孕11~13<sup>+6</sup>周三维超声测量胎盘体积与新生儿出生体重及胎盘重量和体积的相关性

doi:10.3877/cma.j.issn.1672-6448.2015.02.011

目的

研究早中孕期胎盘体积与新生儿出生体重、胎盘体积及胎盘重量等各项指标之间的相关性。

方法

对2011年6月至2012年7月在北京协和医院就诊的孕11～13⁺⁶周孕妇留取胎盘容积数据，离线采用4Dview软件中三维超声体积测量技术VOCAL法计算出胎盘体积，并以相应头臀长区间相对应的胎盘体积的对数均值比较得出胎盘体积的中位倍数值。选取无合并症及胎儿畸形的孕产妇，记录其年龄及基础体重指数(BMI)，随访至足月胎儿出生，记录新生儿出生体重、胎盘重量及胎盘长径、宽径、厚度并计算出体积。

结果

相关性分析显示：（1）早中孕期胎盘体积中位倍数值与新生儿出生体重具有显著相关性：斯皮尔曼秩相关系数为0.200（P<0.05）；但与出生时胎盘重量及胎盘体积关系不大：斯皮尔曼秩相关系数为0.164，0.112（P>0.05）。（2）新生儿出生体重与胎盘重量、胎盘体积及孕妇基础体重显著相关：斯皮尔曼秩相关系数分别为0.478，0.361，0.259（P<0.01）。（3）胎儿出生时胎盘重量与胎盘体积及孕妇体重指数显著相关：斯皮尔曼秩相关系数分别为0.467（P<0.01），0.198（P<0.05)。多元回归分析显示：（1）新生儿出生体重（g）?=?1136.9+1530.9×MOM+45.3×BMI-15.0×孕妇年龄（r?=?0.29，P?=?0.01<0.05）。（2）胎盘重量（g）?=?88.1+315.3×MOM+10.0×BMI+0.1×孕妇年龄（r?=?0.27，P?=?0.02<0.05）。

结论

早中孕期11～13⁺⁶周胎盘体积与新生儿出生体重、胎盘重量具有一定相关性，可以进行线性拟合。该研究结果为通过早中孕期胎盘体积进一步预测小于或大于胎龄儿具有一定的参照价值。

关键词: 超声检查，三维, 胎盘, 胎儿发育

Objective

The aim of the study was to determine the placenta volume (PV) at 11-13⁺⁶ weeks of gestation by three-dimensional ultrasound (3DUS) in combination with birth weight, placenta weight, placenta volume at birth and maternal age, body mass index (BMI) additionally.

Methods

From June 2011 to July 2012, placental volumes were prospectively measured by VOCAL (Virtual Organ Computer-aided Analysis) method in 129 normal pregnancies of Peking Union Medical College Hospital at 11-13⁺⁶ weeks of Gestation, multiples of the median was calculated (MOM) after logarithmic₁₀ transformation referring to different crown-rump length (CRL) groups. The normal pregnancies were selected without any combinations or fetal abnormalities, then recorded the birth weights, placenta diameters and thicknesses and placenta weight at delivery. The maternal basic status was also concluded in the study.

Results

Correlation analysis results: (1) The transformed placenta volume MOM showed a significant correlation (Spearman rho=0.200, P<0.05) with birthweight but not with placenta weight or placenta volume calculated as ellipsoid (Spearman rho=0.164, 0.112 respectively, P>0.05). (2) The birthweight showed significant correlations with placenta weight, placecnta volume and maternal BMI (Spearman rho=0.478, 0.361, 0.259 respectively, P<0.01). (3) The placenta weight at birth showed a significant correlation with placenta volume at birth (Spearman rho=0.467, P<0.01) and maternal BMI (Spearman rho=0.198, P<0.05). Regression analysis results: (1) Birth weight (g)=1136.9+1530.9×MOM+45.3×BMI-15.0×maternal age (r?=?0.29, P?=?0.01<0.05). (2) Placenta weight (g)=88.1+315.3×MOM+10.0×BMI+0.1×maternal age (r?=?0.27, P?=?0.02<0.05).

Conclusions

The placental volume at 11-13⁺⁶ weeks of gestation has significant correlation with birthweight. This might assist in the identification of the high risk pregnancies caring large or low for gestational age fetuses.

Key words: Ultrasonography, three-dimensional, Placenta, Fetal development

图1 胎盘体积容积测量图显示在3个不同正交平面（A、B、C）所描画的胎盘图像，右下角自动合成的三维图像为计算机虚拟胎盘容积成像

表1 129名早中孕期孕妇的胎儿胎盘体积测量结果

组别	例数	头臀长度（cm）	胎盘体积平均测值（cm³，±s）
1	24	45～54	68.8±16.9^a
2	43	55～64	73.1±7.4^a
3	38	65～74	91.5±19.5^b
4	24	75～84	103.7±14.6

表1 129名早中孕期孕妇的胎儿胎盘体积测量结果

组别	例数	头臀长度（cm）	胎盘体积平均测值（cm³，±s）
1	24	45～54	68.8±16.9^a
2	43	55～64	73.1±7.4^a
3	38	65～74	91.5±19.5^b
4	24	75～84	103.7±14.6

图2 早中孕期（11～13⁺⁶周）129名孕妇的胎儿胎盘体积与头臀长度的线性相关曲线

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Correlation and regression analysis of placenta volume at 11-13⁺⁶ weeks of pregnancy with newborn baby weights, placenta weights and volumes at birth

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Correlation and regression analysis of placenta volume at 11-13+6 weeks of pregnancy with newborn baby weights, placenta weights and volumes at birth

Correlation and regression analysis of placenta volume at 11-13⁺⁶ weeks of pregnancy with newborn baby weights, placenta weights and volumes at birth