A systematic review of the ultrasound estimation of fetal weight

Abstract

The range and use of ultrasound fetal measurements have gradually been extended. Measurements have been combined to estimate fetal weight by mathematically based non-linear regression analysis or physically based volumetric methods. Fetal weight estimation is inaccurate, with poor sensitivity for prediction of fetal compromise. Several authors have shown the unacceptable level of intra- and interobserver variability in fetal measurement and the impact of errors on growth assessment. The aims of this study were to review the available methods and possible sources of inaccuracy. Four databases were searched for studies comparing ultrasound estimated fetal weight (EFW) with birth weight. Studies meeting the inclusion criteria evaluated 11 different methods. Errors were graphically summarized. No consistently superior method has emerged. Volumetric methods provide some theoretical advantages. Random errors are large and must be reduced if clinical errors are to be avoided. The accuracy of EFW is compromised by large intra- and interobserver variability. Efforts must be made to minimize this variability if EFW is to be clinically useful. This may be achieved through averaging of multiple measurements, improvements in image quality, uniform calibration of equipment, careful design and refinement of measurement methods, acknowledgment that there is a long learning curve, and regular audit of measurement quality. Further work to improve the universal validity and accuracy of fetal weight estimation formulae is also required.