL) were compared between African Americans (AA), Caucasians, and Hispanics using ANOVA and Student t-test.

Results: Included were 1327 AA, 147 Caucasian, and 86 Hispanic subjects. The AC was significantly smaller in AA than Caucasians (p?=?0.008). There was no difference between AA and Caucasians in BPD, HC, FL, or HL. There were no differences between Hispanics and either Caucasians or AA in any of the biometries evaluated.

Conclusions: A single fetal growth curve is not applicable across all ethnicities. AA fetuses have smaller AC then Caucasian fetuses from 17 to 22.9 weeks, which is typically the period when anatomic surveys are performed. Because AC contributes heavily to estimated fetal weight calculations, physicians may be over estimating growth restriction in AA patients. Ethnicity-specific fetal growth curves are indicated to limit unnecessary follow up.     

Ultrasound measurement of fetal size in rural Guatemala.

OBJECTIVES: To describe the fetal growth pattern of a population from rural Guatemala and determine when during gestation growth faltering becomes evident. METHODS: Ultrasound examinations were conducted for 319 women. Femur length (FL), biparietal diameter (BPD), abdominal (AC) and head circumference (HC) were compared with reference values. RESULTS: FL and AC were similar to reference values throughout gestation. BPD and HC were below the 50th percentile by 30 weeks' gestation and below the 10th percentile later in gestation. We expected all four dimensions to show marked growth restriction during gestation. Measurement differences may explain the results but would call into question the value of cross-study comparisons. Infants born small for gestational age were small in all measures as early as 15 weeks. CONCLUSIONS: Fetal growth faltering begins in early gestation among infants who were born small. The lack of deviation from reference data for FL and AC requires further clarification.     

Reference charts and equations of Korean fetal biometry

OBJECTIVE: To construct new reference charts and equations for fetal biparietal diameter (BPD), head circumference (HC), abdominal circumference (AC) and femur diaphysis length (FDL) from Korean fetuses at 12-40 weeks. METHOD: Prospective cross-sectional data obtained in one center for 5 years from a population of pregnant women undergoing ultrasound examination between the 12th and 40th week of gestation. Exclusion criteria comprised all maternal and fetal conditions possibly affecting fetal biometry. No fetuses were excluded on the basis of abnormal biometry. For each measurement, regression models were fitted to estimate both the mean and the standard deviation at each menstrual age. RESULTS: Biometric measurements were obtained for 10 455 fetuses. New charts and reference equations are reported for BPD, HC, AC and FDL. Reference equations are cubic models. CONCLUSION: We present new Korean reference charts and equations for fetal biometry. They can be easily used in obstetric ultrasound studies for the Korean population.     

Antenatal care in The Gambia: Missed opportunity for information, education and communication

Background

Conventionally, the pregnancy duration is accepted to be 280–282 days. Fetuses determined by ultrasound biometry to be small in early pregnancy, have an increased risk of premature birth. We speculate that the higher rate of preterm delivery in such small fetuses represents a pathological outcome not applicable to physiological pregnancies. Here we test the hypothesis that in low-risk pregnancies fetal growth (expressed by fetal size in the second trimester) is itself a determinant for pregnancy duration with the slower growing fetuses having a longer pregnancy.

Methods

We analysed duration of gestation data for 541 women who had a spontaneous delivery having previously been recruited to a cross-sectional study of 650 low-risk pregnancies. All had a regular menses and a known date of their last menstrual period (LMP). Subjects were examined using ultrasound to determine fetal head circumference (HC), abdominal circumference (AC) and femur length (FL) at 10–24 weeks of gestation. Length of the pregnancy was calculated from LMP, and birth weights were noted. The effect of fetal size at 10–24 weeks of gestation on pregnancy duration was assessed also when adjusting for the difference between LMP and ultrasound based fetal age.

Results

Small fetuses (z-score -2.5) at second trimester ultrasound scan had lower birth weights (p < 0.0001) and longer duration of pregnancy (p < 0.0001) than large fetuses (z-score +2.5): 289.6 days (95%CI 288.0 to 291.1) vs. 276.1 (95%CI 273.6 to 278.4) for HC, 289.0 days (95%CI 287.4 to 290.6) vs. 276.9 days (95%CI 274.4 to 279.2) for AC and 288.3 vs. 277.9 days (95%CI 275.6 to 280.1) for FL. Controlling for the difference between LMP and ultrasound dating (using HC measurement), the effect of fetal size on pregnancy length was reduced to half but was still present for AC and FL (comparing z-score -2.5 with +2.5, 286.6 vs. 280.2 days, p = 0.004, and 286.0 vs. 280.9, p = 0.008, respectively).

Conclusion

Fetal size in the second trimester is a determinant of birth weight and pregnancy duration, small fetuses having lower birth weights and longer pregnancies (up to 13 days compared with large fetuses). Our results support a concept of individually assigned pregnancy duration according to growth rates rather than imposing a standard of 280–282 days on all pregnancies.     

Intra- and interobserver reproducibility study of early fetal growth parameters

OBJECTIVE: To assess the intra- and interobserver reproducibility of fetal biometry measurements by transabdominal ultrasound in early pregnancy. METHODS: The study consisted of 21 singleton pregnancies with a gestational age between 9 and 14 weeks. Intraclass correlation coefficients (ICCs) and coefficients of variation (CVs) were calculated. Bland and Altman plots were computed to analyze agreement for measurements between and among observers. Limits of agreement +/- 2 SD for the differences in fetal biometry measurements in proportions of the mean of the measurements were derived. RESULTS: High intra- and interobserver ICCs were found, ranging from 0.998, crown-rump length (CRL) to 0.982, femur length (FL) and CVs ranging from 1.4% (CRL) to 5.9% (FL). Limits of agreement in the Bland and Altman plots ranged from - 2.7 to 2.3% (CRL) difference from the mean to - 13 to 23% (FL) difference. Agreement for fetal biometry increased with fetal size. CONCLUSIONS: This study demonstrated good reproducibility of most measurements of fetal biometry in early pregnancy by abdominal ultrasound. CRL and biparietal diameter (BPD) showed high reproducibility and agreement, and head circumference (HC) to a lesser extend, from 9 weeks of gestational age onwards. abdominal circumference (AC) is only reliable from circa 11 weeks onwards. FL has a poor reproducibility before 14 weeks of gestational age.