A customized standard of large size for gestational age to predict intrapartum morbidity
A customized standard of large size for gestational age to predict intrapartum morbidity
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DOI：
10.1016/j.ajog.2011.02.068
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发表时间：
2011-06-01
影响因子：
9.8
通讯作者：
Simhan, Hyagriv N.
中科院分区：
文献类型：
--
作者：
Larkin, Jacob C.;Speer, Paul D.;Simhan, Hyagriv N.
目的：本研究的目的是确定定制的大胎龄(LGA)标准是否可以识别围产期风险增加的孕妇。STUDY设计：我们评估了7510个胎儿体重估计值，以生成胎儿生长曲线。接下来，我们分析了5072例孕妇分娩时的胎龄、生理和病理变量，以预测出生体重，并计算出定制的理想出生体重和LGA的临界值。在对32,271例妊娠的单独分析中，比较了定制标准(LGA(CUST))确定为LGA的妊娠和传统标准确定的LGA或巨大儿的妊娠与巨大儿相关的不良结局的发生率。结果：LGA确定的妊娠增加了肩难产、三度或四度撕裂和头盆不称的风险。结论：LGA的定制化标准确定了那些不符合LGA/巨大儿传统标准的孕妇，其围产期发病率增加的风险。
OBJECTIVE: The purpose of this study was to determine whether a customized standard of large-for-gestational age (LGA) identifies pregnancies with increased perinatal risk.STUDY DESIGN: We evaluated 7510 estimates of fetal weight to generate a fetal growth curve. Next, we analyzed the gestational age at delivery, physiologic and pathological variables from 5072 pregnancies to predict birthweight, and calculated a customized ideal birthweight and cutoff for LGA. In a separate analysis of 32,271 pregnancies, rates of macrosomia-related adverse outcomes were compared in pregnancies that had been identified as LGA by a customized standard (LGA(cust)) and those pregnancies that had been identified as LGA or macrosomic by conventional standards.RESULTS: LGAcust pregnancies carried increased risk of shoulder dystocia, third-or fourth-degree laceration, and cephalopelvic disproportion. LGAcust pregnancies that did not meet conventional criteria for LGA/macrosomia were at increased risk of all measured outcomes.CONCLUSION: A customized standard of LGA identifies a previously unrecognized population that is at increased risk of perinatal morbidity.