产前多超声参数评估胎儿生长受限的价值及诊断假阴性影响因素分析OACSTPCD

Objective:To explore the value of prenatal color Doppler ultrasound in the evaluation of fetal growth restriction(FGR)and analyze the influencing factors of false negative ultrasound diagnosis.Methods:From October 2019 to July 2023,118 fetuses diagnosed as FGR by prenatal color Doppler ultrasound and confirmed by postpartum follow-up were selected as the true positive group of FGR,and 60 fetuses with negative FGR diagnosed by prenatal color Doppler ultrasound and postpartum FGR were selected as the false negative group of FGR.The ultrasonic parameters of different gestational weeks between the two groups were compared at the first examination.The clinical data of the two groups of fetuses were compared,and the factors affecting the false negative of FGR diagnosed by ultrasound were screened by random forest algorithm and multivariate Logistic regression analysis.Multi-factor Logistic regression model was constructed and its prediction efficiency was evaluated.Results:At the 12th and 14th week of pregnancy,the abdominal circumference and femoral length of the false negative group were significantly longer than those of the true positive group,and the end systolic peak(S)/end diastolic peak(D)of blood flow in the false negative group was significantly lower than that in the true positive group(P＜0.05).At 15-27 weeks of pregnancy,the abdominal circumference and femoral length of the fetus in the false negative group were significantly longer than those in the true positive group(P＜0.05).At 28-37 weeks of pregnancy,the abdominal circumference of the fetus in the false negative group was significantly longer than that in the true positive group(P＜0.05).The results of random forest algorithm and multivariate Logistic regression analysis showed that higher weight gain during pregnancy,gestational diabetes mellitus,breech position,gestational age＞40 weeks,male fetus and increased abdominal circumference were the risk factors for false negative FGR diagnosis by ultrasound(P＜0.05).When the probability of false negative diagnosis of FGR by model prediction ultrasound is 0.85,the Yoden index is the highest(74.46),the sensitivity is 86.45％,and the specificity is 88.01％.the logical regression goodness-of-fit test results show that Nagelkerke R2 is 0.602 before and after Bootstrap verification of the model.Conclusion:With the increase of gestational weeks(12-37 weeks),the number of differences between true-positive and false-negative fetuses diagnosed by ultrasound for the first time decreased gradually.Weight gain during pregnancy,gestational diabetes and fetal position were the risk factors affecting false-negative diagnosis of FGR by ultrasound.