Leopold's Maneuvers Research Articles

Peripartum Prediction of Fetal Weight in Gravidas With Obesity.

Estimated fetal weight (EFW) is an important metric at delivery as neonates with abnormal birthweight and their mothers are at higher risk of birth complications. Data regarding optimal EFW assessment in gravidas with obesity is inconsistent, and with the increasing incidence of obesity, clarification of this question is crucial. We aimed to compare accuracy of ultrasound (US)-derived EFW and clinical assessments of EFW in predicting neonatal birthweight among gravidas with obesity. This prospective cohort study enrolled gravidas with obesity and a singleton pregnancy admitted for delivery at term. EFW was determined using either US biometry or clinical assessment (Leopold's maneuvers, Johnson's formula, and Insler's formula) at time of admission. Our primary outcome was accurate EFW, defined as EFW within 500 g of birthweight. Secondary outcomes included ability to predict small-for-gestational age (SGA) and large-for-gestational age (LGA) birthweights. These outcomes were compared between all EFW methods. A total of 250 gravidas with a median body mass index of 36.4 kg/m2 were enrolled. Admission US outperformed Leopold's maneuvers in obtaining accurate EFW (81.6% versus 74.5%, P = .03). When comparing all methods, Johnson's and Insler's formulae performed the worst, accurately predicting EFW in only 27.4% and 14.3% of cases, respectively. Likewise, US-derived EFW outperformed Leopold's maneuvers and fundal height in the prediction of SGA and LGA neonates. US is more accurate than clinical assessment of EFW in gravidas with obesity both for estimation of actual birthweight and prediction of abnormal birthweight. Universal late third-trimester or peripartum US for EFW should be considered in gravidas with obesity.

Accuracy of OBGYN Resident Physician Clinical Estimation of Fetal Weight in Term Pregnancies Before and After a Teaching Curriculum

Purpose: Accurate prediction of fetal birth weight can improve antepartum and intrapartum shared decision-making with patients. Therefore, this study primarily sought to determine if OBGYN residents are more accurate at clinically estimating fetal weight via Leopold maneuvers following a teaching curriculum including a hands-on simulation model. Secondary aims were to determine if accuracy changes depending on training level, maternal or fetal characteristics. Methods: A paired t-test was used to evaluate the primary aim of the teaching curriculum’s effect on accuracy of correct fetal weight estimation. Nineteen residents served as their own controls to assess differences in accuracy by performing 10-12 estimates prior to and after the teaching curriculum. The curriculum consisted of a short verbal workshop with images of how to perform Leopold maneuvers, along with five models that were created to represent a gravid uterus with a fetus measured in the 5th, 25th, 50th, 75th, 95th percentiles. Residents were also tested on models with unknown weights to confirm accuracy prior to completing the teaching curriculum. The inclusion criteria during the fetal weight estimates pre- and post-curriculum was as follows: mother had to deliver during hospital admission; gestational age was between 37 weeks and 41 weeks; singleton pregnancy; mother had not undergone rupture of membranes; mother was English speaking. Accuracy was defined as estimated fetal weight within 10% of actual birth weight. Generalized Logistic Mixed Models were used to assess accuracy when adjusting for PGY level, maternal and fetal characteristics. Maternal characteristics including age, BMI, race, pregestational diabetes, gestational diabetes, polyhydramnios, and oligohydramnios were abstracted from maternal medical charts via retrospective chart review. Infant characteristics including fetal macrosomia, fetal growth restriction, and gestational age were also recorded. Analyses were conducted using SAS 9.4; all p-values were two-sided and p-values <0.05 were deemed statistically significant. Results: Nineteen OBGYN residents performed a total of 443 Leopold maneuvers to estimate fetal weight. Overall, resident estimation accuracy within 10% of actual birth weight improved from 65.5% to 67.4% (p=0.49) after the teaching curriculum. Senior residents showed a greater improvement after the teaching curriculum than junior residents, however it was not statistically significant. This could be due to the low sample size. Increasing gestational age was associated with higher odds of accurate estimation of fetal weight (OR 1.34, p=0.0295). There were no other differences in accuracy based on other maternal or fetal factors. Conclusion: The teaching of Leopold maneuvers is often not formalized in residency programs. This study did not show the expected improvement in accuracy of fetal weight estimation. Considerations that may impact clinical estimations include improving the simulation model, revising the teaching curriculum, and/or doing the teaching curriculum more frequently. Incorporating this hands-on simulation annually within the residency program educational curriculum to standardize the learning experience may be beneficial.

Effects of game-based learning integrated with the self-regulated learning strategy on nursing students' entrustable professional activities: A quasi-experimental study

BackgroundIn the field of nursing education, the expertise and knowledge required to perform Leopold's Maneuvers are critical, forming an integral part of Entrustable Professional Activities for nursing students. As a result, mastering Leopold's Maneuvers has become a core component of nursing education. Despite this, the prevailing didactic methods in many nursing courses tend to limit interactive and contextual learning experiences, which can hinder students' ability to engage deeply with the subject matter. This lack of engagement may subsequently affect both the effectiveness of students' learning and students' clinical judgment capacity, essential elements in the competencies of Entrustable Professional Activities. MethodsA quasi-experimental design was employed in this study, involving a total of 55 nursing university students, with 28 participants in the experimental group and 27 in the control group. The research incorporated game-based learning integrated with the self-regulated learning strategy, and employed a pretest, posttest, and questionnaires to assess students' learning performance, self-efficacy, and learning motivation. The experimental group participated in game-based learning with the self-regulated learning strategy, whereas the control group experienced game-based learning without the integration of self-regulated learning. Learning performance was analyzed using an independent samples t-test, while Analysis of Covariance was employed to compare the self-efficacy and learning motivation of the two groups. ResultsThe findings showed that the integration of game-based learning with the self-regulated learning strategy can significantly improve students' learning performance, self-efficacy, and learning motivation. ConclusionAs an integral part of Entrustable Professional Activities, Leopold's Maneuvers were integrated into an interactive game-based learning environment, coupled with the self-regulated learning strategy in nursing education. This approach aimed at cultivating core competencies among nursing students. This study has demonstrated its efficacy in engaging students effectively, serving as a dynamic resource for immersive learning in Leopold's Maneuvers, aligning well with the design considerations for promoting Entrustable Professional Activities in nursing education.

Are Junior Residents Accurate at Predicting Fetal Weight? An Analysis of Junior Residents' Performance of Estimated Fetal Weight Using Ultrasound and Leopold's Maneuver.

Performing accurate estimated fetal weights (EFWs) is a critical skill developed in obstetrics residency training. Resident physicians are often the first to perform EFWs on obstetric patients when they enter care. Evaluating residents' accuracy in performing EFWs is crucial for assessing their achievement in residency training milestones and providing patient care. As part of an educational initiative program between 2014 and 2020, postgraduate year 1 (PGY1) and postgraduate year 2 (PGY2) residents performed EFW measurements on 10 term (>37w0d) patients using ultrasound and Leopold's maneuver and 10 preterm (>24w0d and <37w0d) patients using ultrasound. Clinical characteristics, mode of delivery, and actual birthweights (BWs) were recorded for each patient. The accuracy of these estimates was evaluated using mixed-effect regression models. Thirty-three residents, 1127 deliveries, and 1790 EFW measurements were evaluated. Overall, the percentage of residents with estimations within 10% of actual BW went up in PGY2 for Leopold's and ultrasound term births, but not for preterm ultrasound births. Maternal body mass index and actual BW were associated with absolute percentage estimation error. After adjusting for these variables, there was a statistically significant decrease in error between PGY1 and PGY2 for Leopold's method in term births; ultrasound (term and preterm) showed more modest reductions in error during PGY2. Resident physicians have accurate estimates of EFWs early in their training, beginning in their first year of residency by both Leopold's maneuver and ultrasound. Furthermore, PGY2 residents performed better than PGY1 residents for Leopold's method.

Accuracy of Estimated Fetal Weight by Ultrasound Versus Leopold Maneuver.

Estimated fetal weight (EFW) is frequently used for clinical decision-making in obstetrics. The goals of this study were to determine the accuracy of EFW assessments by Leopold and ultrasound and to investigate any associations with maternal characteristics. Postgraduate years 1 and 2 obstetrics and gynecology resident physicians from Harbor-UCLA Medical Center from 2014 to 2020 performed EFW assessments on 10 preterm (<37 weeks' gestational age) fetuses by ultrasound biometry and 10 full-term (≥37 weeks' gestational age) fetuses by ultrasound biometry and Leopold maneuver. Assessments were included if the patients delivered within 2 weeks of the assessments. One thousand six hundred ninety-seven EFW assessments on 1183 patients performed by 33 residents were analyzed; 72.6% of sonographic full-term EFWs, 69% of Leopold full-term EFWs, and 61.5% of sonographic preterm EFWs were within 10% of the neonatal birth weight (BW). The lowest estimation error in our study occurred when actual BW was 3600 to 3700 g. After adjusting for BW, residents were found to have lower accuracy when the mother had a higher body mass index (BMI) for full-term estimation methods (Leopold and ultrasound, β = 0.13 and 0.12, P = 0.001 and 0.002, respectively). Maternal BMI was not related to estimation error for preterm fetuses ( β = 0.01, P = 0.75). Clinical and sonographic EFW assessments performed by obstetrics and gynecology junior residents are within 10% of neonatal BW much of the time. In our cohort, they tended to overestimate EFWs of lower-BW infants and underestimate EFWs of higher-BW infants. Accuracy of full-term EFW assessments seems to decrease with increasing maternal BMI.

THE INFLUENCE OF PROBLEM-BASED LEARNING METHOD ON THE LEOPOLD MANEUVER CLINICAL SKILL IN DIPLOMA MIDWIFERY STUDENTS

Background: In dealing with the current condition of the Covid-19 pandemic, the education system finds the alternative and changes the regular learning to an online system. This online system depends on vital aspects such as well-structured, interactive, and substantive programs. Consequently, educators are challenged to be more frequently innovative and active in assessing and evaluating learning needs. Implementing a proper learning method helps to encourage students' willingness to learn since they are the core of the learning process. Therefore, this research considered Problem-based Learning as a suitable learning method to implement and improve clinical skills. By learning from a problem, students are indirectly instructed to learn how to collect and integrate new knowledge.&#x0D; Objectives: This study focuses on determining the implementation of Problem-Based Learning methods on the Leopold maneuver antenatal midwifery care subject in the diploma midwifery students.&#x0D; Methods: This study uses a quasi-experimental design with a one group pretest-posttest design. The samples in this study are 30 students from Megarezky University. Data are analyzed by univariate and bivariate with chi-square test. This study uses a questionnaire to measure students' interest and motivation in participating in learning in antenatal care courses, and to measure skills in performing the Leopold maneuver using a standardized checklist from the Antenatal Care Module of the Ministry of Health. This research is conducted within two months (December to January 2022).&#x0D; Results: The result reveals that the Problem-Based Learning Method (PBL) effectively increases the score of students' clinical skills with a p-value: 0.000 &lt; 0.05.&#x0D; Conclusion: Problem-Based Learning Method (PBL) effectively improves the clinical skills of Leopold maneuver Antenatal care.

Evaluation of the Effectiveness of Different Training Techniques in the Development of Leopold's Maneuver Skills: A Randomized Controlled Trial.

This randomized controlled trial evaluated the outcomes of simulation- and video-based training for teaching nursing students Leopold's maneuver. Their self-efficacy and anxiety levels were also explored. Data were collected among 121 participants [low-fidelity simulator group (LFSG) n = 43; video training group (VTG) n = 41; control group (CG) n = 37] using a Student Information Form, Leopold's Maneuver Skill Checklist, Spielberger State Anxiety Inventory, and General Self-Efficacy Scale. The primary outcome measure was the participants' performance; the secondary outcome measures were their anxiety and self-efficacy levels and grade point averages. The LFSG and VTG participants performed Leopold's maneuvers better than the CG participants. A negative correlation between anxiety and self-efficacy in the LFSG and CGs was found, while there was a positive correlation between grade point average and self-efficacy in the VTG. Educational institutions with an insufficient number of instructors and laboratory infrastructure can use video-based training as an alternative to simulation-based education to reach more students.

Asymmetric twinning: A preterm baby with sacrococcygeal teratoma and parasitic twin born to a 16-year-old primigravida

A 16-year-old primigravida, at 33 weeks and 5 days age of gestation came in due to preterm labor. Sonographic examination revealed an incidental finding of a mass attached to the sacrococcygeal area. The mass has a cystic and solid component diagnosed as sacrococcygeal teratoma. Attached to the mass were two lower extremity structures identified as femurs with feet and was considered as an underdeveloped parasitic twin. A classical cesarean section was performed because of the advanced preterm labor, and a live female infant weighing 2500 g was delivered. The parasitic lower limbs, however, inadvertently detached during delivery. There was a high index of suspicion because of a larger fundic height of 37 cm compared to the age of gestation and the difficult palpation on Leopold's maneuver. Accuracy of ultrasound findings helped the obstetricians to a timely and prepared for delivery.

Baseline Clinical Skill of Medical Students Entering the Obstetrics and Gynecology Core Clinical Clerkship.

Determine baseline clinical skills of medical students entering the Obstetrics and Gynecology (OB/GYN) clerkship with prior clinical curricular exposure. Students are introduced to clinical correlates sooner in the preclinical curriculum to facilitate adult learning. There are few studies determining clerkship-specific clinical skills readiness in OB/GYN, a specialty with historically limited previous exposure. An anonymous 15-question clinical readiness survey (1-5 Likert scale) was administered to medical students during their OB/GYN Orientation at the University of Texas Health Science Center San Antonio over four academic years, 2014-2018, to determine baseline OB/GYN clinical skill knowledge and confidence. Statistical analysis included Spearman rank correlation and Kruskal-Wallis tests, with significance defined as p < 0.05. The survey was completed by 346 students (77% participation). Overall, students felt most confident in knot tying skills (17%) and closed gloving technique (7%) and least confident in knowledge of labor curve (86%), Leopold's maneuvers (88%), and Montevideo units (MVU) (90%). Confidence in performing closed gloving (4% vs. 11%, p < 0.01) and tying knots (8% vs. 27%, p < 0.01) was significantly higher during rotations later in the academic year. Students who expressed a higher level of interest felt more prepared for the clerkship (rs = 0.21, p < 0.01). Results indicate that confidence in obstetric-specific clinical skills is relatively low throughout the academic year; however, baseline surgical skills show improvement. It is important for teaching faculty to know baseline clinical skills of the medical student with earlier clinical exposure to enhance adult learning and optimize clinical competency. In medical students receiving earlier clinical exposure, confidence in baseline obstetric-specific clinical skill is relatively low throughout the academic year. Confidence in general surgical skills demonstrates improvement over the academic year.

The impact of using Direct observation of procedural skills (DOPS ) evaluation method on the some clinical skills of midwifery students

Background: The present study was done in order to evaluate the students’ clinical skill, enhance the quality of cares given, and consider limitations of common evaluation ways, as well as loss of texts about impact of new evaluation in education. The aim of this study was the impact of using direct observation of procedural skill (DOPS) evaluation method on some clinical skills of midwifery students. Methods: This quasi-experimental study was performed on 70 midwifery students in the delivery ward of Fatemieh Hospital in Hamadan during the first semester of 2017-2018. In this stage, the students in the control group were evaluated according to the current method of the faculty and the experimental group was evaluated by the DOPS method through a checklist. Finally, the evaluation scores of students were compared in both control and experimental groups. Results: According to T-test results, the average score in vaginal examination, Leopold maneuver and hearing fetal heart rate has been equal before doing the test (P>0.05); however, after intervention the difference between the results obtained from these two groups was significant (p 0.05), the scores have significantly increased in test group (p <0.05). Conclusion: Findings showed that using DOPSevaluation way can be effective in enhancing clinical skills of midwifery students in vaginal examination; however, Leopold maneuver and hearing fetal heart rate are recommended for other procedures.

The effect on pregnant women's prenatal attachment of a nursing practice using the first and second Leopold's maneuvers.

This study aimed to determine the effect on pregnant women's prenatal attachment of a nursing practice using the first and second Leopold's maneuvers. This experimental, randomized and controlled study was conducted in a pregnancy class of a training and research hospital in Kocaeli, Turkey from September 2016 to September 2017. Its sample included 100 pregnant women, 50 in the experimental group and 50 in the control group (https://www.random.org, accessed: 09.20.2016). Data were collected using a personal information form, the Prenatal Attachment Inventory (PAI) and the Fetal Position Awareness Scale (FPAS). The study offered education that included fetal development, the first and second Leopold's maneuvers, and Leopold's maneuvers were administered in the 28th week of the women's pregnancy and re-administered in the 32nd and 36th weeks of pregnancy. No intervention was administered to the control group in these weeks, but the scales were administered. The sociodemographic, obstetric, social support and baby-related characteristics of the groups were similar (p > .05). There were no statically significant differences between their mean PAI and FPAS scores in the 28th week of pregnancy (p > .05). The experimental group's mean PAI and the FPAS scores in the 32nd and 36th weeks of pregnancy were significantly higher than those of the control group (p < .01). The study concluded that Leopold's maneuvers affected the pregnant women's prenatal attachment levels.

Accuracy of Leopold's Maneuver Compared to Ultrasound in Estimating Fetal Birth Weight [12B

INTRODUCTION:Estimation of fetal birth weight is a critical data point that can affect the management of women in term labor. However, the superior method of estimating fetal birth weight (EFW) using Leopold's maneuvers versus ultrasound continues to be debated. This study aimed to compare the accur

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

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&lt;.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 &lt;8 lbs group while 10.5% in &lt;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.

Ultrasound versus Clinical Examination to Estimate Fetal Weight at Term.

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.

A new strategy in nursing education: From hybrid simulation to clinical practice

Various instructional environments are used in nurse education to develop students' psychomotor and communication skills, reduce their anxiety levels, and enhance their satisfaction. To examine the effect of three different instructional environments on the development of the students' psychomotor and communication skills and their levels of anxiety and satisfaction. A prospective study design was used. The study sample consisted of 60 nursing students. Before the implementation of the study, the students' cognitive skills and trait anxiety levels were evaluated. The students were divided into five groups and five nursing activities (Leopold's maneuvers, teaching breastfeeding, family planning education, teaching vulvar self-examination and teaching breast self-examination) were specified for each group. They implemented these nursing activities under the supervision of a faculty member in the nursing skills laboratory (NSL), standardized patient laboratory (SPL) and clinical practice environment (CPE) respectively. In each instructional environment, the students' psychomotor and communication skills, state anxiety levels and satisfactions were evaluated. The median scores for psychomotor skills [NSL=73.1;SPL=81.5;CPE=88.6] and communication skills [NSL=64.9;SPL=71.6;CPE=79.0] were found to increase as the students went on practicing in a more complicated environment (p<0.05). Similarly, it was determined that the students' anxiety levels decreased as they were practicing incrementally [NSL=33.0;SPL=32.0;CPE=31.0]. As the instructional environments were getting more similar to the reality, the students' satisfaction levels were found to become higher. Students who deliberately practice in the instructional environments until they are competent develop their psychomotor skills while reducing their anxiety levels, and enhancing their communication skills and satisfaction. For that reason, the development of students' competency areas is thought to be effective for enhancement of patients and health care workers' safety.

Use of the Learning Curve-Cumulative Summation Test for Leopold Maneuvers Assessment in a Simulator: A Pilot Study.

Simulation enables medical students to practice clinical skills in a safe environment. Graduates in medicine must be able to correctly perform an examination on a pregnant woman using Leopold maneuvers. Learning curves-cumulative summation (LC-CUSUM) may help determine when the student has achieved a specific skill. Our objective was to perform the LC-CUSUM test regarding the ability of students to correctly carry out Leopold maneuvers; a pregnancy simulator was used, transferring the results to a clinical setting. Five medical students were trained to carry out Leopold maneuvers using the simulator. Each student performed maneuvers for 50 cases of different fetus positions; a LC-CUSUM was plotted for each student. Afterward, the students performed the Leopold maneuvers on 5 pregnant women. Of the 5 students, 3 achieved a level of proficiency; the attempts needed for reaching this level were 13, 13, and 37, respectively. The other 2 students did not reach proficiency level. Of the students who became successfully proficient with the simulator, one of them attained a 100% success rate in pregnant patients, whereas the other two had success rates of 80%. The students who did not achieve a level of competency with the simulator had only a 60% success rate with patients. Because of the differences observed between students in the number of attempts needed for achieving proficiency in Leopold maneuvers, we believe that each student should build his/her own learning curve. Achieving competency in carrying out Leopold maneuvers using the simulator could be transferable to patients.

Electronic Poster Presentations, Maternal Fetal Medicine

Electronic Poster Presentations, Maternal Fetal Medicine

Quality assessment of peripartum care.

Background:Maternal health improvement is one of the eight goals of the third millennium development, set in 2000. Pregnancy complications are the most important causes of maternal mortality worldwide. Proper and qualified health care access is one the most important factors for reducing maternal and neonatal mortality rates.Objectives:This study aimed to determine quality of peripartum care in Lorestan province in 2013.Materials and Methods:This was a descriptive cross-sectional study, in which quality of peripartum care was assessed among 200 women (sample size was determined according to other studies), referred to Lorestan province public hospitals. Quality assessment according to the WHO was used for the framework of structure, process and outcome. Data was collected by a researcher-made checklist, developed based on the administered instructions by Iran Health Ministry. The checklists were filled by observation. The calculated quality scores were expressed as percentage. SPSS version 18 was used for data analysis.Results:The mean percentages of compatibility with desirable situation were 54%, 57% and 66% in first, second and third stage of labor, respectively. The lowest scores were related to: Leopold maneuvers in the first stage, hand washing in the second stage and pulse control in the third stage of labor.Conclusions:Quality of peripartum care is moderate in Lorestan province, therefore, continuous evaluation of quality of care by administrators and hospital staff is essential to improve this quality and will ultimately result in maternal and neonatal health improvement.

Accuracy of Estimated Fetal Weight by Ultrasonography Compared With the Leopold Maneuver and Effect of Maternal Obesity

INTRODUCTION: Estimated fetal weight is used routinely in the evaluation of the labor patient. Precise estimated fetal weight is necessary to provide adequate and accurate counseling to our patients. With the growing obesity epidemic, it is likely the clinical relevance of estimated fetal weight by Leopold's maneuvers is declining. The objective of this study was to test if estimated fetal weight by Leopold maneuvers or by ultrasonography is a more accurate assessment of delivery weight and if these measurements are affected by maternal body mass index (BMI). METHODS: A retrospective chart review of 102 term gravidas presenting either in labor or for induction was conducted. Term pregnancies with both documented estimated fetal weight by ultrasound examination and by Leopold's maneuvers were included. Birth weight was recorded and compared with the estimates. Maternal height and weight at delivery were used to calculate BMI. SPSS was used for the analysis. RESULTS: Estimated fetal weight by ultrasound examination and estimated fetal weight by Leopold's maneuvers differed significantly. Estimated fetal weight by ultrasound examination more accurately predicted actual birth weight with BMI greater than 30 kg/m2. CONCLUSION: Both ultrasound assessment and clinical estimation of fetal weight are strongly associated with actual birth weight. Ultrasonography provides a more accurate assessment of fetal weight in the term patient than clinical estimation by residents.

Clinical accuracy of estimated fetal weight in term pregnancies in a teaching hospital

Objective: To evaluate whether clinical characteristics alter the accuracy of clinical estimation of fetal weight (EFW) in term pregnancies in a teaching hospital.Methods: Secondary analysis of a retrospective cohort study of patients presenting for labor at term. Clinical EFW was performed using Leopold maneuvers. A Spearman’s rank correlation coefficient (r) was used to evaluate the linear relationship between clinical EFW and actual birth weight (BW). Body mass index (BMI), gestational age, fetal station, and admission diagnosis were evaluated with respect to their impact on clinical EFW. The primary outcome was an absolute error between clinical EFW and actual BW >500 g.Results: Of 3797 patients, 941 (24.8%) had an absolute error in clinical EFW exceeding 500 g. The overall correlation between clinical EFW and actual BW was weak (r = 0.4). There was a significant trend of improved accuracy of clinical EFW with increasing gestational age; however, BMI, fetal station, and admission diagnosis did not have significant effects. Of 221 cases of macrosomia (>4000 g), 181 (81.9%) were undetected by clinical EFW.Conclusion: The correlation between clinical EFW and actual BW is overall weak, particularly in patients with macrosomic fetuses; however, BMI, admission diagnosis, and fetal station do not have a significant impact.