Accuracy of Clinical Estimated Fetal Weight at Term and Effect on Clinical Management [30C

Abstract

INTRODUCTION: Although Obstetrics/Gynecology residents are faced with learning a wide variety of complex skills during their training, clinical estimation of fetal weight (EFW) via Leopold's maneuvers, despite the surrounding controversy of use, is a relatively simplistic skill. We wanted to determine the correlation of clinical EFW with actual birth weight (BW) in term pregnancies, and determine if this knowledge had an impact on length of labor or mode of delivery. METHODS: Retrospective chart review of singleton pregnancies between 37 and 42 weeks, admitted for labor and delivery were randomly selected, between 2013 and 2016. For 80% power, 452 women were needed to detect a difference of 10% between EFW and BW. The statistical tests used were Pearson and Spearman-Rho Correlation, Mann Whitney-U Tests and Chi Square test as appropriate. RESULTS: Of 497 women randomly selected, 9 were excluded for missing data. The mean age of was 26.8 (+/- 6.1); 33% were African American, 30% Hispanic, 27.5% White; with macrosomia rate of 7.5%. EFW had a significant, moderate positive correlation with BW (r =.43, p<.001). The accuracy of EFW within 20% of actual BW was 89.2%. A significant relationship between mode of delivery and EFW noted (20.3% cesarean delivery in <8 lbs group while 10.5% in <8 lbs) (p=0.014). However, estimating a larger EFW did not prolong labor (367[219-580] vs 426[223-630] minutes respectively) (p=0.26). CONCLUSION: Continued practice and reinforcement of recording EFW, as part of physical examination, provides clinicians with an accurate and important tool that can aid in management of women in term labor.