Screening for Intrauterine Growth Restriction in Uncomplicated Pregnancies: Time for Action
Screening for Intrauterine Growth Restriction in Uncomplicated Pregnancies: Time for Action
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DOI：
10.1055/s-0032-1321497
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发表时间：
2013-01-01
影响因子：
2
通讯作者：
Abuhamad, Alfred Z.
中科院分区：
文献类型：
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作者：
Chauhan, Suneet P.;Rouse, Dwight J.;Abuhamad, Alfred Z.
一项随机临床试验 (RCT) 指出，妊娠晚期进行超声检查，结合足月分娩时胎儿生长异常情况，可显着降低无并发症妊娠中出现小于胎龄 (SGA) 新生儿的可能性。我们确定了筛查测试的 15 个特征，并试图确定是否有证据可以常规获得妊娠晚期胎儿体重的超声检查估计值并降低 SGA 率。在 15 个建议特征中，目前有 10 个（67%）已满足，两个不确定（超声检查是否具有成本效益或可靠），一个（测试必须发挥作用）可能有效。由于缺乏证明发病率降低的随机对照试验，因此可能存在前置时间和长度偏差。为了观察围产期综合发病率降低 36%（从 4.1% 降至 2.6%），与常规产前护理相比，需要将 6000 名妇女在妊娠晚期随机分配至少两次超声检查。这样的随机对照试验是有保证和合理的。
A randomized clinical trial (RCT) noted that sonographic examination in the third trimester, in conjunction with delivery at term for abnormalities of fetal growth, significantly decreased the likelihood of small-for-gestational-age (SGA) neonates in uncomplicated pregnancies. We identified 15 characteristics of screening tests and attempted to determine if there is evidence to routinely obtain sonographic estimates of fetal weight in the third trimester and decrease rates of SGA. Of the 15 suggested characteristics, currently 10 (67%) are fulfilled, two are uncertain (sonographic examination is cost-effective or reliable), and one (the test must do its job) is possibly valid. Due to the lack of RCTs demonstrating reduction in morbidity, there is potential for lead-time and length bias. To observe a 36% decrease (from 4.1 to 2.6%) decrease in composite perinatal morbidity, 6000 women need to be randomized to at least two sonographic examinations in the third trimester versus routine prenatal care. Such an RCT is warranted and justified.