超声评估胎儿双肩径与肩难产的相关性  

Correlation between fetal biacromial diameter estimated by ultrasound and shoulder dystocia

作　　者：周富强[1] 杨雅婷 梁亮 鄂占森[1] 陈金华[1] 何学森[1] 蔡莹莹[1] 刘宇清[1] ZHOU Fuqiang;YANG Yating;LIANG Liang;E Zhansen;CHEN Jinhua;HE Xuesen;CAI Yingying;LIU Yuqing(Department of Ultrasound,Shenzhen Longgang Central Hospital,Shenzhen 518000,China)

机构地区：[1]深圳市龙岗中心医院超声科,广东深圳518000

出　　处：《中国医学物理学杂志》2025年第3期369-373,共5页Chinese Journal of Medical Physics

基　　金：深圳市龙岗区医疗卫生科技计划项目(LGWJ2022-18)。

摘　　要：目的:验证Youssef公式的准确性,同时评估超声估测的胎儿双肩径(BA)和其他胎儿生物径线是否可以用于预测巨大儿及肩难产,为临床预测肩难产提供参考。方法:200例37~42周的孕妇分娩前3 d内行超声检查,收集胎儿双顶径(BPD)、头围(HC)、腹围(AC)、肱骨长(HL)、股骨长(FL)、胸廓横径、上臂中点直径等数据,利用Youssef公式估测胎儿BA,分娩后1 d内测量新生儿BA、体质量、身长,对上述数据行相关性分析。根据新生儿体质量分为巨大儿组和非巨大儿组,根据是否肩难产分为肩难产组和非肩难产组。结果:(1)Youssef公式估测胎儿BA与新生儿BA相符(P>0.05);估测的BA与BPD、HC、AC、新生儿体质量均呈正相关性(P<0.001)。(2)巨大儿组与非巨大儿组间的BA、BA/AC及BA/HC比值差异均有统计学意义(P<0.05);ROC曲线显示当估测的BA阈值为16.05 cm时,预测巨大儿敏感度为92.3%,特异度为88.2%;BA/AC阈值为0.455时,敏感度仅为61.5%,特异度为77%;BA/HC阈值为0.465时,敏感度仅为76.9%,特异度为72.7%。(3)肩难产组的BA/BPD、BA/HC和BA-BPD值均高于非肩难产组(P<0.05),但两组间的新生儿体质量无统计学差异(P>0.05)。ROC曲线显示,BA阈值为15.45 cm时,预测肩难产敏感度为100%,但特异度仅为66.8%;BA/BPD阈值为1.695时,敏感度为100%,特异度为80.6%;BA/HC阈值为0.475时,敏感度为100%,特异度为81.6%。BA与BPD的差值阈值为6.35 cm时,敏感度为100%,特异度为76%。结论:胎儿BA、BA/BPD、BA/HC、BA/AC和BA-BPD可能是肩难产及巨大儿的有效预测因子。Objective To verify the accuracy of Youssef's formula and evaluate whether fetal biacromial diameter(BA) and other fetal biological diameters estimated by ultrasound can be used to predict macrosomia and shoulder dystocia,so as to provide the possibility for clinical prediction of shoulder dystocia.Methods A total of 200 pregnant women with a gestational period of 37-42 weeks were examined with ultrasound within 3 days before delivery for collecting biparietal diameter(BPD),head circumference(HC),abdominal circumference(AC),humerus length(HL),femur length(FL),thoracic transverse diameter and midpoint diameter of upper arm;and the fetal BA was estimated by Youssef's formula.Neonatal BA,body mass and body length were measured within 1 day after delivery.The above data were analyzed for correlation.Newborns were grouped according to their body mass(macrosomia vs non-macrosomia) and whether they had shoulder dystocia or not(shoulder dystocia vs non-shoulder dystocia).Results(1) The fetal BA estimated by Youssef's formula was consistent with neonatal BA(P>0.05),and the estimated BA was positively correlated with BPD,HC,AC and neonatal body mass(P<0.001).(2) The BA,BA/AC and BA/HC in macrosomia group were different from those in non-macrosomia group(P<0.05).ROC curve showed that the sensitivity and specificity were 92.3% and 88.2% for macrosomia prediction when the estimated BA threshold was 16.05 cm,and those were 61.5% and 77.0% when BA/AC threshold was 0.455,and 76.9% and 72.7%when BA/HC threshold was 0.465.(3) Shoulder dystocia group had neonatal weight close to non-shoulder dystocia group(P>0.05),but higher BA/BPD,BA/HC and BA-BPD(P<0.05).ROC curve showed that the sensitivity and specificity were100.0% and 66.8% for shoulder dystocia when BA threshold was 15.45 cm,100.0% and 80.6% when BA/BPD threshold was1.695,100.0% and 81.6% when BA/HC threshold was 0.475,and 100.0% and 76.0% when the threshold difference between BA and BPD was 6.35 cm.Conclusion Fetal BA,BA/BPD,BA/HC,BA/AC and BA-BPD may be effective predictor

关 键 词：超声 肩难产 胎儿双肩径 巨大儿 

分 类 号：R445.1[医药卫生—影像医学与核医学]