足月 EFW<第10百分位胎儿中估重生长速度对围产结局的附加预测价值
本研究为回顾性队列研究，纳入600例32周后诊断为EFW<第10百分位且足月分娩的单胎妊娠。按间隔特定标准评估估重生长速度，并比较慢速生长与标准多普勒及生物测量指标对不良围产结局的预测能力。结果显示慢速估重生长速度未提高不良结局预测效能。
要点
- 足月EFW<第10百分位胎儿中，慢速估重生长速度不改善不良围产结局预测。
- EFW<第3百分位、异常UtA-PI和低CPR是复合不良结局的独立预测因素。
- 在已有多普勒和生物测量标准基础上，估重生长速度临床价值有限。
核心结论
- 在足月EFW<第10百分位胎儿中，慢速估重生长速度未能在已有多普勒和生物测量标准之外提高不良围产结局预测能力。
研究设计与样本
- 回顾性队列研究，在一家三级围产中心开展。
- 纳入600例32周以上诊断为EFW<第10百分位且足月分娩的单胎妊娠。
- 估重生长速度依据间隔特定标准，在诊断SGA至分娩前最后一次超声之间评估，要求至少两次超声且间隔≥14天。
主要发现
- 慢速估重生长速度发生率为31.8%。
- 慢速生长组末次超声EFW<第3百分位比例高于非慢速组：52.4%对23.2%，p<0.001。
- 慢速生长组出生体重<第3百分位比例为51.6%，非慢速组为62.8%，p<0.05。
- 慢速生长组脐动脉多普勒异常率高于非慢速组：4.2%对1.0%，p=0.023。
- 复合不良结局发生率在两组间无显著差异：22.7%对26.6%，p=0.689。
关键数值与推荐
- 胎儿生长受限定义：EFW<第3百分位，或大脑中动脉搏动指数或脑胎盘比<第5百分位，或脐动脉或子宫动脉搏动指数≥第95百分位。
- 慢速估重生长速度定义为按孕周调整后低于第10百分位。
- 慢速生长速度阈值对应出生时SGA检出假阳性率为10%。
临床怎么用
- 对足月EFW<第10百分位胎儿，临床评估重点仍应放在EFW<第3百分位、UtA-PI和CPR等指标。
- 估重生长速度在该人群中的常规临床应用缺乏额外预测价值。
局限性
- 研究为回顾性队列设计。
- 复合不良结局发生率在慢速生长与非慢速生长组间无显著差异。
以上解读依据论文摘要（全文未开放获取或许可不允许翻译转载）。
原文
ABSTRACT Objective To evaluate whether estimated fetal weight (EFW) growth velocity (GV), assessed using interval-specific standards, provides additional prediction beyond standard criteria for identifying adverse outcomes in term foetuses with EFW < 10th centile. Design Retrospective cohort study. Setting Tertiary perinatal centre. Population A cohort of 600 singleton pregnancies diagnosed with EFW < 10th above 32 weeks and term delivered. Methods GV between the diagnosis of SGA (EFW < 10th centile) and the last ultrasound before delivery was defined according to interval-specific standards in cases with at least two scans ≥ 14 days apart. Slow GV was considered the threshold for a 10% false positive rate for detecting SGA at birth according to published references [Hugh O. 2022]. Fetal growth restriction (FGR) was defined if: EFW < 3rd centile, middle cerebral artery pulsatility index or cerebroplacental ratio (CPR) < 5th centile, or umbilical or uterine artery pulsatility index (UtA-PI) ≥ 95th centile. Slow GV was defined below the 10th centile adjusted for gestational age. Logistic regression analysis was performed. Main Outcome Measures A composite adverse outcome (CAO) comprising neonatal morbidity or preeclampsia. Results Slow GV was observed in 31.8% of cases. No significant differences were observed between groups in maternal characteristics, gestational age at diagnosis. At the last scan, foetuses with slow GV more frequently had an EFW < 3rd centile (52.4% vs. 23.2%; p < 0.001) and BW < 3rd centile (51.6% vs. 62.8; p < 0.05) and abnormal umbilical artery Doppler (4.2% vs. 1.0%; p = 0.023). No differences were observed in CAO rates (22.7% vs. 26.6%; p = 0.689). In multivariable analysis, EFW < 3rd centile, abnormal UtA-PI, and low CPR were independent predictors of CAO. Adding slow GV did not improve predictive performance (AUC 0.64 vs. 0.64; p = 0.54). Conclusions In term foetuses with EFW < 10th centile, slow EFW GV does not enhance the prediction of adverse perinatal outcomes beyond established Doppler and biometric criteria, questioning its clinical utility.
引用
- BJOG：Added Value of Estimated Fetal Weight Growth Velocity to Doppler Evaluation for the Prediction of Perinatal Outcomes Among Foetuses With EFW < 10th Centile at Term: A Retrospective Cohort Study
供执业医师工作参考，不替代临床判断；数值与分级以指南原文为准。