Construction of <i>Z</i>-score reference ranges of fetal ductus arteriosus inner diameter during mid- and late-pregnancy_West China Medical Journal

Authors：

FENG Tao ¹ ,  TIAN Li ² , LIAO Daqin ¹ , WANG Kening ¹ , GU Kaili ¹

1. Department of Ultrasonography, the Third Affiliated Hospital of Henan University of Chinese Medicine, Zhengzhou, Henan 450046, P. R. China;
2. College of Acupuncture and Massage, Henan University of Chinese Medicine, Zhengzhou, Henan 450000, P. R. China;

Corresponding author：

TIAN Li, Email: tlky@hactcm.edu.cn

Keywords：

Fetal arterial ductus; Z-score; Biparietal diameter; Femoral diaphysis length; Gestational age; Fetal echocardiography

DOI：

10.7507/1002-0179.201911149

Video：

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Objective To establish the Z-score reference ranges of fetal arterial ductus (DA) inner diameter of normal fetus at 20 to 40 weeks’ gestation.Methods A cross-sectional study was conducted in 781 normal singleton pregnancies with 20-40 weeks of gestation who underwent fetal echocardiography in the Third Affiliated Hospital of Henan University of Chinese Medicine from November 2018 to September 2019. The DA diameter, biparietal diameter (BPD), and femoral diaphysis length (FL) were measured and used to estimate gestational age (GA). With BPD, FL, and GA as independent variables and DA as dependent variables, linear regression analyses were conducted on the mean and standard deviation of each parameter to construct the best Z-score models.Results The linear regression equations reflected strong positive correlations between the fetal biological growth parameter BPD, FL, GA, and fetal DA inner diameter. The heteroscedasticity of standard deviations was eliminated by the weighted regression of absolute stagger, and the best Z-score models were constructed. The linear regression equations of GA (week), BPD (mm), FL (mm), and DA inner diameter (mm) were as follows: Y=−2.661+0.217×GA, Y=−2.505+0.084×BPD, Y=−1.734+0.100×FL; the linear regression equations of GA (week), BPD (mm), FL (mm), and the standard deviation of DA inner diameter (mm) were as follows:Y=−0.273+0.025×GA, Y=−0.440+0.013×BPD, Y=−0.180+0.012×FL. According to the models, Z-score normal range reference values of fetal DA inner diameter were calculated.Conclusions There are good linear relationships between fetal DA inner diameter and GA, BPD and FL. The Z-score reference ranges of fetal DA diameter during mid- and late-pregnancy are constructed, which are helpful to quantitatively evaluate the normal development of fetal DA and provide a reference for clinical diagnosis of fetal DA abnormality.

Citation： FENG Tao, TIAN Li, LIAO Daqin, WANG Kening, GU Kaili. Construction of Z-score reference ranges of fetal ductus arteriosus inner diameter during mid- and late-pregnancy. West China Medical Journal, 2020, 35(9): 1082-1089. doi: 10.7507/1002-0179.201911149 Copy

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14.	Mao YK, Zhao BW, Zhou L, et al. Z-score reference ranges for pulsed-wave Doppler indices of the cardiac outflow tracts in normal fetuses. Int J Cardiovasc Imaging, 2019, 35(5): 811-825.
15.	Sirilert S, Tongprasert F, Srisupundit K, et al. Z score reference ranges of fetal cardiothoracic diameter ratio. J Ultrasound Med, 2019, 38(4): 999-1007.

1. Alvarez SGV, McBrien A. Ductus arteriosus and fetal echocardiography: implications for practice. Semin Fetal Neonatal Med, 2018, 23(4): 285-291.
2. Merlocco A. Fetal hemodymanic effects on ductus arteriosus development and influences on postnatal management in infants with ductal-dependent pulmonary blood flow. Congenit Heart Dis, 2019, 14(1): 100-104.
3. 李永鹏, 都鹏飞. 胎龄20-28周胎儿心血管发育与孕周的曲线构建. 世界最新医学信息文摘, 2019, 19(61): 215-217, 221.
4. 陈慧明, 张丽范, 赵丽娟. 中孕中期胎儿动脉导管参考值范围的建立及其对胎儿先天性心脏病的诊断价值. 中国实用医药, 2015(8): 13-15.
5. 姚英, 严英榴, 张蕴, 等. 中孕中期胎儿动脉导管参考值范围的建立及其意义. 复旦学报(医学版), 2011, 38(4): 300-302.
6. Mao YK, Zhao BW, Zheng FH, et al. Z -scores for fetal left atrial size and left atrium-descending aorta distance in fetuses with isolated total anomalous pulmonary venous connection. Prenat Diagn, 2017, 37(10): 992-1000.
7. 赵胜. ISUOG胎儿心脏超声检查指南(修订版). 中国产前诊断杂志(电子版), 2014(1): 46-54.
8. Royston P, Wright EM. How to construct ‘normal ranges’ for fetal variables. Ultrasound Obstet Gynecol, 1998, 11(1): 30-38.
9. 袁丽君, 曹铁生, 段云友. 胎儿心血管超声影像医学. 北京: 科学出版社, 2017: 4-5.
10. Mielke G, Benda N. Cardiac output and central distribution of blood flow in the human fetus. Circulation, 2001, 103(12): 1662-1668.
11. Rocha LA, Rolo LC, Nardozza LMM, et al. Z-score reference ranges for fetal heart functional measurements in a large brazilian pregnant women sample. Pediatr Cardiol, 2019, 40(3): 554-562.
12. Li XY, Zhou QC, Huang H, et al. Z-score reference ranges for normal fetal heart sizes throughout pregnancy derived from fetal echocardiography. Prenat Diagn, 2015, 35(2): 117-124.
13. Lee W, Riggs T, Amula V, et al. Fetal echocardiography: Z-score reference ranges for a large patient population. Ultrasound Obstet Gynecol, 2010, 35(1): 28-34.
14. Mao YK, Zhao BW, Zhou L, et al. Z-score reference ranges for pulsed-wave Doppler indices of the cardiac outflow tracts in normal fetuses. Int J Cardiovasc Imaging, 2019, 35(5): 811-825.
15. Sirilert S, Tongprasert F, Srisupundit K, et al. Z score reference ranges of fetal cardiothoracic diameter ratio. J Ultrasound Med, 2019, 38(4): 999-1007.

West China Medical Journal

Construction of Z-score reference ranges of fetal ductus arteriosus inner diameter during mid- and late-pregnancy

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