胎儿生物学参数超声参考值专家共识——双顶径、头围、腹围和股骨长

共识 妇产科· 产科与妊娠 · 中华预防医学会

一、定义

BPD 是指胎儿头部左右两侧之间最宽部位的长度, 为一侧顶骨至另一侧顶骨的距离。HC 是指胎儿颅骨外缘的周长。AC 是指胎儿腹部皮肤外缘的周长。FL 是指骨化的股骨干的长度, 即上下干骺端之间骨化的距离[10-12]。

二、测量时机

根据《超声产前筛查指南》(2022版)[10], BPD、HC、AC和FL的常规测量时机为中、晚孕期(孕14周及以后)。

三、测量方法

根据《超声产前筛查指南》(2022版)[10]，推荐以下测量方法(表1，图1)。

表1 主要胎儿生物学参数标准化测量方法

|参数|测量切面|切面要求及观察内容|游标放置位置| |---|---|---|---| |BPD|经丘脑横切面|切面要求: 显示颅骨强回声环、大脑镰、透明隔腔、两侧丘脑及丘脑后方的大脑脚观察内容: 颅骨强回声环呈椭圆形, 大脑镰居中, 第三脑室位于丘脑之间|游标置于近端颅骨板外缘至远端颅骨板内缘(即“外-内”)| |HC|经丘脑横切面|切面要求及观察内容同BPD|沿胎儿颅骨外缘包络测量头围径线, 不包括头皮及软组织| |AC|腹围横切面|切面要求: 显示胃泡及脐静脉腹内段观察内容: 胃泡位于腹腔左侧; 腹主动脉位于脊柱左前方; 下腔静脉位于脊柱右前方|沿腹壁皮肤外缘测量| |FL|股骨长轴切面|切面要求: 显示股骨长轴(双侧)观察内容: 观察股骨形态、长短|测量一侧骨化的股骨干骺端中点之间的距离|

注：BPD为双顶径；HC为头围；AC为腹围；FL为股骨长

四、质控要点

本共识基于《超声产前筛查指南》(2022版)[10]标准测量方法,并借鉴 Salomon 等[13]的质控方法,制定了经丘脑横切面、腹围横切面、股骨长轴切面及其测量的质控要点(表2)。

五、正常参考值推荐

本共识系统检索了国内外主要胎儿生物学参数正常参考值的研究,重点关注目前应用较广、热度较高的相关研究,共纳入10项研究[4-7, 16-21]。

在此基础上,本研究采用牛津大学推荐的正常参考值研究质量评价方法[3],并遵循推荐原

DOI: 10.3877/cma.j.issn.1672-6448.2024.08.002

基金项目:国家重点研发计划(2022YFC2704700, 2022YFC2704701, 2022YFF0606305)

通信作者:吴青青(100026 北京,首都医科大学附属北京妇产医院超声科),Email: qingqingwu@ccmu.edu.cn;朱军(610041 成都,四川大学华西第二医院全国妇幼卫生监测办公室/中国出生缺陷监测中心,出生缺陷与相关妇儿疾病教育部重点实验室),Email: zhujun028@163.com

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中华医学超声杂志(电子版)2024年8月第21卷第8期 Chin J Med Ultrasound (Electronic Edition), August 2024, Vol.21, No.8

![TVCSPCCFLIVCLIVERUVSPCPAOSTAHCN1b1a1cLSTVCSPCC.*****************************FIVCLIVER....**.*******.***..*AOUVST1fAH1d1eCNLS\n](1/parseimages/figure5317ccac7f9949d1a98c0e02305aa8e3_0_2.png) 注：FL为股骨长；T为丘脑；TV为第三脑室；CP为大脑脚；CSP为透明隔腔；CC为胼胝体；AH为侧脑室前角；CN为尾状核；LS为大脑外侧裂；LIVER为肝脏；IVC为下腔静脉；AO为腹主动脉；ST为胃泡；SP为脊柱；UV为脐静脉

图1 主要胎儿生物学参数超声测量切面、测量方法及模式图。图a为经丘脑横切面测量双顶径(外-内)、头围,图d为对应的模式图;图b为腹围横切面测量腹围,图e为对应的模式图;图c为股骨长轴切面测量股骨长,图f为对应的模式图

表2 主要胎儿生物学参数超声测量切面及质控标准

|超声测量切面|测量指标|质控要点| |---|---|---| |经丘脑横切面|BPD、 HC|1. 丘脑可见 2. 透明隔腔可见 (18~37 周[14-15]) 3. 小脑不可见 4. 大脑脚、大脑外侧裂可见 5. 对称平面: 显示颅骨强回声环, 颅骨强回声环呈椭圆形, 大脑镰居中 6. 感兴趣区图像放大至超声图像区域 50% 以上 7. 测量游标放置正确| |腹围横切面|AC|1. 胃泡可见 2. 脐静脉连接门静脉窦水平 3. 脊柱横切面 4. 肾脏不可见、肺不可见 5. 单侧仅可显示一条肋骨 6. 感兴趣区图像放大至超声图像区域 50% 以上 7. 测量游标放置正确| |股骨长轴切面|FL|1. 股骨上下两侧的干骺端清晰显示 2. 声束尽可能垂直于股骨长轴(长轴与水平线的夹角<15°) 3. 感兴趣区图像放大至超声图像区域 50% 以上 4. 测量游标放置正确|

则[8], 同时结合前期研究基础[9], 遴选出当前共识度较高的胎儿生物学参数超声参考值。最终本共识推荐2015年美国国家儿童健康与人类发展研究所(National Institute of Child Health and Human Development, NICHD)亚裔种族单胎胎儿生物学参数超声参考值[19](表3)。

根据推荐原则[8],该参考值研究为多中心、纵向研究,研究质量评分较高;发表于2015年,年代较新;该研究中的BPD、HC、AC和FL参数与我国指南的测量要求一致;该研究纳入了亚裔人群。然而,该参考值研究尚存在一定不足,如样本量偏小(仅460例亚裔)、纳入了非严格意义的“低风险人群”(体质量指数为19.0~29.9)等。

六、临床意义

BPD、HC、AC和FL的测量在计算估测胎儿体重 (estimated fetal weight, EFW)、估计孕龄等方面发挥着重要作用[1]。按照标准方法获得的高质量胎儿生物学参数测量值,可以与同孕龄正常参考值比对,并获得该测量值所在的百分位数或Z分数(即标准差的倍数),同时结合母体和胎儿的其他临床情况,客观判断测量值是否偏离预期

中华医学超声杂志(电子版)2024年8月第21卷第8期 Chin J Med Ultrasound (Electronic Edition), August 2024, Vol.21, No.8

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|孕龄(周)|双顶径(BPD)|双顶径(BPD)|双顶径(BPD)|双顶径(BPD)|双顶径(BPD)|双顶径(BPD)|头围(HC)|头围(HC)|头围(HC)|头围(HC)|头围(HC)|头围(HC)|头围(HC)|头围(HC)|头围(HC)| |---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---| |孕龄(周)|$3^{rd}$|$5^{th}$|$10^{th}$|$50^{th}$|$90^{th}$|$95^{th}$|$97^{th}$|$3^{rd}$|$5^{th}$|$10^{th}$|$50^{th}$|$90^{th}$|$95^{th}$|$97^{th}$|| |10|10.0|10.2|10.5|11.8|13.3|13.8|14.1|39.9|40.6|41.7|45.9|50.4|51.8|52.7|| |11|12.9|13.2|13.6|15.2|17.0|17.6|17.9|50.6|51.5|52.8|57.8|63.3|64.9|66.0|| |12|16.1|16.4|16.9|18.9|21.0|21.7|22.1|62.2|63.2|64.8|70.6|77.0|78.9|80.2|| |13|19.4|19.8|20.4|22.6|25.1|25.9|26.4|74.3|75.4|77.2|83.9|91.1|93.3|94.7|| |14|22.8|23.2|23.9|26.4|29.2|30.1|30.6|86.6|87.9|89.9|97.3|105.3|107.7|109.3|| |15|26.1|26.6|27.3|30.1|33.1|34.1|34.7|98.9|100.3|102.5|110.5|119.2|121.8|123.5|| |16|29.3|29.8|30.6|33.6|36.9|37.8|38.5|110.9|112.4|114.7|123.3|132.6|135.3|137.1|| |17|32.4|32.9|33.7|36.9|40.3|41.4|42.1|122.6|124.2|126.6|135.6|145.3|148.1|150.0|| |18|35.3|35.8|36.7|40.0|43.6|44.7|45.4|133.9|135.6|138.1|147.5|157.4|160.4|162.3|| |19|38.1|38.7|39.6|43.1|46.8|47.9|48.6|145.1|146.8|149.4|159.0|169.3|172.3|174.3|| |20|41.0|41.6|42.6|46.1|49.9|51.1|51.8|156.4|158.1|160.8|170.7|181.1|184.2|186.2|| |21|44.0|44.6|45.6|49.2|53.1|54.3|55.1|167.8|169.6|172.3|182.4|193.0|196.1|198.1|| |22|47.0|47.6|48.6|52.3|56.4|57.6|58.4|179.3|181.1|183.9|194.0|204.8|208.0|210.0|| |23|49.9|50.6|51.6|55.5|59.6|60.8|61.6|190.7|192.5|195.3|205.7|216.6|219.7|221.8|| |24|52.9|53.6|54.7|58.6|62.8|64.1|64.9|201.9|203.6|206.8|217.1|228.1|231.3|233.5|| |25|55.9|56.6|57.7|61.7|66.0|67.3|68.1|212.9|214.8|217.7|228.3|239.5|242.7|244.9|| |26|58.8|59.5|60.6|64.7|69.1|70.4|71.3|223.6|225.5|228.4|239.2|250.5|253.8|256.0|| |27|61.6|62.4|63.5|67.7|72.2|73.5|74.3|233.8|235.8|238.8|249.7|261.2|264.5|266.7|| |28|64.4|65.1|66.3|70.6|75.1|76.5|77.3|243.6|245.6|248.6|259.8|271.5|274.9|277.1|| |29|67.0|67.8|69.0|73.3|78.0|79.3|80.2|252.8|254.8|257.9|269.3|281.3|284.7|287.0|| |30|69.5|70.3|71.5|76.0|80.7|82.1|83.0|261.3|263.4|266.6|278.3|290.6|294.1|296.5|| |31|71.9|72.7|73.9|78.5|83.3|84.7|85.6|269.2|271.3|274.7|286.7|299.3|303.0|305.4|| |32|74.1|74.9|76.2|80.8|85.7|87.2|88.1|276.4|278.6|282.1|294.5|307.5|311.3|313.8|| |33|76.2|77.0|78.3|83.3|88.0|89.5|90.4|282.9|285.2|288.8|301.7|315.2|319.1|321.7|| |34|78.0|78.9|80.2|85.0|90.1|91.6|92.6|288.8|291.2|294.9|308.3|322.3|326.4|329.0|| |35|79.7|80.6|81.9|86.8|92.0|93.5|94.5|294.0|296.5|300.3|314.2|328.8|333.0|335.8|| |36|81.2|82.1|83.5|88.5|93.7|95.3|96.3|298.5|301.1|305.0|319.5|334.7|339.1|342.0|| |37|82.6|83.5|84.8|89.9|95.3|96.8|97.9|302.3|304.9|309.0|324.1|339.8|344.4|347.5|| |38|83.7|84.6|86.0|91.1|96.6|98.2|99.2|305.2|308.0|312.2|327.8|344.2|349.0|352.1|| |39|84.6|85.5|87.0|92.1|97.7|99.3|100.3|307.3|310.1|314.5|330.7|347.7|352.7|355.9|| |40|85.3|86.2|87.7|93.0|98.6|100.2|101.3|308.3|311.3|315.9|332.6|350.3|355.4|358.8||

|孕龄(周)|腹围(AC)|腹围(AC)|腹围(AC)|腹围(AC)|腹围(AC)|腹围(AC)|腹围(AC)|腹围(AC)|股骨长(FL)|股骨长(FL)|股骨长(FL)|股骨长(FL)|股骨长(FL)|股骨长(FL)|股骨长(FL)| |---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---| |孕龄(周)|$3^{rd}$|$5^{th}$|$10^{th}$|$50^{th}$|$90^{th}$|$95^{th}$|$97^{th}$|$3^{rd}$|$5^{th}$|$10^{th}$|$50^{th}$|$90^{th}$|$95^{th}$|$97^{th}$|| |10|30.9|31.5|32.4|36.0|40.0|41.2|42.0|1.6|1.7|1.8|2.2|2.6|2.8|2.9|| |11|39.2|39.9|41.1|45.4|50.1|51.6|52.5|2.9|3.0|3.2|3.8|4.6|4.8|5.0|| |12|48.4|49.2|50.6|55.7|61.3|63.0|64.1|4.7|4.9|5.1|6.1|7.2|7.6|7.8|| |13|58.3|59.3|60.9|66.8|73.3|75.2|76.5|7.0|7.3|7.6|8.9|10.5|11.0|11.3|| |14|68.8|70.0|71.8|78.4|85.7|87.9|89.4|9.8|10.0|10.5|12.2|14.2|14.8|15.3|| |15|79.7|81.0|83.0|90.4|98.5|100.9|102.5|12.7|13.1|13.6|15.7|18.1|18.8|19.3|| |16|90.8|92.2|94.3|102.5|111.3|113.9|115.6|15.7|16.1|16.8|19.1|21.9|22.7|23.3|| |17|101.8|103.3|105.7|114.5|123.9|126.8|128.6|18.7|19.1|19.8|22.4|25.4|26.3|26.9|| |18|112.9|114.5|117.0|126.3|136.4|139.4|141.4|21.4|21.9|22.6|25.4|28.5|29.5|30.1|| |19|123.8|125.5|128.1|138.0|148.7|151.8|153.9|24.1|24.6|25.3|28.2|31.5|32.4|33.1|| |20|134.6|136.4|139.2|149.6|160.8|164.1|166.3|26.7|27.2|28.0|31.0|34.3|35.3|36.0|| |21|145.3|147.2|150.2|161.1|172.8|176.3|178.6|29.4|29.9|30.7|33.8|37.1|38.1|38.8|| |22|155.9|157.9|161.0|172.4|184.6|188.2|190.6|32.1|32.6|33.4|36.5|39.9|40.9|41.5|| |23|166.2|168.3|171.5|183.4|196.2|200.0|202.5|34.7|35.2|36.0|39.1|42.5|43.6|44.2|| |24|176.3|178.4|181.8|194.3|207.6|211.5|214.1|37.2|37.7|38.6|41.7|45.1|46.2|46.8|| |25|186.1|188.4|191.9|204.9|218.8|222.9|225.6|39.6|40.2|41.0|44.2|47.7|48.7|49.4|| |26|195.7|198.1|201.8|215.4|229.9|234.2|237.0|42.0|42.5|43.4|46.6|50.1|51.2|51.8|| |27|205.2|207.6|211.5|225.8|241.0|245.5|248.4|44.2|44.8|45.7|49.0|52.5|53.5|54.2|| |28|214.5|217.1|221.2|236.1|252.1|256.8|259.9|46.3|46.9|47.8|51.2|54.8|55.9|56.6|| |29|223.9|226.7|230.9|246.7|263.4|268.4|271.7|48.4|49.9|49.9|53.4|57.1|58.2|58.9|| |30|233.4|236.3|240.8|257.3|275.0|275.0|280.3|283.7|50.4|51.0|51.9|55.5|59.3|60.4|61.1| |31|242.8|245.8|250.5|268.0|286.7|292.3|295.9|52.3|52.9|53.9|57.5|61.4|62.6|63.4|| |32|252.0|255.2|260.2|278.7|298.5|304.3|308.2|54.1|54.7|55.7|59.5|63.5|64.7|65.5|| |33|260.9|264.3|269.6|289.1|310.1|316.3|320.4|55.8|56.5|57.5|61.4|65.6|66.8|67.6|| |34|269.5|273.1|278.7|299.3|321.4|328.0|332.3|57.5|58.1|59.2|63.2|67.5|68.8|69.6|| |35|277.6|281.4|287.3|309.0|332.4|339.3|343.9|59.0|59.8|60.9|65.0|69.4|70.7|71.5|| |36|285.2|289.2|295.4|318.3|342.9|350.3|355.1|60.6|61.3|62.4|66.7|71.2|72.5|73.4|| |37|292.4|296.6|303.1|327.2|353.3|360.9|366.0|62.0|62.7|63.9|68.3|72.9|74.2|75.1|| |38|299.4|303.7|310.6|335.9|363.2|371.4|376.8|63.3|64.1|65.3|69.7|74.5|75.9|76.8|| |39|306.2|310.7|317.9|344.5|373.4|382.4|387.7|64.5|65.3|66.6|71.1|76.0|77.4|78.3|| |40|312.9|317.7|325.2|353.3|383.8|392.9|398.9|65.6|66.4|67.7|72.4|77.4|78.9|79.9||

注：$3^{rd}$、$5^{th}$、$10^{th}$、$90^{th}$、$90^{th}$、$95^{th}$ 分别表示第3、5、10、50、90、95、97 百分位数：NICHHD 为美国国家儿童健康与人类发展研究所

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中华医学超声杂志(电子版)2024年8月第21卷第8期 Chin J Med Ultrasound (Electronic Edition), August 2024, Vol.21, No.8

值及偏离程度,为后续临床正确处理提供科学依据[11, 22-23]。

胎儿主要生物学参数也是判断是否合并胎儿生长受限(fetal growth restriction, FGR)、小于胎龄儿(small for gestational age, SGA)、小头畸形等胎儿生长异常的重要依据之一。然而,目前判断异常的截断而未统一。例如SGA,来自中国[24]、美国[25]、英国[2, 26]、加拿大[27]和新西兰[28]等国内外的专业指南或共识,均使用AC或EFW<第10百分位数作为判断标准之一;但也有使用第5、第3百分位数或均数-2SD为截断值的报道[2]。此外,对于胎儿小头畸形,英国[22]、加拿大[29]等国内外专业指南或共识,均使用HC<均数-3SD作为判断标准之一;但也有使用均数-2SD、第3百分位数为截断值的报道[30-31]。值得注意的是,目前对不同截断值筛查效果的评价研究较少,因此以上截断值仅作为参考,在实际应用过程中应根据临床情况综合判断。

本共识推荐的胎儿生物学参数超声参考值仅作为辅助性工具使用,不应视为判断的唯一标准,临床应用中需考虑个体差异、技术限制、遗传因素等临床实际情况进行综合评估。同时,当依据本共识推荐的参考值得到的结果与临床实践偏差较大时,如有需要,可结合其他的基于不同人群建立的多种参考值进行综合判断。

专家共识编写组成员

组长：李胜利（深圳市妇幼保健院）；吴青青（首都医科大学附属北京妇产医院）；朱军（四川大学华西第二医院）

执笔人:赵建新(四川大学华西第二医院);陈春屹(四川大学华西第二医院);赵胜(湖北省妇幼保健院)

参与讨论的专家(按姓名拼音排序);陈欣林(湖北省妇幼保健院);戴晴(北京协和医院);邓学东(南京医科大学附属苏州医院);高新茹(西北妇女儿童医院);纪学芹(北京大学第一医院宁夏妇女儿童医院);栗河舟(河南省妇幼保健院);李胜利(深圳市妇幼保健院);李天刚(甘肃省妇幼保健院);刘国辉(内蒙古自治区妇幼保健院);刘艳秋(江西省妇幼保健院);罗红(四川大学华西第二医院);骆迎春(湖南省妇幼保健院);漆洪波(重庆市妇幼保健院);冉素真(重庆市妇幼保健院);任芸芸(复旦大学附属妇产科医院);尚宁(广东省妇幼保健院);孙路明(同济大学附属妇产科医院);唐瑶(贵州医科大学附属医院);王和(四川大学华西第二医院);王艳萍(四川大学华西第二医院);吴青青(首都医科大学附属北京妇

产医院);谢红宁(中山大学附属第一医院);严英榴(复旦大学附属妇产科医院);杨家翔(四川省妇幼保健院);尹爱华(广东省妇幼保健院);尹虹(山东省妇幼保健院);张晓辉(浙江大学医学院附属妇产科医院);赵胜(湖北省妇幼保健院);周欣(江西省妇幼保健院);周毓青(上海市长宁区妇幼保健院);朱军(四川大学华西第二医院)

志谢 四川大学华西第二医院王玉吉、周嘉园、康红在共识研讨和制定过程中提供了帮助;深圳市妇幼保健院文华轩提供了模式图及声像图

参考文献

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7 Hadlock FP, Deter RL, Harrist RB, et al. Fetal abdominal circumference as a predictor of menstrual age [J]. AJR Am J Roentgenol, 1982, 139(2): 367-370.

8 中华预防医学会出生缺陷预防与控制专业委员会产前超声诊断学组,中华医学会超声医学分会妇产学组,胎儿生物学参数超声参考值专家共识:总论[JOL].中华医学超声杂志(电子版),2024,21(8):753-756.

9 Zhao J, Yuan Y, Tao J, et al. Which fetal growth charts should be used? A retrospective observational study in China [J]. Chin Med J (Engl), 2022, 135(16): 1969-1977.

10 中华医学会超声医学分会妇产超声学组,国家卫生健康委妇幼司全国产前诊断专家组医学影像组,超声产前筛查指南[J].中华超声影像学杂志,2022,31(1): 1-11.

11 Salomon LJ, Alfirevic Z, Berghella V, et al. ISUOG practice guidelines (updated): performance of the routine mid-trimester fetal ultrasound scan [J]. Ultrasound Obstet Gynecol, 2022, 59(6): 840-856.

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中华医学超声杂志(电子版)2024年8月第21卷第8期 Chin J Med Ultrasound (Electronic Edition), August 2024, Vol.21, No.8

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15 中华医学会超声医学分会妇产超声学组。胎儿透明隔腔超声检查专家共识[J].中华超声影像学杂志,2021,30(1): 1-4.

16 Snijders RJ, Nicolaides KH. Fetal biometry at 14-40 weeks' gestation [J]. Ultrasound Obstet Gynecol, 1994, 4(1): 34-48.

17 Leung TN, Pang MW, Daljit SS, et al. Fetal biometry in ethnic Chinese: biparietal diameter, head circumference, abdominal circumference and femur length [J]. Ultrasound Obstet Gynecol, 2008, 31(3): 321-327.

18 Papageorghiou AT, Ohuma EO, Altman DG, et al. International standards for fetal growth based on serial ultrasound measurements: the fetal growth longitudinal study of the INTERGROWTH-21st project [J]. Lancet, 2014, 384(9946): 869-879.

19 Buck Louis GM, Grewal J, Albert PS, et al. Racial/ethnic standards for fetal growth: the NICHD fetal growth studies [J]. Am J Obstet Gynecol, 2015, 213(4): 449.1-449.41.

20 Zhang Y, Meng H, Jiang Y, et al. Chinese fetal biometry: reference equations and comparison with charts from other populations [J]. J Matern Fetal Neonatal Med, 2019, 32(9): 1507-1515.

21 Kiserud T, Piaggio G, Carroli G, et al. The World Health Organization fetal growth charts: A multinational longitudinal study of ultrasound biometric measurements and estimated fetal weight [J]. PLoS Med, 2017, 14(1): e1002220.

23 Khalil A, Sotiriadis A, D'antonio F, et al. ISUOG practice guidelines: performance of third-trimester obstetric ultrasound scan [J]. Ultrasound Obstet Gynecol, 2024, 63(1): 131-147.

23 Bilardo CM, Chaoui R, Hyeth I, JA et al. ISUOG practice guidelines (updated): performance of 11-14-week ultrasound scan [J]. Ultrasound Obstet Gynecol, 2023, 61(1): 127-143.

24 中华医学会围产医学分会胎儿医学学组,中华医学会妇产科学分 会产科学组.胎儿生长受限专家共识(2019版)[J].中华围产医学

杂志, 2019, 22(6): 361-380.

Lees CC, Romero R, Stampalija T, et al. Clinical opinion: The diagnosis and management of suspected fetal growth restriction: an evidence-based approach [J]. Am J Obstet Gynecol, 2022, 226(3): 366-378.

26 Morris RK, Johnstone E, Lees C, et al. Investigation and care of a small-for-gestational-age fetus and a growth restricted fetus (green-top guideline No. 31) [J]. BJOG, 2024, 131(9): e31-e80.

27 Kingdom J, Ashwal E, Lausman A, et al. Guideline No. 442: fetal growth restriction: screening, diagnosis, and management in singleton pregnancies [J]. J Obstet Gynaecol Can, 2023, 45(10): 102154.

28 Accident Compensation Corporation, Health New Zealand | Te Whatu Ora. Small for Gestational Age / Fetal Growth Restriction Guidelines [EB/OL]. [2023-07-18]. https://www.tewhatuora.govt.nz/publications/small-for-gestational-age-fetal-growth-restriction-guidelines

29 De Bie I, Boucoiran I. No. 380-investigation and management of prenatally identified microcephaly [J]. J Obstet Gynaecol Can, 2019, 41(6): 855-861.

30 Desilva M, Munoz FM, Sell E, et al. Congenital microcephaly: Case definition & guidelines for data collection, analysis, and presentation of safety data after maternal immunisation [J]. Vaccine, 2017, 35(48 Pt A): 6472-6482.

31 Krow-Lucal ER, De Andrade MR, Cananéa JNA, et al. Association and birth prevalence of microcephaly attributable to Zika virus infection among infants in Paraíba, Brazil, in 2015-16: a case-control study [J]. Lancet Child Adolesc Health, 2018, 2(3): 205-213.

(收稿日期: 2024-06-30)

(本文编辑: 汪荣)

中华预防医学会出生缺陷预防与控制专业委员会产前超声诊断学组,中华医学会超声医学分会妇产学组.胎儿生物学参数超声参考值专家共识——双顶径、头围、腹围和股骨长[J/OL].中华医学超声杂志(电子版),2024,21(8): 757-761.

表1 主要胎儿生物学参数标准化测量方法
参数测量切面切面要求及观察内容游标放置位置
BPD经丘脑横切面切面要求: 显示颅骨强回声环、大脑镰、透明隔腔、两侧丘脑及丘脑后方的大脑脚观察内容: 颅骨强回声环呈椭圆形, 大脑镰居中, 第三脑室位于丘脑之间游标置于近端颅骨板外缘至远端颅骨板内缘(即“外-内”)
HC经丘脑横切面切面要求及观察内容同BPD沿胎儿颅骨外缘包络测量头围径线, 不包括头皮及软组织
AC腹围横切面切面要求: 显示胃泡及脐静脉腹内段观察内容: 胃泡位于腹腔左侧; 腹主动脉位于脊柱左前方; 下腔静脉位于脊柱右前方沿腹壁皮肤外缘测量
FL股骨长轴切面切面要求: 显示股骨长轴(双侧)观察内容: 观察股骨形态、长短测量一侧骨化的股骨干骺端中点之间的距离
表2 主要胎儿生物学参数超声测量切面及质控标准
超声测量切面测量指标质控要点
经丘脑横切面BPD、 HC1. 丘脑可见 2. 透明隔腔可见 (18~37 周[14-15]) 3. 小脑不可见 4. 大脑脚、大脑外侧裂可见 5. 对称平面: 显示颅骨强回声环, 颅骨强回声环呈椭圆形, 大脑镰居中 6. 感兴趣区图像放大至超声图像区域 50% 以上 7. 测量游标放置正确
腹围横切面AC1. 胃泡可见 2. 脐静脉连接门静脉窦水平 3. 脊柱横切面 4. 肾脏不可见、肺不可见 5. 单侧仅可显示一条肋骨 6. 感兴趣区图像放大至超声图像区域 50% 以上 7. 测量游标放置正确
股骨长轴切面FL1. 股骨上下两侧的干骺端清晰显示 2. 声束尽可能垂直于股骨长轴(长轴与水平线的夹角<15°) 3. 感兴趣区图像放大至超声图像区域 50% 以上 4. 测量游标放置正确
表 3
孕龄(周)双顶径(BPD)双顶径(BPD)双顶径(BPD)双顶径(BPD)双顶径(BPD)双顶径(BPD)头围(HC)头围(HC)头围(HC)头围(HC)头围(HC)头围(HC)头围(HC)头围(HC)头围(HC)
孕龄(周)$3^{rd}$$5^{th}$$10^{th}$$50^{th}$$90^{th}$$95^{th}$$97^{th}$$3^{rd}$$5^{th}$$10^{th}$$50^{th}$$90^{th}$$95^{th}$$97^{th}$
1010.010.210.511.813.313.814.139.940.641.745.950.451.852.7
1112.913.213.615.217.017.617.950.651.552.857.863.364.966.0
1216.116.416.918.921.021.722.162.263.264.870.677.078.980.2
1319.419.820.422.625.125.926.474.375.477.283.991.193.394.7
1422.823.223.926.429.230.130.686.687.989.997.3105.3107.7109.3
1526.126.627.330.133.134.134.798.9100.3102.5110.5119.2121.8123.5
1629.329.830.633.636.937.838.5110.9112.4114.7123.3132.6135.3137.1
1732.432.933.736.940.341.442.1122.6124.2126.6135.6145.3148.1150.0
1835.335.836.740.043.644.745.4133.9135.6138.1147.5157.4160.4162.3
1938.138.739.643.146.847.948.6145.1146.8149.4159.0169.3172.3174.3
2041.041.642.646.149.951.151.8156.4158.1160.8170.7181.1184.2186.2
2144.044.645.649.253.154.355.1167.8169.6172.3182.4193.0196.1198.1
2247.047.648.652.356.457.658.4179.3181.1183.9194.0204.8208.0210.0
2349.950.651.655.559.660.861.6190.7192.5195.3205.7216.6219.7221.8
2452.953.654.758.662.864.164.9201.9203.6206.8217.1228.1231.3233.5
2555.956.657.761.766.067.368.1212.9214.8217.7228.3239.5242.7244.9
2658.859.560.664.769.170.471.3223.6225.5228.4239.2250.5253.8256.0
2761.662.463.567.772.273.574.3233.8235.8238.8249.7261.2264.5266.7
2864.465.166.370.675.176.577.3243.6245.6248.6259.8271.5274.9277.1
2967.067.869.073.378.079.380.2252.8254.8257.9269.3281.3284.7287.0
3069.570.371.576.080.782.183.0261.3263.4266.6278.3290.6294.1296.5
3171.972.773.978.583.384.785.6269.2271.3274.7286.7299.3303.0305.4
3274.174.976.280.885.787.288.1276.4278.6282.1294.5307.5311.3313.8
3376.277.078.383.388.089.590.4282.9285.2288.8301.7315.2319.1321.7
3478.078.980.285.090.191.692.6288.8291.2294.9308.3322.3326.4329.0
3579.780.681.986.892.093.594.5294.0296.5300.3314.2328.8333.0335.8
3681.282.183.588.593.795.396.3298.5301.1305.0319.5334.7339.1342.0
3782.683.584.889.995.396.897.9302.3304.9309.0324.1339.8344.4347.5
3883.784.686.091.196.698.299.2305.2308.0312.2327.8344.2349.0352.1
3984.685.587.092.197.799.3100.3307.3310.1314.5330.7347.7352.7355.9
4085.386.287.793.098.6100.2101.3308.3311.3315.9332.6350.3355.4358.8
表 4
孕龄(周)腹围(AC)腹围(AC)腹围(AC)腹围(AC)腹围(AC)腹围(AC)腹围(AC)腹围(AC)股骨长(FL)股骨长(FL)股骨长(FL)股骨长(FL)股骨长(FL)股骨长(FL)股骨长(FL)
孕龄(周)$3^{rd}$$5^{th}$$10^{th}$$50^{th}$$90^{th}$$95^{th}$$97^{th}$$3^{rd}$$5^{th}$$10^{th}$$50^{th}$$90^{th}$$95^{th}$$97^{th}$
1030.931.532.436.040.041.242.01.61.71.82.22.62.82.9
1139.239.941.145.450.151.652.52.93.03.23.84.64.85.0
1248.449.250.655.761.363.064.14.74.95.16.17.27.67.8
1358.359.360.966.873.375.276.57.07.37.68.910.511.011.3
1468.870.071.878.485.787.989.49.810.010.512.214.214.815.3
1579.781.083.090.498.5100.9102.512.713.113.615.718.118.819.3
1690.892.294.3102.5111.3113.9115.615.716.116.819.121.922.723.3
17101.8103.3105.7114.5123.9126.8128.618.719.119.822.425.426.326.9
18112.9114.5117.0126.3136.4139.4141.421.421.922.625.428.529.530.1
19123.8125.5128.1138.0148.7151.8153.924.124.625.328.231.532.433.1
20134.6136.4139.2149.6160.8164.1166.326.727.228.031.034.335.336.0
21145.3147.2150.2161.1172.8176.3178.629.429.930.733.837.138.138.8
22155.9157.9161.0172.4184.6188.2190.632.132.633.436.539.940.941.5
23166.2168.3171.5183.4196.2200.0202.534.735.236.039.142.543.644.2
24176.3178.4181.8194.3207.6211.5214.137.237.738.641.745.146.246.8
25186.1188.4191.9204.9218.8222.9225.639.640.241.044.247.748.749.4
26195.7198.1201.8215.4229.9234.2237.042.042.543.446.650.151.251.8
27205.2207.6211.5225.8241.0245.5248.444.244.845.749.052.553.554.2
28214.5217.1221.2236.1252.1256.8259.946.346.947.851.254.855.956.6
29223.9226.7230.9246.7263.4268.4271.748.449.949.953.457.158.258.9
30233.4236.3240.8257.3275.0275.0280.3283.750.451.051.955.559.360.461.1
31242.8245.8250.5268.0286.7292.3295.952.352.953.957.561.462.663.4
32252.0255.2260.2278.7298.5304.3308.254.154.755.759.563.564.765.5
33260.9264.3269.6289.1310.1316.3320.455.856.557.561.465.666.867.6
34269.5273.1278.7299.3321.4328.0332.357.558.159.263.267.568.869.6
35277.6281.4287.3309.0332.4339.3343.959.059.860.965.069.470.771.5
36285.2289.2295.4318.3342.9350.3355.160.661.362.466.771.272.573.4
37292.4296.6303.1327.2353.3360.9366.062.062.763.968.372.974.275.1
38299.4303.7310.6335.9363.2371.4376.863.364.165.369.774.575.976.8
39306.2310.7317.9344.5373.4382.4387.764.565.366.671.176.077.478.3
40312.9317.7325.2353.3383.8392.9398.965.666.467.772.477.478.979.9
图1 主要胎儿生物学参数超声测量切面、测量方法及模式图。图a为经丘脑横切面测量双顶径(外-内)、头围,图d为对应的模式图;图b为腹围横切面测量腹围,图e为对应的模式：TVCSPCCFLIVCLIVERUVSPCPAOSTAHCN1b1a1cLSTVCSPCC.*****************************FIVCLIVER....**.*******.***..*AOUVST1fAH1d1eCNLS

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引用 / 出处

中华预防医学会. 胎儿生物学参数超声参考值专家共识——双顶径、头围、腹围和股骨长[S/OL]. .