海南医科大学学报

目的:探讨足月分娩前不同B超测量径线对新生儿出生体重和巨大儿的预测价值,为指导临床实践提供科学依据。方法:对3 971名孕妇,在分娩前3天内超声测量胎儿双顶径、头围、胸径、腹围、股骨长、肱骨长,追踪胎儿的出生体重,使用SPSS10.0软件包分析胎儿各径线长与出生体重的关系。结果:B超测量胎儿的双顶径、头围、胸径、腹围、股骨长、肱骨长与新生儿出生时体重相关性均有统计学意义(均P<0.001)。腹围和股骨长是巨大儿重要影响指标(P值均<0.001)。"新生儿出生体重(g)=13.6×腹围(mm)+41.4×股骨长(mm)-4 182"模型对预测新生儿出生体重具有一定价值,但对巨大儿预测价值相对较低(假阴性率为79.8%)。ROC曲线胎儿腹围、股骨长预测巨大儿的最佳临界值分别为357.5mm和71.5 mm,该界值预测巨大儿的灵敏度分别为67.4%和75.6%,特异度分别为83.0%和60.5%。结论:足月分娩前超测量胎儿胸围和股骨长是预测新生儿出生体重的较好指标,腹围大于357.5mm、股骨长大于71.5mm对预测巨大儿具有一定临床价值。

Objective: To determine the reliability of the fetal body measurements by ultrasound as predictors of birth weight so as to provide scientific evidence to guide clinical practice.Methods:Totally 3 971 pregnant women substantially completed this survey.Fetal biparietal diameter,head circumference,thoracic diameter,abdominal circumference,thigh bone length,humerus length were measured by ultrasound within 3 days of delivery and the birth weight were also followed.SPSS10.0 was used to analyze the correlation between fetal body measurements and birth weight.Results:Fetal biparietal diameter,head circumference,thoracic diameter,abdominal circumference,thigh bone length,humerus length were significantly correlated with birth weight(P<0.05).Higher abdominal circumference and thigh bone length were the risk factors of fetal macrosomia(P<0.05).The prediction model of birth weight was "birth weight(g)= 13.6 × abdominal circumference(mm)+41.4 ×thigh bone length(mm) – 4182.The model had lower predictive value for macrosomia(false negative rate was 79.8%).Receiver operator characteristic curve(ROC) was used to decide cut off points of abdominal circumference,thigh bone length to screening macrosomia(357.5mm,71.5mm).Those values had sensitivity of 67.4% and 75.6%,had specificity of 83.0% and 60.5%.Conclusions: Abdominal circumference and thigh bone length are the valuable indicators to predicting birth weight.Abdominal circumference more than 357.5mm and thigh bone length more than 71.5mm can help to screen macrosomia.