Abstract
BackgroundThe aim of the study was to investigate the accuracy of ultrasound-derived estimated fetal weight (EFW) and to determine its impact on management and outcome of delivery.MethodsIn this single-center cohort analysis, women with a singleton term pregnancy in the beginning stages of labor were included. Women with immediately antepartum EFW (N = 492) were compared to women without ultrasound (N = 515).ResultsEFW was correct (deviation from birth weight ≤ 10%) in 72.2% (355/492) of patients with fetal biometry; 19.7% (97/492) were underestimated, and 8.1% (40/492) were overestimated. Newborns with a lower birth weight were more frequently overestimated, and newborns with higher birth weight were more frequently underestimated. The mean difference between EFW and real birth weight was − 114.5 g (standard deviation ±313 g, 95% confidence interval 87.1–142.0). The rate of non-reassuring fetal heart tracing (9.8% vs. 1.9%, P < 0.001) and of caesarean delivery (9.1% vs. 5.0%, P = 0.013) was higher in women with EFW. Overestimation was associated with an increased risk for delivery by caesarean section (odds ratio 2.80; 95% confidence interval 1.2–6.5, P = 0.017). After adjustment, EFW remained associated with increased non-reassuring fetal heart tracing (odds ratio 4.73; 95% confidence interval 2.3–9.6) and caesarean delivery (odds ratio 1.86; 95% confidence interval 1.1–3.1). The incidence of perineal tears of grade 3/4, shoulder dystocia, postnatal depression and neonatal acidosis did not differ between groups.ConclusionsAntepartum ultrasound-derived EFW does not improve maternal and fetal outcome and is therefore not recommended.
Highlights
The aim of the study was to investigate the accuracy of ultrasound-derived estimated fetal weight (EFW) and to determine its impact on management and outcome of delivery
There is only weak evidence for this approach, the determination of EFW could be of forensic relevance in cases of birth-related damage; subsequently, claims are continuously increasing in Germany and other countries [6]
Knowledge of EFW could become legally relevant, and it could influence the management of delivery and facilitate decisions in favor of a secondary caesarean section even if a vaginal delivery was initially intended
Summary
The aim of the study was to investigate the accuracy of ultrasound-derived estimated fetal weight (EFW) and to determine its impact on management and outcome of delivery. There is only weak evidence for this approach, the determination of EFW could be of forensic relevance in cases of birth-related damage; subsequently, claims are continuously increasing in Germany and other countries [6]. Knowledge of EFW could become legally relevant, and it could influence the management of delivery and facilitate decisions in favor of a secondary caesarean section even if a vaginal delivery was initially intended. The aim of this study was to correlate the immediate antepartum ultrasound-derived EFW with the birth weight and to investigate if knowledge of EFW influences a) the management of delivery and b) maternal and fetal outcome parameters
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