Estimation of Fetal Weight in Fetuses With Abdominal Wall Defects Comparison of 2 Recent Sonographic Formulas to the Had lock Formula
Estimation of Fetal Weight in Fetuses With Abdominal Wall Defects Comparison of 2 Recent Sonographic Formulas to the Had lock Formula
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DOI：
10.7863/jum.2010.29.7.1069
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发表时间：
2010-07-01
影响因子：
2.3
通讯作者：
Odibo, Anthony O.
中科院分区：
文献类型：
--
作者：
Nicholas, Sara;Tuuli, Methodius G.;Odibo, Anthony O.
Objective.胎儿体重的估计是特别具有挑战性的胎儿腹壁缺陷（AWD）。我们试图在AWD胎儿中比较两种最新超声公式与Hadlock公式（Am J Obstet Gynecol 1985; 151：333-337）的准确性和筛查效率。方法.这是一项AWD胎仔的回顾性队列研究。纳入了分娩前14天内超声估计胎儿体重（EFW）的胎儿。使用个体生物特征测量值，使用Honarvar（Int J Gynaecol Obstet 2001; 73：15-20;股骨长度[FL]）Siemer（Ultrasound Obstet Gynecol 2008; 31：397-400; FL，双顶径[BPD]和枕额径）和Hadlock（BPD，头围，腹围和FL）公式计算EFW。使用已发表的超声胎儿生长速度标准，根据超声检查和分娩日期之间的间隔生长调整计算的EFW。比较胎儿宫内发育迟缓筛查的准确率和筛查效率。结果纳入76例胎儿：腹裂53例，脐膨出23例。分娩时的中位孕龄为36.6周（范围：25.0 - 39.0周）。Siemer公式的平均百分比误差最低（-2.5% [95%置信区间（CI），-6.2%至+1.2%]），无系统偏倚（P = 0.182）。Hadlock公式具有最高的精确度（随机误差，11.4%），敏感性（91%）和预测IUGR的准确性（85% [95%CI，77%至94%]）。结论. 3种超声公式均不能理想估计AWD胎儿的体重。当绝对EFW的精度是目标时，应使用Siemer公式。为了使IUGR的诊断更具临床意义，使用Hadlock公式是合理的。
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.