妊娠23~24周三维容积超声预测晚发型胎儿生长受限的应用价值

目的探讨妊娠23~24周三维容积超声部分肢体体积预测晚发型胎儿生长受限(FGR)的应用价值。方法选取在我院行产前检查并于出生后最终确诊为晚发型FGR的产妇74例(病例组),另选同期正常产妇200例为对照组。应用超声测量妊娠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质量(EFW1);应有三维容积超声测量胎儿上臂中段50%的体积(AVol)和大腿中段50%的体积(TVol),EFW1联合AVol或TVol生成EFW2或EFW3。比较两组上述各参数差异;应用受试者工作特征(ROC)曲线分析各个参数预测晚发型FGR的价值。结果两组双顶径、头围、腹围、股骨长度、EFW1、EFW2、EFW3比较差异均无统计学意义;两组AVol和TVol比较差异均有统计学意义(均P<0.05)。ROC曲线分析显示,AVol和TVol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、准确率、曲线下面积分别为63.5%vs.69.4%、89.4%vs.88.1%、81.4%vs.83.2%、0.70 vs.0.74;二者曲线下面积比较差异无统计学意义;二者联合预测晚发型FGR的敏感性、特异性及准确率分别为79.0%、94.8%及90.1%,均较二者单独应用的诊断效能高。结论妊娠23~24周胎儿的AVol和TVol可作为预测晚发型FGR的特征性指标。     

超声生物学指标预测胎儿出生时体重的价值

目的应用超声检测胎儿多项生物学指标,预测胎儿出生时体重。方法超声检测293例晚孕胎儿双顶径、头围、腹围、股骨径,分析其与胎儿出生时体重的关系。结果单指标腹围、双顶径、股骨径、头围与新生儿出生体重均呈正相关,其中腹围与出生体重相关性最好,双顶径及股骨长次之;拟和四个自变量,均选入方程,其复相关系数为0．890（P〈0．001）。其中腹围引入回归方程预测293例中胎儿体重,绝对误差值〈±250g的257例,占87．7％,平均相对误差为4．4％。腹围对非巨大儿体重的胎儿诊断敏感性为99．6％,正确率为95．6％。结论腹围预测胎儿出生体重,方法简单准确,具有较好的临床实用价值。     

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%。     

B超测量胎儿腹围预测胎儿体重的价值

目的 研究B超测量胎儿腹围预测巨大胎儿的临床价值。方法 选择184例宫高＋腹围≥140cm的足月单胎孕妇，应用B超测量胎儿双顶径（BPD），头围（HC）腹围（AC），股骨长度（FL）；根据新生儿体重将孕妇分为巨大儿组及非巨大儿组，比较两组间差异；分析腹围与新生儿体重的关系。结果 胎儿腹围与新生儿体重的相关性最好（r=0.84），当胎儿腹围≥35.0cm时，可以预测85.7%的巨大胎儿。结论 超声测量胎儿腹围能准确预测巨大胎儿的体重。     

胎儿出生体重与双顶径测量方法的相关性分析

目的探讨胎儿出生体重与双顶径(BPD)测量方法的相关性。方法选取295例晚孕期孕妇,使用HadlockⅠ及HadlockⅢ公式估测胎儿体重,比较两种不同BPD测量方法(颅骨板近端外缘至远端内缘的间距、双侧颅骨板外缘的间距)估测的胎儿体重(EFW)与实际新生儿出生体重的相关性。结果使用HadlockⅠ公式,BPD选取颅骨板近端外缘至远端内缘测量方法估测的胎儿体重与实际体重之间的绝对误差百分比在5%以内;估测平均体重值与实际平均体重值比较,无明显差异性(P>0.05);平均绝对误差、平均相对误差在各方法中均最小;在绝对误差≤250 g的男孩和女孩两组中的符合比率均最高;在男孩组、女孩组与实际体重比较中,均无明显差异性(P>0.05)。结论使用HadlockⅠ公式,BPD选取颅骨板近端外缘至远端内缘的测量法所获得胎儿估测体重与实际出生体重相关性高于其他三种方法。     

超声测量胎儿多项生物指标预测巨大儿的临床价值

目的:观察和分析超声测量胎儿多项生物指标在巨大儿预测中的临床应用价值。方法:从2016年3月起到2017年3月期间在本院进行超声检查的所有孕妇中选取其中的180例作为本次的观察研究对象,对这180例孕妇在分娩前进行超声检查,通过超声检查测量这180例胎儿的头围、腹围、双顶径和股骨长,并对比分析胎儿的头围、腹围、双顶径和股骨长的超声测量与实际情况的差异性。结果:在各项生物指标当中,双顶径、腹围和股骨长均具有一定的相关性,其相关系数分别为0.148、0.382和0.336;从各项生物指标的超声测量数据所预测体重与新生儿的实际体重对比情况来看,误差在±200g以内的新生儿一共有136例,占75.56%。结论:上述结果表明巨大儿与胎儿的双顶径、腹围和股骨长具有一定的关系,采用超声测量胎儿多项生物指标能够提高巨大儿的预测准确率,具有临床推广应用价值。     

三维超声对妊娠期糖尿病孕妇产前胎儿体重的预测研究

目的:研究妊娠期糖尿病(GDM)孕妇行三维超声预测产前胎儿体重的效果。方法:数据取自我院2022年1月1日至2022年12月30日收治的100例GDM孕妇,均行三维超声检查,根据“新生儿体重结果”分参照组(正常胎儿,n=60)、科研组(巨大儿,n=40),分析两组胎儿生长情况、各因素指标数值,产前预测胎儿体重。结果:两组比较新生儿的双顶径、股骨长无差异,头围、双顶径及股骨长与体质量比较无差异,P>0.05;较参照组,科研组头围、腹围及体质量更高;腹围与新生儿体质量有差异,P<0.05(具有统计学意义)。结论:三维超声产前监测GDM孕妇的腹围可发现胎儿异常、早期做好预防。     

三维超声部分肢体体积联合二维超声参数在胎儿体质量估测中的应用

目的探讨三维容积超声测量部分肢体体积在胎儿体质量估测中的应用价值。方法选择孕产妇103例,应用胎儿上臂、大腿中段50%的体积(AVol、TVol)参数,及双顶径(BPD)、头围(HC)、股骨长(FL)、腹围(AC)、大腿中段软组织厚度(STT)参数,与出生体质量进行相关及回归分析。结果 TVol、AVol、AC、STT、HC、BPD、FL与出生体质量均呈线性相关关系(r分别为0.815、0.702、0.589、0.543、0.410、0.397、0.378,P均0.001)。以出生体质量为因变量,以HC、AC、AVol、TVol为自变量拟合的多元线性回归方程为Y=-2 701.125+6.705X1+8.670X2+13.843X3+4.422X4。结论三维超声测量胎儿部分肢体体积,可为超声估测胎儿体质量提供重要价值。     

Hadlock不同公式估算头围偏小胎儿体质量的准确性分析

目的： 探讨采用Hadlock不同公式中头围参数估算头围偏小胎儿体质量的准确性。方法： 选取2014年2月至2020年8月在复旦大学附属妇产科医院建卡分娩的孕产妇328例，采用Hadlock Ⅰ、Ⅱ、Ⅲ、Ⅳ公式分别估算胎儿体质量，采用平均百分比误差（mean percentage error，MPE）、平均绝对百分比误差（mean absolute percentage error，MAPE）和出生体质量±15%区间比较4种公式的准确性，并用Bland-Altman分析和组内相关系数检验4种公式的一致性。结果： 328例胎儿的平均出生体质量为（2 084.4±778.1） g，MAPE范围为（8.9±8.9）%~（10.1±9.7）%，出生体质量±15%区间内预测值为80.2%~83.5%，差异均无统计学意义。Bland-Altman结果提示，各公式估算体质量与实际出生体质量的平均差值均较小（6.5~73 g）。组内相关系数一致性分析显示，各估算体质量公式与出生体质量间的一致性均较好（ICC>0.75）。结论： 在头围偏小胎儿中，不论估算体质量公式中是否包含头围测量，采用Hadlock Ⅰ、Ⅱ、Ⅲ、Ⅳ公式估算体质量准确性和一致性均较好。     

巨大儿133例临床特征及预测公式可信度分析

目的探讨预测巨大儿公式的可信度.方法将两年内分娩的巨大儿133例作为研究组,选择足月分娩正常儿101例作为对照组,以宫高、腹围、双顶径、股骨长为研究内容,探讨预测巨大儿的新公式.结果研究组宫高、腹围、双顶径、股骨长的平均值均明显大于对照组;以宫高≥35 cm、宫高+腹围≥140 cm、腹围×宫高+200≥4 000 g、双顶径≥95 mm、股骨长≥75 mm作为预测巨大儿的公式,其可信度在52%～77%之间,若按宫高+腹围+双顶径+股骨长≥305预测巨大儿的可信度为90%以上.结论不考虑长度单位,宫高+腹围+双顶径+股骨长≥305,预测巨大儿的可信度最高,具有临床推广应用价值.     

巨大胎儿体质量估测新公式的建立和验证

目的 创建用于巨大胎儿体质量估测新公式,并将新公式和现有的25个公式进行比较.方法 对1153例胎儿(其中239例巨大胎儿)在出生前1周以内行产科超声检查,测量胎儿双顶径(BPD)、头围(HC)、腹围(HC)、和股骨长(FL),出生后记录胎儿体质量.采用逐步回归法设计新公式,1034例(914例非巨大胎儿+120例巨大胎儿)数据用于建立新的全范围体质量预测公式,239例巨大胎儿中120例数据为训练集,被用于建立疑似巨大胎儿胎重估测公式,其余119例巨大胎儿(测试集)用于公式验证,并与国内外常用25个公式相比较.结果 全范围体质量估测公式为:lgBW=0.180(HC)+0.00628 (AC)-0.00318(HC)2+0.00173 (AC) (FL)+0.0000430 (BPD) (HC)2.疑似巨大胎儿胎重估测公式为:lgBW=0.730(BPD) -0.0375 (BPD)2+0.000264 (AC) (FL).新估测公式对119例测试集的平均误差为(- 87.89±230.95)g,平均绝对百分误差为(4.4±3.9)％,25个公式中误差最小公式的平均估测误差为(115.61±345.09)g,平均绝对百分误差为(6.8±5.4)％,新公式与公认的其他常用公式相比,平均绝对误差、平均绝对百分误差均为最低.结论 新公式评估胎儿体质量的准确性较高.新公式适宜于评估中国胎儿体质量,尤其适合评估巨大胎儿体质量.     

Estimation of Fetal Weight in Fetuses With Abdominal Wall Defects

Objective. Estimation of fetal weight is particularly challenging in fetuses with abdominal wall defects (AWDs). We sought to compare the accuracy and screening efficiency for intrauterine growth restriction (IUGR) of 2 recent sonographic formulas to those of the Hadlock formula (Am J Obstet Gynecol 1985; 151:333–337) in fetuses with AWDs. Methods. This was a retrospective cohort study of fetuses with AWDs. Fetuses with sonographically estimated fetal weights (EFWs) within 14 days before delivery were included. Using the individual biometric measurements, EFWs were calculated using the Honarvar (Int J Gynaecol Obstet 2001; 73:15–20; femur length [FL]), Siemer (Ultrasound Obstet Gynecol 2008; 31:397–400; FL, biparietal diameter [BPD], and occipitofrontal diameter), and Hadlock (BPD, head circumference, abdominal circumference, and FL) formulas. The calculated EFWs were adjusted for interval growth between the dates of sonography and delivery using published sonographic fetal growth velocity standards. Accuracy and screening efficiency for IUGR were compared. Results. Seventy‐six fetuses were included: 53 with gastroschisis and 23 with omphalocele. The median gestational age at delivery was 36.6 weeks (range, 25.0 to 39.0 weeks). The Siemer formula had the lowest mean percentage error (?2.5% [95% confidence interval (CI), ?6.2% to +1.2%]) without systematic bias (P = .182). The Hadlock formula had the highest precision (random error, 11.4%), sensitivity (91%), and accuracy for predicting IUGR (85% [95% CI, 77% to 94%]). Conclusions. None of the 3 sonographic formulas is ideal for estimating fetal weight in fetuses with AWDs. The Siemer formula should be used when accuracy in the absolute EFW is the goal. For the purpose of making the more clinically relevant diagnosis of IUGR, use of the Hadlock formula is justified.     

New formula for estimating fetal weight below 1000 g: comparison with existing formulas.

Most estimated fetal weight formulas have been derived and tested with larger fetuses, yet accuracy in predicting birth weight is more critical at the limit of viability. Complete data from 142 pregnancies in which delivery took place within 7 days of an ultrasonographic examination were used to create an appropriate formula for fetuses less than 1000 g and compare it with 10 currently available formulas. Our formula (In [BW] = 0.66 x 1n [HC] + 1.04 x 1n [AC] + 0.985 x 1n [FL]) was significantly more accurate than all other formulas and also performed better on a prospective cohort of 27 fetuses with estimated fetal weight less than 1000 g. Of the existing formulas, the Hadlock formula (using head circumference, abdominal circumference, femur length) was the most accurate, being significantly more accurate than all but the Woo formula with all but the Woo formula.     

Intrapartum fetal weight estimation: a comparison of three formulae

To determine the relative accuracy of fetal weight estimation using the biparietal diameter (BPD), the abdominal circumference (AC), and the femur length (FL) in three formulae (BPD/AC, FL/AC, and BPD/AC/FL), 63 patients in labor were examined. All patients delivered within 24 hours of ultrasound examination. A good correlation was found between the estimated fetal weight and the actual birth weight, using the three formulae: BPD/AC (r = 0.96); FL/AC (r = 0.95); and BPD/AC/FL (r = 0.96). The FL/AC formula overestimated fetal weight (P less than 0.01), however, particularly in fetuses weighing more than 2000 g. The mean percentage error with the BPD/AC formula was 0.99 per cent, 3.82 per cent with the FL/AC, and 2.43 per cent with the BPD/AC/FL formula. This study showed that although all three formulae were comparable, the best estimation of the birth weight was obtained when either the BPD/AC or the BPD/AC/FL formulae were used. Additionally, the results demonstrate that reliable estimates of fetal weight can be made even at term or in laboring patients.     

Estimation of fetal weight: mean value from multiple formulas.

Mean fetal weight value from multiple formulas was compared to fetal weight from single formulas. Data were collected on 975 fetuses who had estimation of fetal weight by ultrasonography within 1 week before birth. Improvement in estimation of fetal weight occurred using either the mean value of multiple formulas or the Hadlock BPD/FL/AC, in comparison to fetal volume, BPD/AC, or FL/AC. BPD/FL/AC appeared to provide the best estimate of true weight in terms of overall accuracy and in terms of not showing a trend in either overestimating or underestimating true weight.     

Fetal transabdominal biometry at 11-14 weeks of gestation.

OBJECTIVE: To establish comprehensive transabdominal ultrasonographic reference ranges for viable normal singleton human fetuses at 11-14 weeks' gestation. METHODS: Single transabdominal ultrasound measurements were taken once per pregnancy at a gestational age of between 11+0 and 14+0 weeks (crown-rump length, 45-84 mm), in viable singleton fetuses with nuchal translucency < or = 3 mm and without detectable structural anomalies, using four standard planes: (i) biparietal diameter (BPD) and fronto-occipital diameter (FOD) resulting in head circumference (HC), anterior horn (Va), posterior horn (Vp), and hemisphere (HEM); (ii) transcerebellar diameter (TCD) and cisterna magna (CM); (iii) abdominal anteroposterior (AAP) and abdominal transverse diameter (ATD) resulting in abdominal circumference (AC); and (iv) femur length (FL). The respective ratios Va/HEM, Vp/HEM, HC/AC, BPD/FL, BPD/FOD, FL/CRL, FL/BPD and FL/AC and the estimated weight were derived. Reference ranges were constructed and the mean and 5th and 95th centiles were plotted against gestation. RESULTS: There was a general increase in biometric parameters with gestation. The ratios for the ventricles vs. hemisphere and BPD/FL ratio decreased while the BPD/FOD and HC/AC ratios remained constant. Analysis of the reference range for BPD/FL was performed in both 167 and 664 fetuses and the results showed almost the identical type of equation, indicating a high degree of accuracy for the growth charts. CONCLUSIONS: We have established comprehensive reference ranges for first-trimester fetal biometry by transabdominal sonography. These charts may have a role in the diagnosis of early onset symmetrical or asymmetrical growth restriction and in the interpretation of measurements in chromosomally abnormal fetuses, and they may help in the detection of skeletal dysplasias or acrania/anencephaly.     

胎儿超声生物学指标的Z-评分值在评估胎儿生长发育中的应用研究

摘 要 目的 探讨孕中、晚期超声生物学指标的Z-评分对评估胎儿生长发育的应用价值。方法 选取我院单胎孕妇中,筛查出巨大儿（A组）103例,胎儿生长受限（B组）48例,合并妊娠期糖尿病而血糖控制满意、出生体质量正常儿（C组）169例分别作为观察组,正常妊娠、胎儿体质量正常的196例为正常对照组。回顾分析中孕期（20+1～24周）、晚孕早期（28+1～33周）、晚孕晚期（34+1周～分娩）三个阶段的生长参数,包括胎儿双顶径（BPD）及头围（HC）、腹围（AC）、股骨长（FL）、头腹围比值（HC/AC）、腹围的Z-评分（AC的Z-评分）、头腹围比值的Z-评分（HC/AC的Z-评分）,比较不同阶段两组间各生长参数的差异、GDM的巨大儿与非GDM的巨大儿间的差异。结果 在中孕期、晚孕早期、晚孕晚期三个阶段,A组腹围的Z-评分值明显大于正常对照组、B组腹围的Z-评分明显小于正常对照组（P＜0.05）,且随孕龄的增加, A组、B组腹围的Z-评分值与正常对照组的偏离度进行性加大。C组在中孕期、晚孕早期腹围的Z-评分值与正常对照组无明显差别,仅在晚孕晚期其腹围的Z-评分值略高于正常对照组（P=0.045）。GDM的巨大儿组与非GDM的巨大儿组在体型上存在差异,表现为晚孕后期,GDM的巨大胎儿组头腹围比的Z-评分值小于非GDM的巨大儿组（P＜0.05）。传统超声生物学指标中,在中孕期（20+1～24周）只有A组的AC与正常对照组有差异、B组与正常组无明显差异。晚孕早期、晚孕晚期两阶段A组、B组BPD、HC、AC、FL、HC/AC均与正常对照组有差异（P＜0.05）,但无法直观判断各指标与正常对照组的偏离程度。结论：超声生物学指标的Z-评分有助于更准确定量评估胎儿宫内生长发育状况,在诊断胎儿宫内生长发育异常以及动态观察随访中有一定临床应用价值,值得推广。     

Regression formula for estimation of fetal weight with use of abdominal circumference and femur length: a prospective study.

Ultrasonographic fetal measurements from 293 singleton pregnancies were obtained within 7 days of delivery. Biparietal diameter, abdominal circumference, femur length, and actual birth weight data of the first 93 fetuses in the study were used as variables to determine the best mathematical model for relating estimated fetal weight to biparietal diameter, abdominal circumference, and femur length. With the aid of a computer, three regression equations were derived. The best model was Log10 (weight) = 0.77125 + 0.13244 (AC) - 0.12996 (FL) - 1.73588 (AC x AC)/1000 + 3.09212 (FL x AC)/1000 + 2.18984 (FL/AC); (R2 = 0.987). The accuracy of this formula was then compared prospectively, first with the formulas published by Shepard and coworkers, Rose and McCallum, and Hadlock and colleagues in the entire sample of 200 patients, second in 46 large, 101 appropriate, and 53 small for gestational age fetuses, and then in 44 fetuses of pregnancy complicated by diabetes. The difference between actual and estimated birth weights generated by the study formula had no systematic error (Student's t-test, P > 0.05) in cumulative data, and in small or appropriate and large for gestational age fetuses. As this derived formula is very cumbersome to manipulate, tables have been prepared with computer assistance to read the estimated fetal weight directly.     

三维斑点追踪成像技术对高血压患者左心房功能的评价

目的应用三维斑点追踪成像技术评价不同时相左心房容积、射血分数和应变功能参数在左心室重构和非重构高血压患者中的变化特征。 方法收集2020年1月至2020年8月在四川省人民医院进行心脏超声检查的高血压患者90例（左心室重构组40例,非重构组50例）,另选取健康受试者40例,均进行标准三维和二维经胸超声心动图图像采集及参数分析。测量比较3组受试者的常规心脏参数,左心房储器、管道及泵时相的长轴和圆周应变,不同时相左心房射血分数,左心室整体长轴应变等,并研究不同时相左心房应变与射血分数、左心室整体长轴应变的相关性。 结果与健康受试者相比,高血压非左心室重构组左心房管道及泵时相的长轴应变降低（11.7%±3.0% vs 14.6%±1.4%、12.6%±3.4% vs 15.2%±2.2%）,而储器、管道及泵时相圆周应变增加（34.3%±6.3% vs 29.0%±5.1%、14.6%±3.1% vs 12.4%±2.1%和19.3%±4.4% vs 16.6%±2.3%,均P＜0.05）;左心室重构高血压组的左心房不同时相容积均显著增加（均P＜0.05）,射血分数、长轴及圆周应变均显著降低（均P＜0.05）。左心室重构高血压患者不同时相的左心房长轴及圆周应变与射血分数、左心室整体长轴应变均呈正相关（r=0.35~0.77,均P＜0.05）,左心房管道圆周应变与储器、泵功能射血分数及左心室整体长轴应变相关性最高,相关系数r分别为0.77、0.71、0.66。 结论复杂的左心房功能可以应用三维斑点追踪成像技术来评价,包括快速获取不同时相左心房射血分数、左心房长轴及圆周应变参数,圆周应变是反映左心房功能的重要参数。三维斑点追踪成像可为早期发现高血压患者左心房功能改变及临床早期干预提供有价值的信息。     

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。