超声测值口算法与公式法预测巨大儿体重的比较

目的：探讨超声测值口算法预测巨大儿的可行性。方法：对1900例胎儿的头围、腹围进行超声测量，其中巨大儿230例，参照出生时体重与口算法及公式法测得的体重相比较。结果：口算法预测巨大儿体重符合194例，符合率92％，公式法预测胎儿体重符合200例，符合率96％，两组相比无显著性差异。结论：口算法与公式法预测巨大儿的符合率无显著性差异，口算法方法简单，更具有临床实用性。     

A Comparison of the Mid-Arm Circumference/Head Circumference Ratio and Ponderal Index for the Evaluation of Newborn Infants after Abnormal Intrauterine Growth

ABSTRACT. We studied the accuracy of the ponderal index and the mid-arm circumference/head circumference ratio for detecting newborn infants who were likely to be symptomatic because of aberrant intrauterine growth. Sixty infants were evaluated because of suspected intrauterine growth retardation; both the mean ponderal index and mid-arm circumference/head circumference ratio were significantly lower in the group of 30 symptomatic infants than in the group of 30 asymptomatic infants ( p <0.05). However, the mid-arm circumference/head circumference ratio identified a significantly higher percentage of the symptomatic infants than the ponderal index (80% vs. 47%; p =0.007). An additional 60 infants were evaluated because of suspected abnormal intrauterine growth acceleration. The mean mid-arm circumference/head circumference ratio, but not the ponderal index, was significantly higher in the group of 30 symptomatic infants than in the group of 30 asymptomatic infants ( p <0.005). Again, the mid-arm circumference/head circumference ratio identified a significantly higher percentage of the symptomatic infants than the ponderal index (79% vs. 33%; p <0.001). The mid-arm circumference/head circumference ratio is more accurate than the ponderal index for the evaluation of potentially symptomatic newborn infants who suffered abnormal fetal growth. The ponderal index is not useful for the detection of symptomatic large-for-dates infants.     

妊娠期饮食控制对胎儿体重及分娩方式的影响

目的通过妊娠期母体饮食的合理搭配及对摄入热量的控制,从而控制孕妇的体重增加及胎儿出生时体重、减少糖耐量异常及妊娠期糖尿病的发生率、减少巨大儿的发生率及相对头盆不称的发生率,最终达到降低剖宫产率的目的。方法选择2001年1月至2004年3月在我院门诊行系统产前检查的无任何内外科合并症及遗传病史的孕妇2300名,根据年龄、孕前体重、孕产次进行配对分组。观察组(A组)1100例;对照组(B组)1200例。观察组孕妇在医生的指导下对其饮食进行合理搭配,控制孕妇每日饮食热量的摄入,对照组孕妇的饮食未作任何控制。对比2组间孕妇平均体重增加值,糖耐量异常(IGT)及妊娠期糖尿病(GDM)发生率,胎儿出生时的平均体重,巨大儿发生率及剖宫产率的差异。结果观察组与对照组之间在孕妇平均体重增加值,糖耐量异常(IGT)发生率,妊娠期糖尿病(GDM)发生率,胎儿出生时的平均体重,巨大儿发生率,剖宫产率方面统计学差异显著(P<0.01)。结论通过对孕妇进行营养指导及饮食控制,可有效地控制孕妇体重增加,减少IGT及GDM的发生率,有效地控制胎儿出生时的体重,有效地减少因胎儿体重过大所致的头盆不称、产程延长等,有效降低剖宫产率。     

营养指导对妊娠性糖尿病孕妇血糖控制及巨大儿发生率的影响

[背景]探讨营养指导对妊娠性糖尿病(GDM)孕妇血糖控制及巨大儿发生率的影响.[病例报告]对240名孕妇进行50 g糖筛查试验,对异常者进行75 g糖筛查试验,对GDM及糖耐量低下孕妇行个体化营养指导及血糖监测.240名孕妇中糖筛查异常者为62名(25.8%),GDM孕妇为17例(7.1%),糖耐量低下孕妇为16例(6.5%),巨大儿发生率为7.8%.17例GDM孕妇所产婴儿中巨大儿发生例数为7例.[讨论]合理的营养指导可有效地控制GDM孕妇血糖,降低巨大儿的发生率.     

624例巨大儿影响因素分析

目的应用描述性研究的方法,探讨巨大儿的危险因素,为避免巨大儿的发生和为临床提前干预提供可靠的理论依据。方法符合标准的624例产妇确立为分析和研究的对象,分为观察组（体重≥4 000 g）和对照组（体重〈4 000 g）。结果观察组产妇平均年龄、身高、体重、孕周明显高于对照组;经产妇、产妇空腹血糖大于6.16 mmol/L发生巨大儿的几率观察组明显高于对照组;观察组男性出生率明显高于对照组。同时对3种预测巨大儿的方法进行了评价,发现宫高、腹围预测巨大儿的灵敏度最高。结论孕妇的年龄、身高、体重、产次、孕周、空腹血糖、新生儿性别与巨大儿发生有关。     

Percentage Change in Antenatal Body Mass Index as a Predictor of Neonatal Macrosomia

PURPOSE We wanted to evaluate the predictive value of percentage change in antenatal maternal body mass index (BMI) as it relates to macrosomia, as well as to compare change in pregnancy BMI with existing weight gain guidelines.     

Use of the amniotic fluid index combined with estimated fetal weight within 10 days of delivery for prediction of macrosomia at birth.

OBJECTIVE: The purpose of this study was to assess the value of combining the sonographically estimated fetal weight (EFW) and amniotic fluid index (AFI) measured within 10 days of term delivery for prediction of macrosomia at birth. METHODS: Prospective sonographic fetal biometric measurements and delivery ward data of a single center, uploaded separately over a 4-year period, were retrospectively linked to yield an unselected sample of nondiabetic pregnancies with live-born term neonates. RESULTS: Of the 1925 pregnancies evaluated, 140 (7.2%) were macrosomic (birth weight > or =4000 g). The AFI was significantly higher in the macrosomic group (P < .001). On receiver operating characteristic curve analysis, the area under the curve was larger for predictions based on the EFW alone than on the AFI. An EFW of 4000 g or higher had a positive predictive value of 46.6% for macrosomia at birth. Use of the previously suggested combined EFW and AFI cutoffs of 3689 g and 119 mm, respectively, yielded a positive predictive value of 30.3%. CONCLUSIONS: Combined use of the EFW and AFI rather than the EFW alone does not improve prediction of macrosomia at birth.     

Predicting macrosomia.

OBJECTIVE: The purpose of this study was to evaluate the prediction of fetal macrosomia based on ultrasound estimates of fetal weight and amniotic fluid volume combined with clinical risk factors. METHODS: A retrospective cohort study of women undergoing indicated obstetric ultrasound examinations within 7 days of delivery was conducted. RESULTS: A total of 3115 women gave birth within 7 days of ultrasound examinations that included an estimated fetal weight (EFW) and an amniotic fluid index (AFI). Clinical risk factors were associated with an 8% positive predictive value for a birth weight of 4000 g or higher. Adding an ultrasound EFW of 4000 g or higher increased the positive predictive value to 62%. Adding an AFI of 20 cm or higher to the clinical risk factors and the ultrasound EFW further increased the positive predictive value to 71%. CONCLUSIONS: An ultrasound EFW of 4000 g or higher within 1 week of delivery combined with clinical risk factors and an increased AFI is associated with macrosomia at birth in 71% of cases.     

对比不同超声估重公式预测巨大胎儿体质量

目的 观察不同超声估重（SFEW）公式预测巨大胎儿的准确率，分析其影响因素。方法 回顾629例巨大儿，根据体质量分为A组和B组；将产前超声所测双顶径（BPD）、头围（HC）、腹围（AC）及股骨长（FL）代入不同公式，比较SFEW预测值与出生后实测值的差异。结果 不同估算公式SFEW测值均明显低于实测值（P均<0.001），其中Hadlock公式预测值与实测值的差异最小；产前超声生物学测值与出生后实测体质量及身长低度相关（r_s<0.50）。B组身长、体质量指数（BMI）及各超声生物学测值均明显大于A组（P均<0.05）；不同公式计算B组误差均明显大于A组（P均<0.05）。结论 SFEW有效可行，但易低估胎儿体质量，各公式参数不能充分体现巨大胎儿躯干外脂肪分布差异对体质量的影响可能是原因之一。