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題 名 | Refined Fetal Abdominal Growth Assessment in Normal Pregnancy: Part Ⅰ. Abdominal Anteroposterior Diameter=正常懷孕胎兒腹部生長的改良式評估--第一部份:腹部前後徑 |
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作 者 | 游振祥; 姚博琳; 張炯心; 柯慧貞; 林鈺山; 張峰銘; | 書刊名 | 中華醫學雜誌 |
卷 期 | 59:3 1997.03[民86.03] |
頁 次 | 頁164-170 |
分類號 | 417.343 |
關鍵詞 | 絕對殘餘值; 前後徑; 胎腹; 懷孕週數; 標準差; 標準化殘餘值; Absolute residual Anteroposterior diameter; Fetal abdomen; Gestational age; Standard deviation; Standardized residual; |
語 文 | 英文(English) |
中文摘要 | 背景: 利用胎兒器官的生長情形來評估胎兒的生長情況已經行之多年,但是截至目前為止尚沒有單獨利用胎兒腹部前後徑長度來評估胎兒大小的報告。以往這種類似的胎兒生長評估方法,其研究的取材和統計分析方面存在著瑕疵,其中三種最大的缺點在於(1)非橫向(noncross-sectional)的取材(2)無法保證所選定的胎兒完全正常 (3) 統計方面有缺失。經常是將各週的標準差視為一常數而非一隨週數改變的變數。這種觀念在1993年奧特曼這位學者提出後有了轉變,目前認為應該要將各週的標準差視為一變數。 方法:為了改進以上所提研究上的缺失,我們從1989年1月1日起至1995年12月31日止,前瞻性且橫向性的選定了2,077個胎兒的產前超音波資料,以為研究的基礎。入選的條件包括(1)正確的最後一次月經並和懷孕早期的超音波比較無誤(2)單胞胎懷孕(3)產前超音波沒有發現胎兒結構上或染色體方面有異常,並於產後確認(4)胎兒出生的週數介於37至41週之間(5)剛出生時沒有窒息的現象(6)適當的胎兒出生體重(7)孕婦沒有足以影響胎兒發育的內科併發症或產科合併症。所有的資料利用奧特曼所提出的統計模式來做迴歸分析,並找出一最適合的預測公式以求出各週數各種百分比的最佳預測值。 結果:最佳的迴歸公式分別為:週數 (GA) = 20.8569 - 3.36743 x AAPD + 0.86927 x (AAPD)2 - 0.03789 x (AAPD)3 + k x [1.2533 x (0.36772 + 0.10938 x AAPD] 及胎腹前後徑 (AAPD) = -2.49495 + 0.38247 x GA - 1.07071 x 0.001 x (GA)2 + k x [1.2533 x (0.01760 + 0.01372 x (GA)]。前者的相關係數為0.97287,後者為0.97122。 結論:各懷孕週數的標準差會隨週數而變,胎兒的生長情況可以用胎兒腹部前後徑來加以評估,而且有極高的相關性。我們建議使用胎兒腹部前後徑來評估胎兒的生長。 |
英文摘要 | Background: The assessment of the adequacy of fetal growth by parameters other than the abdominal anteroposterior diameter (AAPD) of the fetus has been studied exten-sively. However the designs of these studies and the statistical methods used appears to deserve some criticism, based on present knowledge. Noncross-sectional cases selection, uncertainty of the fetal normality and inadequacy in statistical method, mostly ignored the changing property of each standard deviation (SD) of each gestational age (GA) which was proposed by Altman et. al. in 1993, are the three most common flaws in previous publishes. We tried to use AAPD with a strict study design as well as a reasonable statistical method to evaluate the fetal growth. Methods: This study was performed in the Division of Maternal Fetal Medicine, National Cheng Kung University Hospital, Taiwan. The prenatal sonographic data of the fetuses were collected prospectively based on the following criteria: (1) accurate dating by knowing the maternal last menstration period (LMP) and early ultrasonography of the fetuses, (2) singleton pregnancy, (3) no fetal structural or chromosomal abnormality confirmed by prenatal ultrasonography and postnatal examination, (4) GA at birth was between 37 and 41 weeks' gestation, (5) no birth asphyxia, (6) appropriate birth body weight, and (7) no maternal medical disease or obstetrical complication which might predictably interfere with fetal growth. The collected data were analyzed by polynomial regression test and the best-fit equation for prediction of fetal growth was selected. The standard deviation (SD) of each GA was modeled before constructing the fetal growth centile charts by Altman's method. Results: A total of 2077 cross-sectional sonographic data meeting the above criteria were collected for statistical analysis. The best-fit equation for the prediction of fetal GA by AAPD is GA = 20.8539 - 3.36743 x AAPD + 0.86927 x (AAPD)2 - 0.03789 x (AAPD)3 +/- k x [1.2533 x (0.36772 + 0.10938 x AAPD)], (r=0.97287, p < 0.0001). The best-fit equation for prediction of fetal AAPD by GA is AAPD = -2.49495 + 0.38247 x GA - 1.07071 x 0.001 x (GA)2 +/- k x [1.2533 x (0.01760 + 0.01372 x GA)], r=0.97122, p < 0.0001. The SD of AAPD for each complete GA was not the same. The fetal growth centile charts in the study are presented in this article. Conclusions: The SD of each complete GA changed with each specific GA. The GA of the fetus can be assessed accurately by measuring the AAPD alone. The utilization of these growth centile charts for evaluation of fetal growth is recommended. |
本系統中英文摘要資訊取自各篇刊載內容。