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Lindström L, Cnattingius S, Axelsson O, Granfors M. Accuracy and precision of sonographic fetal weight estimation in Sweden. Acta Obstet Gynecol Scand 2023; 102:699-707. [PMID: 36964980 DOI: 10.1111/aogs.14554] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2022] [Revised: 02/17/2023] [Accepted: 03/06/2023] [Indexed: 03/27/2023]
Abstract
INTRODUCTION Fetal growth assessment by ultrasound is an essential part of modern obstetric care. The formula by Persson and Weldner for estimated fetal weight (EFW), used in Sweden since decades, has not yet been evaluated. The objective of this study was to evaluate accuracy and precision of the formula by Persson and Weldner, and to compare it to two other formulae using biparietal diameter instead of head circumference. MATERIAL AND METHODS The study population consisted of 31 521 singleton pregnancies delivered at 22+0 gestational weeks or later, with an ultrasound EFW performed within 2 days before delivery, registered in the Swedish Pregnancy Register between 2014 and 2021. Fetal biometric ultrasound measurements were used to calculate EFW according to the formulae by Persson and Weldner, Hadlock 2 and Shepard. Bland-Altman analysis, systematic error (mean percentage error), random error (standard deviation [SD] of mean percentage error), proportion of weight estimates within ±10% of birthweight, and proportion with underestimated and overestimated weight was calculated. Moreover, calculations were made after stratification into small, appropriate, and large for gestational age (SGA, AGA and LGA), respectively, and gestational age at examination. RESULTS For the formula by Persson and Weldner, MPE was -2.7 (SD 8.9) and the proportion of EFW within ±10% from actual birthweight was 76.0%. MPE was largest for fetuses estimated as severe SGA (<3rd percentile, -5.4) and for the most preterm fetuses (<24 weeks, -5.4). For Hadlock 2 and Shepard's formulae, MPE were 3.9 (SD 8.9) and 3.4 (SD 9.7), respectively, and the proportions of EFW within ±10% from actual birthweight were 69.4% and 67.1%, respectively. MPE was largest for fetuses estimated as severe LGA (>97th percentile), 7.6 and 9.4, respectively. CONCLUSIONS The recommended Swedish formula by Persson and Weldner is generally accurate for fetal weight estimation. The systematic underestimation of EFW and random error is largest in extreme preterm and estimated SGA-fetuses, which is of importance in clinical decision making. The accuracy of EFW with the formula by Persson and Weldner is as good as or better than Hadlock 2 and Shepard's formulae.
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Affiliation(s)
- Linda Lindström
- Division of Clinical Epidemiology, Department of Medicine (Solna), Karolinska Institutet, Stockholm, Sweden
- Department of Women's and Children's Health, Uppsala University, Uppsala, Sweden
| | - Sven Cnattingius
- Division of Clinical Epidemiology, Department of Medicine (Solna), Karolinska Institutet, Stockholm, Sweden
| | - Ove Axelsson
- Department of Women's and Children's Health, Uppsala University, Uppsala, Sweden
- Centre for Clinical Research Sörmland, Uppsala University, Eskilstuna, Sweden
| | - Michaela Granfors
- Division of Clinical Epidemiology, Department of Medicine (Solna), Karolinska Institutet, Stockholm, Sweden
- Division of Obstetrics, Department of Women's Health, Karolinska University Hospital, Stockholm, Sweden
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Does the Porter formula hold its promise? A weight estimation formula for macrosomic fetuses put to the test. Arch Gynecol Obstet 2019; 301:129-135. [PMID: 31883045 PMCID: PMC7028832 DOI: 10.1007/s00404-019-05410-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2019] [Accepted: 12/07/2019] [Indexed: 11/06/2022]
Abstract
Purpose Estimating fetal weight using ultrasound measurements is an essential task in obstetrics departments. Most of the commonly used weight estimation formulas underestimate fetal weight when the actual birthweight exceeds 4000 g. Porter et al. published a specially designed formula in an attempt to improve detection rates for such macrosomic infants. In this study, we question the usefulness of the Porter formula in clinical practice and draw attention to some critical issues concerning the derivation of specialized formulas of this type. Methods A retrospective cohort study was carried out, including 4654 singleton pregnancies with a birthweight ≥ 3500 g, with ultrasound examinations performed within 14 days before delivery. Fetal weight estimations derived using the Porter and Hadlock formulas were compared. Results Of the macrosomic infants, 27.08% were identified by the Hadlock formula, with a false-positive rate of 4.60%. All macrosomic fetuses were detected using the Porter formula, with a false-positive rate of 100%; 99.96% of all weight estimations using the Porter formula fell within a range of 4300 g ± 10%. The Porter formula only provides macrosomic estimates. Conclusions The Porter formula does not succeed in distinguishing macrosomic from normal-weight fetuses. High-risk fetuses with a birthweight ≥ 4500 g in particular are not detected more precisely than with the Hadlock formula. For these reasons, we believe that the Porter formula should not be used in clinical practice. Newly derived weight estimation formulas for macrosomic fetuses must not be based solely on a macrosomic data set. Electronic supplementary material The online version of this article (10.1007/s00404-019-05410-7) contains supplementary material, which is available to authorized users.
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Preyer O, Husslein H, Concin N, Ridder A, Musielak M, Pfeifer C, Oberaigner W, Husslein P. Fetal weight estimation at term - ultrasound versus clinical examination with Leopold's manoeuvres: a prospective blinded observational study. BMC Pregnancy Childbirth 2019; 19:122. [PMID: 30971199 PMCID: PMC6458793 DOI: 10.1186/s12884-019-2251-5] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2018] [Accepted: 03/18/2019] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Fetal weight estimation is of key importance in the decision-making process for obstetric planning and management. The literature is inconsistent on the accuracy of measurements with either ultrasound or clinical examination, known as Leopold's manoeuvres, shortly before term. Maternal BMI is a confounding factor because it is associated with both the fetal weight and the accuracy of fetal weight estimation. The aim of our study was to compare the accuracy of fetal weight estimation performed with ultrasound and with clinical examination with respect to BMI. METHODS In this prospective blinded observational study we investigated the accuracy of clinical examination as compared to ultrasound measurement in fetal weight estimation, taking the actual birth weight as the gold standard. In a cohort of all consecutive patients who presented in our department from January 2016 to May 2017 to register for delivery at ≥37 weeks, examination was done by ultrasound and Leopold's manoeuvres to estimate fetal weight. All examiners (midwives and physicians) had about the same level of professional experience. The primary aim was to compare overall absolute error, overall absolute percent error, absolute percent error > 10% and absolute percent error > 20% for weight estimation by ultrasound and by means of Leopold's manoeuvres versus the actual birth weight as the given gold standard, namely separately for normal weight and for overweight pregnant women. RESULTS Five hundred forty-three patients were included in the data analysis. The accuracy of fetal weight estimation was significantly better with ultrasound than with Leopold's manoeuvres in all absolute error calculations made in overweight pregnant women. For all error calculations performed in normal weight pregnant women, no statistically significant difference was seen in the accuracy of fetal weight estimation between ultrasound and Leopold's manoeuvres. CONCLUSIONS Data from our prospective blinded observational study show a significantly better accuracy of ultrasound for fetal weight estimation in overweight pregnant women only as compared to Leopold's manoeuvres with a significant difference in absolute error. We did not observe significantly better accuracy of ultrasound as compared to Leopold's manoeuvres in normal weight women. Further research is needed to analyse the situation in normal weight women.
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Affiliation(s)
- Oliver Preyer
- Department of Obstetrics and Gynaecology, University Teaching Hospital Tauernklinikum Zell am See, Paracelsusstrasse 8, A-5700, Zell am See, Austria.
| | - Heinrich Husslein
- Department of Obstetrics and Gynaecology, Division of General Gynaecology and Gynaecologic Oncology, Medical University of Vienna, Waehringer Guertel 18-20, A-1090, Vienna, Austria
| | - Nicole Concin
- Department of Obstetrics and Gynaecology, Medical University of Innsbruck, Anichstrasse 35, A-6020, Innsbruck, Austria
| | - Anna Ridder
- Paracelsus Medical University, Strubergasse 21, A-5020, Salzburg, Austria
| | - Maciej Musielak
- Department of Obstetrics and Gynaecology, University Teaching Hospital Tauernklinikum Zell am See, Paracelsusstrasse 8, A-5700, Zell am See, Austria
| | - Christian Pfeifer
- Department of Clinical Epidemiology of the Tyrolean State Hospitals Ltd, Cancer Registry of Tyrol, Tirolkliniken GmbH, Anichstrasse 35, A-6020, Innsbruck, Austria
| | - Willi Oberaigner
- Department of Clinical Epidemiology of the Tyrolean State Hospitals Ltd, Cancer Registry of Tyrol, Tirolkliniken GmbH, Anichstrasse 35, A-6020, Innsbruck, Austria
- Department of Public Health, Health Services Research and Health Technology Assessment, Institute of Public Health, Medical Decision Making and HTA, UMIT The Health & Life Sciences University, Eduard-Wallnöfer-Zentrum 1, A-6060, Hall in Tirol, Austria
| | - Peter Husslein
- Department of Obstetrics and Gynaecology, Division of Obstetrics and Fetomaternal Medicine, Medical University of Vienna, Waehringer Guertel 18-20, A-1090, Vienna, Austria
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Hammami A, Mazer Zumaeta A, Syngelaki A, Akolekar R, Nicolaides KH. Ultrasonographic estimation of fetal weight: development of new model and assessment of performance of previous models. ULTRASOUND IN OBSTETRICS & GYNECOLOGY : THE OFFICIAL JOURNAL OF THE INTERNATIONAL SOCIETY OF ULTRASOUND IN OBSTETRICS AND GYNECOLOGY 2018; 52:35-43. [PMID: 29611251 DOI: 10.1002/uog.19066] [Citation(s) in RCA: 109] [Impact Index Per Article: 18.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/16/2018] [Accepted: 03/27/2018] [Indexed: 06/08/2023]
Abstract
OBJECTIVES To develop a new formula for ultrasonographic estimation of fetal weight and evaluate the accuracy of this and all previous formulae in the prediction of birth weight. METHODS The study population consisted of 5163 singleton pregnancies with fetal biometry at 22-43 weeks' gestation and live birth of a phenotypically normal neonate within 2 days of the ultrasound examination. Multivariable fractional polynomial analysis was used to determine the combination of variables that provided the best-fitting models for estimated fetal weight (EFW). A systematic review was also carried out of articles reporting formulae for EFW and comparing EFW to actual birth weight. The accuracy of each model for EFW was assessed by comparing mean percentage error, absolute mean error (AE), proportion of pregnancies with AE ≤ 10% and Euclidean distance. RESULTS The most accurate models, with the lowest Euclidean distance and highest proportion of AE ≤ 10%, were provided by the formulae incorporating ≥ 3 rather than < 3 biometrical measurements. The systematic review identified 45 studies describing a total of 70 models for EFW by various combinations of measurements of fetal head circumference (HC), biparietal diameter, femur length (FL) and abdominal circumference (AC). The most accurate model with the lowest Euclidean distance and highest proportion of AE ≤ 10% was provided by the formula of Hadlock et al., published in 1985, which incorporated measurements of HC, AC and FL; there was a highly significant linear association between EFW and birth weight (r = 0.959; P < 0.0001), and EFW was within 10% of birth weight in 80% of cases. The performance of the best model developed in this study, utilizing HC, AC and FL, was very similar to that of Hadlock et al. CONCLUSION: Despite many efforts to develop new models for EFW, the one reported in 1985 by Hadlock et al., from measurements of HC, AC and FL, provides the most accurate prediction of birth weight and can be used for assessment of all babies, including those suspected to be either small or large. Copyright © 2018 ISUOG. Published by John Wiley & Sons Ltd.
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Affiliation(s)
- A Hammami
- Department of Fetal Medicine, King's College Hospital, London, UK
| | - A Mazer Zumaeta
- Department of Fetal Medicine, King's College Hospital, London, UK
| | - A Syngelaki
- Department of Fetal Medicine, King's College Hospital, London, UK
| | - R Akolekar
- Department of Fetal Medicine, Medway Maritime Hospital, Gillingham, Kent, UK
| | - K H Nicolaides
- Department of Fetal Medicine, King's College Hospital, London, UK
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Lanowski JS, Lanowski G, Schippert C, Drinkut K, Hillemanns P, Staboulidou I. Ultrasound versus Clinical Examination to Estimate Fetal Weight at Term. Geburtshilfe Frauenheilkd 2017; 77:276-283. [PMID: 28392581 DOI: 10.1055/s-0043-102406] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022] Open
Abstract
Introduction At term, fetal weight estimation is an important factor for decisions about the delivery mode and the timing of labor induction. This study aimed to compare the accuracy of abdominal palpation with that of ultrasound performed by different examiners to estimate fetal weight. The study investigated whether differences in the examiners' training affected fetal weight estimates. The accuracy of the weight estimates made for fetuses with extreme birth weights was also evaluated. Finally, the accuracy of Johnson's method and of Insler and Bernstein's formula for estimating fetal weight were compared with the other two methods. Methods This prospective study included singleton pregnancies between 37 weeks of gestation and 12 days post-term planned for vaginal delivery or cesarean section. Ultrasound and abdominal palpation using Leopold's maneuvers were performed by examiners with different levels of professional experience. Fetal weight was additionally estimated using Insler and Bernstein's formula and Johnson's method. Statistical analysis calculated the accuracy of fetal weight estimates for the different examiners and the four methods. Results A total of 204 women were included in the analysis. Trained ultrasound examiners were most accurate when estimating fetal weight compared with all other examiners. The comparison of all four methods showed that fetal weight was assessed most accurately with ultrasound. No learning curve could be established. BMI and advanced gestational age affected the accuracy of the estimated weight. The analysis showed that a greater deviation between estimated weight and actual weight occurred with all four methods for fetuses at either end of the extremes of fetal weight, i.e., with very low or very high birth weights. Conclusion Fetal weight should be estimated using ultrasound. A good ultrasound training is essential.
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Affiliation(s)
- Jan-Simon Lanowski
- Hanover Medical School, Department of Gynecology and Obstetrics, Hanover, Germany
| | - Gabriele Lanowski
- Hanover Medical School, Department of Gynecology and Obstetrics, Hanover, Germany
| | - Cordula Schippert
- Hanover Medical School, Department of Gynecology and Obstetrics, Hanover, Germany
| | - Kristina Drinkut
- Hanover Medical School, Department of Gynecology and Obstetrics, Hanover, Germany
| | - Peter Hillemanns
- Hanover Medical School, Department of Gynecology and Obstetrics, Hanover, Germany
| | - Ismini Staboulidou
- Hanover Medical School, Department of Gynecology and Obstetrics, Hanover, Germany
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Melamed N, Ryan G, Windrim R, Toi A, Kingdom J. Choice of Formula and Accuracy of Fetal Weight Estimation in Small-for-Gestational-Age Fetuses. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2016; 35:71-82. [PMID: 26635253 DOI: 10.7863/ultra.15.02058] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/23/2015] [Accepted: 04/27/2015] [Indexed: 06/05/2023]
Abstract
OBJECTIVES The purpose of this study was to identify the most accurate sonographic models for fetal weight estimation in specific subgroups of small-for-gestational-age (SGA) fetuses. METHODS We conducted a retrospective study of women who delivered an SGA neonate and underwent a sonographic estimation of fetal weight within 7 days of delivery in a single tertiary center (n = 370). The accuracy of fetal weight estimation was compared for 33 sonographic models (27 nontargeted and 6 targeted SGA- or low-birth-weight-specific models) in specific subgroups of SGA fetuses: early versus late SGA, asymmetric versus symmetric, and presence of Doppler abnormalities. RESULTS A wide variation in the accuracy of the different models was found (systematic error, -12.5% to 15.1%; random error, 7.8% to 15.5%). Most nontargeted models tended to systematically overestimate the weight of SGA fetuses. The best performing model in the overall SGA group was the targeted model of Scott et al (J Ultrasound Med 1996; 15:669-672; systematic error ± random error, -2.8% ± 8.3%). However, the optimal models varied for different subgroups of SGA fetuses, and in most cases the targeted models were the most accurate. An approach that used the optimal model for each subgroup of SGA fetuses compared with the uniform use of the model of Scott et al for all SGA fetuses was associated with a lower systematic error (-0.38% versus -2.8%; P < .001) and a higher proportion of weight estimations within 5%, 10%, and 15% of birth weight (48.4% versus 40.8%; P= .038; 78.6% versus 71.4%; P= .022; 95.1% versus 89.2%; P = .003, respectively). CONCLUSIONS Sonographic models in current use for fetal weight estimation in SGA fetuses have significant errors, and their performance varies for specific subgroups of SGA fetuses. An approach that uses subgroup-specific models may improve the accuracy of weight estimation among SGA fetuses.
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Affiliation(s)
- Nir Melamed
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Sunnybrook Health Sciences Center, University of Toronto, Toronto, Ontario, Canada (N.M.); Fetal Medicine Division (Placenta Clinic), Department of Obstetrics and Gynecology (G.R., R.W., J.K.), and Department of Medical Imaging (A.T.), Mount Sinai Hospital, University of Toronto, Toronto, Ontario, Canada.
| | - Greg Ryan
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Sunnybrook Health Sciences Center, University of Toronto, Toronto, Ontario, Canada (N.M.); Fetal Medicine Division (Placenta Clinic), Department of Obstetrics and Gynecology (G.R., R.W., J.K.), and Department of Medical Imaging (A.T.), Mount Sinai Hospital, University of Toronto, Toronto, Ontario, Canada
| | - Rory Windrim
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Sunnybrook Health Sciences Center, University of Toronto, Toronto, Ontario, Canada (N.M.); Fetal Medicine Division (Placenta Clinic), Department of Obstetrics and Gynecology (G.R., R.W., J.K.), and Department of Medical Imaging (A.T.), Mount Sinai Hospital, University of Toronto, Toronto, Ontario, Canada
| | - Ants Toi
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Sunnybrook Health Sciences Center, University of Toronto, Toronto, Ontario, Canada (N.M.); Fetal Medicine Division (Placenta Clinic), Department of Obstetrics and Gynecology (G.R., R.W., J.K.), and Department of Medical Imaging (A.T.), Mount Sinai Hospital, University of Toronto, Toronto, Ontario, Canada
| | - John Kingdom
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Sunnybrook Health Sciences Center, University of Toronto, Toronto, Ontario, Canada (N.M.); Fetal Medicine Division (Placenta Clinic), Department of Obstetrics and Gynecology (G.R., R.W., J.K.), and Department of Medical Imaging (A.T.), Mount Sinai Hospital, University of Toronto, Toronto, Ontario, Canada
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Zahran M, Tohma YA, Erkaya S, Evliyaoğlu Ö, Çolak E, Çoşkun B. Analysis of the effectiveness of ultrasound and clinical examination methods in fetal weight estimation for term pregnancies. Turk J Obstet Gynecol 2015; 12:220-225. [PMID: 28913073 PMCID: PMC5588475 DOI: 10.4274/tjod.28044] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2015] [Accepted: 11/26/2015] [Indexed: 12/01/2022] Open
Abstract
Objective: To compare the accuracy of clinical and ultrasonographic (USG) estimation of fetal weight in non-complicated, term pregnancies. Materials and Methods: Two hundred term pregnant women were included in the study. We used three formulae for the estimation of fetal weight at term; the Hadlock formula for the USG method, and two different formulas for clinical methods, maternal symphysis-fundal height and abdominal circumference at the level of umbilicus. Accuracy was determined by mean percentage error, mean absolute percentage error and proportion of estimates within 10% of actual birth weight (birth weight ±10%). Patients were divided into two groups according to actual birth weight, the normal birth weight group (2500-3999 g) and high birth weight group (≥4000 g). Results: All three methods statistically overestimated birth weight for the high and normal birth weight groups (p<0.001, p=1.000, p=0.233) (p=0.037, p<0.001, and p<0.001). For both groups, the mean absolute percentage errors of USG were smaller than for the other two clinical methods and the number of estimates were within 10% of actual birth weight for USG was greater than for the clinical methods; the differences were statistically significant (p<0.001). No statistically significant difference of accuracy was observed for all three methods for the high birth weight group (p=0.365, p=0.768, and p=0.540). However, USG systematically underestimated birth weight in this group. Conclusion: For estimation of fetal birth weight in term pregnancies, ultrasonography is better than clinical methods. In the suspicion of macrosomia, it must be remembered that no method is better than any other. In addition, if ultrasonography is used, careful management is recommended because ultrasonography overestimates in this group.
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Affiliation(s)
- Mehmet Zahran
- Etlik Zübeyde Hanım Womens's Health Teaching and Research Hospital, Department of Obstetrics and Gynecology, Ankara, Turkey
| | - Yusuf Aytaç Tohma
- Başkent University Faculty of Medicine, Department of Obstetrics and Gynecology, Konya, Turkey
| | - Salim Erkaya
- Etlik Zübeyde Hanım Womens's Health Teaching and Research Hospital, Department of Obstetrics and Gynecology, Ankara, Turkey
| | - Özlem Evliyaoğlu
- Etlik Zübeyde Hanım Womens's Health Teaching and Research Hospital, Department of Obstetrics and Gynecology, Ankara, Turkey
| | - Eser Çolak
- Etlik Zübeyde Hanım Womens's Health Teaching and Research Hospital, Department of Obstetrics and Gynecology, Ankara, Turkey
| | - Bora Çoşkun
- Etlik Zübeyde Hanım Womens's Health Teaching and Research Hospital, Department of Obstetrics and Gynecology, Ankara, Turkey
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Sonographic fetal weight estimation in normal and overweight/obese healthy term pregnant women by gestation-adjusted projection (GAP) method. Arch Gynecol Obstet 2015; 293:775-81. [PMID: 26482584 DOI: 10.1007/s00404-015-3910-z] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2015] [Accepted: 10/09/2015] [Indexed: 10/22/2022]
Abstract
PURPOSE The objective of this study is to assess the ultrasound accuracy in fetal weight estimation related to the time distance between the actual weight recorded at delivery and the period of sonography among normal and overweight/obese pregnant women within 3 weeks prior birth at term. METHODS Four-hundred and ninety patients with healthy pregnancy were studied in a cohort study. The absolute percent error in estimation was achieved by gestation-adjusted projection method from Hadlock model for weight calculation as measure of accuracy. The mean percentage error variation over the weeks was correlated to maternal body mass index (BMI, Kg/m(2)) at ultrasound. The relationship between BMI and ultrasound performance was assessed by linear regression. RESULTS The overall proportion of supposed sonographic estimated fetal weight at birth within ±10 % of the birth weight significantly declines over the weeks (P = .016). The trend toward a progressive deterioration in ultrasound accuracy is not statistically significant for normal weight women (P = .272) but it is for over-weight/obese (P = .044). On univariate analysis, the absolute percent error and absolute error are positively related to BMI. CONCLUSIONS Accuracy is related to the week at ultrasound scan with a gradual deterioration over the time and it worsens with increasing distance in days between the date of ultrasounds and delivery. The deterioration is greater for BMI ≥ 25.
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Girsen AI, Do S, Davis AS, Hintz SR, Desai AK, Mansour T, Merritt TA, Oshiro BT, El-Sayed YY, Blumenfeld YJ. Peripartum and neonatal outcomes of small-for-gestational-age infants with gastroschisis. Prenat Diagn 2015; 35:477-82. [DOI: 10.1002/pd.4562] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2014] [Revised: 01/12/2015] [Accepted: 01/18/2015] [Indexed: 11/06/2022]
Affiliation(s)
- Anna I. Girsen
- Department of Obstetrics and Gynecology; Stanford University School of Medicine; Stanford CA USA
| | - Samantha Do
- Department of Obstetrics and Gynecology; Stanford University School of Medicine; Stanford CA USA
| | - Alexis S. Davis
- Pediatrix Medical Group; San Jose CA USA
- The Fetal and Pregnancy Health Program; Lucile Packard Children's Hospital Stanford; Palo Alto CA USA
| | - Susan R. Hintz
- Division of Neonatal and Developmental Medicine, Department of Pediatrics; Stanford University School of Medicine; Stanford CA USA
- The Fetal and Pregnancy Health Program; Lucile Packard Children's Hospital Stanford; Palo Alto CA USA
| | - Arti K. Desai
- Department of Obstetrics and Gynecology; Loma Linda University School of Medicine; Loma Linda CA USA
| | - Trina Mansour
- Department of Obstetrics and Gynecology; Loma Linda University School of Medicine; Loma Linda CA USA
| | - T. Allen Merritt
- Division of Neonatology, Department of Pediatrics; Loma Linda University School of Medicine; Loma Linda CA USA
| | - Bryan T. Oshiro
- Department of Obstetrics and Gynecology; Loma Linda University School of Medicine; Loma Linda CA USA
| | - Yasser Y. El-Sayed
- Department of Obstetrics and Gynecology; Stanford University School of Medicine; Stanford CA USA
- The Fetal and Pregnancy Health Program; Lucile Packard Children's Hospital Stanford; Palo Alto CA USA
| | - Yair J. Blumenfeld
- Department of Obstetrics and Gynecology; Stanford University School of Medicine; Stanford CA USA
- The Fetal and Pregnancy Health Program; Lucile Packard Children's Hospital Stanford; Palo Alto CA USA
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[Accuracy of ultrasound estimated fetal weight performed by residents at delivery day]. ACTA ACUST UNITED AC 2014; 44:632-8. [PMID: 25481768 DOI: 10.1016/j.jgyn.2014.10.015] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2014] [Revised: 10/13/2014] [Accepted: 10/23/2014] [Indexed: 11/23/2022]
Abstract
UNLABELLED Ultrasound fetal weight estimation (EFW) has become a routine practice in obstetrics with a major impact on obstetrical management. OBJECTIVES To evaluate the accuracy of sonographic fetal weight estimations performed by residents in obstetrics at the delivery day and to search parameters influencing this exam. METHODS A prospective study performed in 299 patients at 37 weeks of gestation or more, during their delivery day. Ultrasound fetal weight estimations were performed by residents and compared to birth weights (BW). The estimated fetal weight (EFW) was calculated using the formula of Hadlock: Log10 EPF=1,335+0.0316 BIP+0,0457 PA+0,1623 LF-0,0034 PA LF. RESULTS Mean absolute difference between EFW and BW was 200g [100-450]. Mean absolute percentage error was 5.71 % [2.7-11.37]. The proportion of the EFW within 10 % of BW was 69.6 %. There was a good correlation between EFW and BW (R=0.79). Obesity and fetal macrosomia had negatively influenced ultrasound performance. For the diagnosis of macrosomia, ultrasound has a sensibility of 38 % and a specificity of 99.59 %. CONCLUSION Ultrasound fetal weight estimations performed by residents in the delivery room were as accurate as those performed by experimented sonographers. Thus, the predictive performance remains limited with a low sensitivity in the diagnosis of macrosomia.
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Aviram A, Aviram R, Tenenbaum-Gavish K, Hiersch L, Ashwal E, Yogev Y, Ben-Haroush A. Deviation of sonographic estimated fetal weight from actual birth weight in two consecutive pregnancies of the same parturients. Fetal Diagn Ther 2014; 37:37-43. [PMID: 25139702 DOI: 10.1159/000363601] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2014] [Accepted: 05/12/2014] [Indexed: 11/19/2022]
Abstract
OBJECTIVE To determine whether maternal features affect the accuracy of sonographic estimated fetal weight (SEFW) by evaluating the consistency of the systematic error of SEFW with regards to the birth weight (BW) in two consecutive pregnancies of the same gravida. METHODS The cohort included women with SEFW within 1 week of delivery (32-42 weeks' gestation) in two consecutive singleton pregnancies from 2007 to 2012. The systematic error was calculated as (SEFW - BW)/BW × 100 and expressed as a percentage of the BW. RESULTS A total of 636 pregnancies (318 gravidas) were eligible for analysis. The BW and SEFW were correlated in both first examined (r = 0.873, p < 0.001) and consecutive (r = 0.843, p < 0.001) pregnancies. There was a significant difference in mean systematic error between first examined and consecutive pregnancies (3.13 ± 8.95 vs. 0.34 ± 8.75%, p < 0.001), with a very weak correlation between the two (r = 0.135, p = 0.16). Nulliparity or multiparity at the first examined pregnancy was not found to be a significant factor, and in both groups the error was higher in the first examined pregnancy. There were no significant differences between parturients with a minor (10% and below) or major (>10%) difference in the systematic error between the two pregnancies. CONCLUSION The systematic error between the SEFW and BW in two consecutive pregnancies is inconsistent, suggesting that it is unaffected by maternal biometric features.
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Affiliation(s)
- Amir Aviram
- Helen Schneider Hospital for Women, Rabin Medical Center, Petach Tikva, Israel
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