METHODS: A retrospective cohort study of pregnant women undergoing first-trimester pre-eclampsia screening at 11-13 gestational weeks was conducted. Maternal characteristics and history, mean arterial pressure (MAP) measurement, uterine artery pulsatility index (UtA-PI) ultrasound, maternal ophthalmic peak ratio Doppler, and placental growth factor (PlGF) serum were collected during the visit. Stillbirth was classified as placental dysfunction-related when it occurred with pre-eclampsia or birth weight <10th percentile. Combined prediction models were developed from significant variables in stillbirths, placental dysfunction-related, and controls. We used the area under the receiver-operating-characteristics curve (AUC), sensitivity, and specificity based on a specific cutoff to evaluate the model\'s predictive performance by measuring the capacity to distinguish between stillbirths and live births.
RESULTS: There were 13 (0.79%) cases of stillbirth in 1643 women included in the analysis. The combination of maternal factors, MAP, UtA-PI, and PlGF, significantly contributed to the prediction of stillbirth. This model was a good predictor for all (including controls) types of stillbirth (AUC 0.879, 95% CI: 0.799-0.959, sensitivity of 99.3%, specificity of 38.5%), and an excellent predictor for placental dysfunction-related stillbirth (AUC 0.984, 95% CI: 0.960-1.000, sensitivity of 98.5, specificity of 85.7).
CONCLUSIONS: Screening at 11-13 weeks\' gestation by combining maternal factors, MAP, UtA-PI, and PlGF, can predict a high proportion of stillbirths. Our model has good accuracy for predicting stillbirths, predominantly placental dysfunction-related stillbirths.
方法:对在11-13孕周接受早孕期先兆子痫筛查的孕妇进行回顾性队列研究。产妇的特点和历史,平均动脉压(MAP)测量,子宫动脉搏动指数(UtA-PI)超声,产妇眼科峰值比率多普勒,随访期间收集胎盘生长因子(PlGF)血清。当发生先兆子痫或出生体重<10百分位数时,死胎被归类为胎盘功能障碍相关。组合预测模型是根据死产的重要变量开发的,胎盘功能障碍相关,和控制。我们使用了接受者工作特征曲线(AUC)下的面积,灵敏度,以及基于特定截止值的特异性,通过测量区分死产和活产的能力来评估模型的预测性能。
结果:分析中包括1643名妇女中13例(0.79%)死产。母性因素的结合,MAP,UtA-PI,和PlGF,显著有助于预测死产。该模型是所有(包括对照)死产类型的良好预测因子(AUC0.879,95%CI:0.799-0.959,敏感性99.3%,38.5%的特异性),和胎盘功能障碍相关死胎的良好预测指标(AUC0.984,95%CI:0.960-1.000,敏感性98.5,特异性85.7)。
结论:妊娠11-13周结合母体因素进行筛查,MAP,UtA-PI,和PlGF,可以预测死产的比例很高。我们的模型对预测死胎有很好的准确性,主要是胎盘功能障碍相关的死胎。