摘要
目的探究超声评估胎儿体重的准确性及其影响因素。方法本研究为回顾性研究。搜集2021年11月—2022年2月于中国人民解放军总医院第一医学中心357名分娩孕妇的临床资料,按照纳入和排除标准,最终纳入333名。依据产前超声评估胎儿体重与新生儿出生体重的差值分组,分为数值准确组、数值低估组及数值高估组;依据新生儿出生体重分级分组,将产前超声评估胎儿体重分为级别准确组、级别低估组及级别高估组。比较组间孕妇的年龄、身高、体质量指数(BMI)、孕周、子宫高度、孕妇腹围、孕期增重、末次超声检查距胎儿出生时间、超声评估胎儿体重,新生儿出生体重及超声医师经验情况。单因素分析影响超声评估胎儿体重准确性的因素;计量资料均为非正态分布,以M(Q_(1),Q_(3))表示,3组间比较采用Kruskal-Wallis H检验,两组比较采用Mann-Whitney U检验;计数资料以例数(%)表示,采用χ^(2)检验比较,P<0.05为差异有统计学意义;本研究将数值准确组或级别准确组作为参照,两两比较采用α分割法,P<0.025为差异有统计学意义。结果(1)数值准确组271名、数值低估组32名、数值高估组30名,超声评估新生儿体重准确率为81.4%(271/333);3组孕妇的子宫高度、末次超声检查距胎儿出生时间、超声评估胎儿体重及新生儿出生体重比较,差异均有统计学意义(P均<0.05);数值低估组与数值准确组孕妇的子宫高度、末次超声检查距胎儿出生时间以及新生儿出生体重比较,差异均有统计学意义(P均<0.025);数值高估组与数值准确组的新生儿出生体重、末次超声检查距胎儿出生时间比较,差异均有统计学意义(P均<0.025)。(2)级别准确组309名、级别低估组17名、级别高估组7名,超声预测新生儿体重分级的准确率为92.8%(309/333),3组孕妇的BMI、末次超声检查距胎儿出生时间比较,差异均有统计学意义(P均<0.05);级别低估组与级别准确组的孕妇BMI比较,差异有统计学意义(P<0.025)。(3)333例新生儿中,巨大儿13名、超声检出3名,敏感度23.1%(3/13)、特异度98.4%(315/320)、阳性预测值为37.5%(3/8);低体重儿13名、超声检出11名,敏感度84.6%(11/13)、特异度97.8%(313/320)、阳性预测值61.1%(11/18)。结论超声检查评估胎儿体重及分级的准确率较高,末次检查距胎儿出生时间、孕妇BMI及新生儿出生体重可能是影响超声评估胎儿体重准确率的主要因素。
Objective To explore the accurancy of ultrasound assessment of fetal weight and its influencing factors.Methods This retrospective study collected clinical data of 357 pregnant women who delivered at the First Medical Center of the PLA General Hospital from November 2021 to February 2022.After applying inclusion and exlusion criteria,a total of 333 cases were included.Based on the difference between prenatal ultrasound-assessed fetal weight and the neonatal birth weight,the paticioants were divided into the numerically accurate group,numerically underestimated group,and numerical overestimated group.Based on the classification of the neonatal birth weight,the prenatal ultrasound-assessed fatal weight was classified into the accurate level group,underestimated level group and overestimated level group.A comparison was made among the groups regarding the maternal age,height,body mass index(BMI),gestational age,uterine height,maternal abdominal circumference,gestational weight gain,time interval between the last ultrasound examination and fetal birth,ultrasound-assessed fetal weight,neonatal birth weight and the experience of the ultrasound physician.Univariate analysis was conducted to identify factors influencing the accuracy of ultrasound-assessed fetal weight.The measurement data were expressed as M(Q_(1),Q_(3)),and the Kruskal-Wallis H test was used for comparisons among the three groups,while the Mann-Whitney U test was used for comparisons between two groups.The(count)enumeration data were expressed as the number of cases(%),andχ^(2)-test was used for comparisons,and P<0.05 was considered statistically significant.In this study,the numerically accurate group or accurate level group was used as the reference.Pairwise comparisons were conducted using theα-splitting method,and P<0.025 indicated a statistically significant difference.Results(1)In the numerically accurate group,there were 271 individuals,the numerically underestimated group there were 32 individuals,and in the numerically overestimated group there were 30 individuals.The accuracy of ultrasound-assessed fetal weight was 81.4%(271/333).Compartisons of uterine height,the time interval between the last ultrasound examination and the fetal birth,fetal weight in the ultrasound-assessed fetal weight,and the neonatal birth weight were all statistically significant among three groups of pregnant women(all P<0.05).Comparisons of uterine height,the time interval between the last ultrasound examination and fetal birth,and fetal weight were statistically significant between the numerically overestimated group and the numerically accurate group(all P<0.025).Comparisons of neonatal birth weight and the time interval between the last ultrasound examination and the fetal birth between the numerically overestimated group and the numerically accurate group showed statistically significant differences(all P<0.025).(2)in the accurate level group,there were 309 individuals,while in the underestimated level group,there were 17 individuals,and in the level overestimated group,there were 7 individuals.The accuracy of ultrasound prediction for neonatal birth weight classification was 92.8%(309/333).Comparisons of BMI and the time interval between the last ultrasound examination and fetal birth among the three groups of pregnant women showed statistically significant differences(all P<0.05).the comparison of BMI between the underestimated level group and the accurate level group showed statistically significant difference(P<0.025).(3)Among the 333 newborns,there were 13 individuals of macrosomia,with 3 individuals detected by ultrasound.The sensitivity was 23.1%(3/13),specificity was 98.4%(315/320),and poditive predictive value was 37.5%(3/8).There were 13 individuals of low birth weight,with 11 individuals detected by ultrasound.The sensitivity was 84.6%(11/13),specificity was 97.8%(313/320),and positive predictive value was 61.1%(11/18).Conclusion Ultrasound examination has a relatively high accuracy rate in assessing fetal weight and classification.the time interval between the last ultrasound examination and the fetal birth,maternal BMI,and neonatal birth weight may be the primary factors influencing the accuracy of ultrasound evaluation of fetal weight.
作者
宋禄达
栗嘉楠
汪龙霞
李晓青
罗渝昆
李秋洋
SONG Luda;LI Jianan;WANG Longxia;LI Xiaoqing;LUO Yukun;LI Qiuyang(Chinese PLA Medical School,Beijing 100853,China;Department of Ultrasound Diagnosis,First Medical Center of Chinese PLA General Hospital,Beijing 100853,China)
出处
《中国研究型医院》
2023年第4期29-34,共6页
Chinese Research Hospitals
基金
国家自然科学基金(81801698)
首都临床特色应用研究与成果推广(Z171100001017141)
军队后勤科研项目(23JSZ10)。
关键词
婴儿
新生
出生体重
超声检查
产前
Infant,newborn
Birth weight
Ultrasonography,prenatal
作者简介
通信作者:李秋洋,Email:liqiuyang0925@163.com。
