单胎头臀长数据库在双胎孕龄确定中的作用  

The application of singleton crown-rump length charts in the first trimester dating of twin pregnancy

作　　者：许慧[1] 胡娅莉[2] 茹彤[2] 顾燕 杨燕[2] 戴晨燕[2] 杨丽娟[2] 王志群[2] 

机构地区：[1]东南大学医学院,南京210009 [2]南京大学医学院附属鼓楼医院

出　　处：《现代妇产科进展》2011年第4期265-268,271,共5页Progress in Obstetrics and Gynecology

基　　金：江苏省社会事业发展重点课题(No:BE2009620)资助

摘　　要：目的：了解11～13^＋6柏孕周单胎妊娠头臀长数据库是否适用于双胎孕龄的确定。方法：以本地区体外受精一胚胎移植受孕的731例妊娠妇女为研究对象，在取卵后11～13^＋6孕周经腹测量胎儿头臀长并记录，随访全妊娠期。剔除胎儿核型异常、结构异常、流产、死胎、死产、失访及双胎妊娠中单绒单羊、单绒双羊、双胎之一消失的胎儿，早产儿不除外。首先建立单胎妊娠不同孕周头臀长的第10^th、50^th和90^th百分位数曲线，将Hadlock曲线和Robinson曲线与实际测量值（实测值）构建的曲线作比较；然后分别计算11～13^＋6孕周通过Hadlock曲线和Robinson曲线确定单胎和双胎大、小胎儿孕龄的系统误差、95％可信区间和随机误差。通过单因素方差分析头臀长实测值的标准得分比较各组胎儿的大小。结果：我们共纳入696例妊娠妇女，其中双胎妊娠241例。11～13^＋6孕周Hadlock曲线估算本地区胎儿大小与实测值构建曲线的平均差异为1．3mm，相当于过高估算孕龄0．7天；而Robinson曲线与实测值构建曲线的平均差异为1．8mm，相当于过高估算孕龄1．0天。Hadlock曲线确定单胎和双胎大、小胎儿孕龄的系统误差分别为0．65天、1．83天和0．24天；Robinson曲线分别为1．33天、2．32天和1．00天。早孕期单胎大小在双胎两个胎儿大小之间。组间两两比较发现小胎儿与单胎大小差异无统计学意义。结论：本地区单胎妊娠早孕期孕龄的确定可用超声自带的数据库评估；单胎妊娠数据库适用于双胎早孕期孕龄的确定，且以小胎儿测量值确定孕龄误差最小。Objective ： To investigate the possibility of singleton dating formulae at 11 13^＋6 gestational weeks from ultrasound scan in dating twin pregnancies. Methods：This study in- volved 731 pregnant women after in-vitro fertilization（IVF） who underwent a scan at 11 -13^＋6 weeks of gestation. Gestational age was calculated from the day of oocyte retrieval. The exclusion criteria included： abnormal karyotype, congenital structure abnormalities, spontaneous miscar- riage, fetal demise, stillbirth, the withdrawing fetus, monochorionic twins and co-twin demise fe- tus but the preterm birth were included. We established a dating formula and curve based on the singleton fetal crown-rump length （CRL） at 11 - 13^＋6 weeks of gestation and then compare the result with the Robinson and Hadlock CRL curves. The systematic measurement error, 95% confidence interval and random measurement error were calculated for singletons, the bigger twins and the smaller twins. Mean CRL Z-score were compared between singletons,the bigger twins and the smaller twins using one-factor analysis of variance. Results： We examined 696 subjects in total, among whom 241 were twin pregnancies. Compared with our curve, the Hadlock curve gave gestational ages at i 1 - 13^＋6 weeks with a difference in CRL of 1.3mm,equivalent to 0.70d. The Robison curve showed a difference in CRL of 1.8 mm at 11 - 13^＋6 weeks,equivalent to 1.0 d. The systematic measurement error of Hadlock curve is O. 65 days, 1.83 days and 0.24 days among different groups at 11 - 13^＋6 weeks. In addition, the systematic measure- ment error of Robinson curve is 1.33 days, 2.32 days and 1.00 days. All measurements from the bigger and the smaller twins straddled those of singletons, regardless of curves used. Lack of a significant difference between singleton and the smaller twins. Conclusion ： Currently available CRL charts can be used for the purpose of dating singleton and twin pregnancies. Furthermore dating by the smaller twins would be the most accuracy.

关 键 词：头臀长 孕龄 双胎妊娠 体外受精一胚胎移植 

分 类 号：R714.5[医药卫生—妇产科学]