ABSTRACT
Objective:To evaluate the efficacy of cerebral-placental-uterine ratio(CPUR)in predicting late-on-set fetal growth restriction(FGR).Methods:From May 2020 to May 2021,1255 women with singleton pregnancy who underwent prenatal examinations at the University of Hong Kong Shenzhen Hospital were selected for fetal growth and Doppler measurements at 35-37 +6 weeks of gestation.Pregnant women with birth weight of newbo-rns＜the 10th percentile were the FGR group.The pulsatility index(PI)of uterine artery(UtA),umbilical artery(UA)and fetal middle cerebral artery(MCA)were analyzed separately and in combination.ROC curve was used to analyze the cerebral-placental-uterine ratio(CPUR),cerebral-placental ratio(CPR),cerebral-uterine ratio(C-UtA)for predicting late-onset FGR;and to evaluate the sensitivity,positive and negative predictive value and of CPUR in the prediction of late-onset FGR.Results:The area under the curve(AUC)of CPUR,CPR,C-UtA and mean UtA-PI for FGR grope were 0.88,0.86,0.84 and 0.72.Under certain cut-off values and 87% specificity,the specificity of CPUR,CPR,C-UtA and mean UtA-Pifor predicting FGR group was 43.2%,46.6%,39.8% and 23.9%,respectively.The positive predictive values of CPUR,CPR,C-UtA and mean UtA-PI,UA-PI for predicting FGR group were 90.5%,71.9%,83.3%,63.6%and 5.2%,respectively.Conclusions:CPUR is more effective in predicting late onset FGR than CPR,C-UtA and mean UtA-PI.It can effectively increase the detection rate of fetal growth restrictionand reduce the FGR risk.
ABSTRACT
OBJECTIVE: To investigate the effects, safety and cost-benefit analysis of Down syndrome screening in first trimester. METHODS: From January 2009 to December 2012, 43 729 pregnant women undergoing 3 methods of Down syndrome traditional screening strategies in Shenzhen Maternity and Child Healthcare Hospital were studied retrospectively, including in 17 502 cases in pregnancy associated plasma protein A (PAPP-A) and free ß-hCG measured biochemistry screening, 14 080 cases in nuchal translucency (NT) screening and 12 147 cases in combined screening, meanwhile, 7 389 cases on non-invasive fetal trisomy test (NIFTY) were performed in Huada Gene Research Institute(BGI). The effects and safety of four screening strategies were assessed throughout a decision tree. The economical characters of each screening strategy were compared by cost-effectiveness analysis as well as cost-benefit analysis. RESULTS: (1) The effects of four strategies are: NIFTY > combined screening > NT screening > biochemistry screening. (2) The safety of four strategies are: NIFTY > combined screening > NT screening > biochemistry screening. (3) Cost-effectiveness analysis and cost-benefit analysis:the biochemistry screening has lowest cost-effectiveness ratio (CER) and highest cost-benefit ratio (CBR), which performed a better economical efficiency. The incremental CER of three traditional screening strategies are all less than the economical burden of Down syndrome.NIFTY has highest CER and negative net present value (NPV), NPV would be positive and CBR would be more than 1 if the price of NIFTY reduce to 1 434 Yuan. CONCLUSIONS: Combined screening possess best screening efficiency, while biochemistry screening was demonstrated more economical in traditional screening.NIFTY is the future of Down syndrome screening.
Subject(s)
Chorionic Gonadotropin, beta Subunit, Human/blood , Down Syndrome/diagnosis , Pregnancy-Associated Plasma Protein-A/analysis , Prenatal Diagnosis/economics , Prenatal Diagnosis/methods , Chorionic Gonadotropin, beta Subunit, Human/adverse effects , Cost-Benefit Analysis , Female , Humans , Nuchal Translucency Measurement/adverse effects , Nuchal Translucency Measurement/economics , Pregnancy , Pregnancy Trimester, First , Pregnancy-Associated Plasma Protein-A/adverse effects , Retrospective Studies , Sensitivity and SpecificityABSTRACT
Objective To investigate the ultrasound characteristics,etiology and prognosis in hydrops fetalis.Methods From September 2002 to May 2010,156 hydrops fetalis presented in Shenzhen Maternity and Child Healthcare Hospital were studied retrospectively,including ultrasound characteristics,etiology,and prognosis.Results All of the 112 typical hydrops fetalis,20 cases with isolated ascites,8 cases with isolated pleural effusion,7 cases with isolated pericardial effusion,5 cases with isolated subcutaneous edema,4 cases with isolated placental thickening were observed by ultrasonography.The major etiology and associated diagnosis consisted of 35.9％ (56/156) of non-immune anemia,9.6％ (15/156) of cardiac abnormalities,7.1％ (11/156) of intrauterine infection,6.4％ (10/156) of twin problems,5.8％ (9/156) of meconium peritonitis,5.1％ (8/156) of thoracic-lung disease,4.5％ (7/156) of chromosomal abnormalities,1.9％ (3/156) of immune anemia.Alpha thalassemia was the most common non-immune anemia (96％,54/56).An etiology and associated diagnosis could be determined in 81.4％ ( 127/156 ) of cases.Follow-up data showed that 7 cases were fetal death,110 women elected to terminate their pregnancies,3 cases lost follow-up,the other 36 cases preserve continuing pregnancy,including 28 liveborn infants and 8 fetal deaths.Etiology of twin-twin transfusion syndrome,meconium peritonitis,congenital chylothorax,intrauterine infection,cardiac abnormalities and so on had survived fetuscases.The survival rate of typical hydrops fetalis in the present series was 3.6％ ( 4/112 ).Conclusions Ascites is the most common characteristics of sonogram in hydrops fetalis.The etiology of hydrops fetalis is extremelycomplex.The prognosis is associated with the etiology and hydrops subtype.