The Suspected Macrosomic Fetus at Term: A Clinical Dilemma

Ray, Ellen; Alhusen, Jeanne L.

doi:10.1111/jmwh.12414

Cited by 9 publications

(12 citation statements)

References 46 publications

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“…The long-standing, mainly midwifery-based tradition of clinical weight estimation by means of Leopold’s manoeuvres is a non-invasive approach to fetal weight estimation that is used when ultrasound is not available [1, 15].…”

Section: Discussionmentioning

confidence: 99%

“…Accuracy of fetal weight estimation is of key importance in antenatal care, as well as in the planning and management of labour and mode of delivery [1–9].…”

Section: Introductionmentioning

confidence: 99%

“…By placing both hands on the woman’s abdomen the examiner can describe the position of the fetus as well as the level of the uterine fundus and thus detect a disproportion between fetus and the female pelvis. Experienced examiners are able to give a clinical estimation of fetal weight after performing Leopold’s manoeuvres including symphysis-fundal height and abdominal palpation [1].…”

Section: Introductionmentioning

confidence: 99%

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Fetal weight estimation at term – ultrasound versus clinical examination with Leopold’s manoeuvres: a prospective blinded observational study

Preyer

Husslein

Concin

et al. 2019

BMC Pregnancy Childbirth

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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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Section: Discussionmentioning

confidence: 99%

“…Accuracy of fetal weight estimation is of key importance in antenatal care, as well as in the planning and management of labour and mode of delivery [1–9].…”

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

Fetal weight estimation at term – ultrasound versus clinical examination with Leopold’s manoeuvres: a prospective blinded observational study

Preyer

Husslein

Concin

et al. 2019

BMC Pregnancy Childbirth

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“…Macrosomia is defined as a birth weight of 4000 g or more, whereas low birth weight is a birth weight of less than 2500 g. The term macrosomia was utilized instead of large for gestational age as evaluating a baby's weight in utero is imprecise and would only serve as a potential indication of suspected macrosomia. 29 , 30 Stillbirth is defined as a baby born with no signs of life at or after 28 weeks' gestation. Preterm delivery is defined as birth that occurs before the start of the 37th week of pregnancy.…”

Section: Methodsmentioning

confidence: 99%

The effect of obesity in pregnancy and gestational weight gain on neonatal outcome in glucose‐tolerant mothers

Loh

Taipin

Said

2021

Obesity Science & Practice

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Background Most studies showing association between mothers with obesity in pregnancy or excessive gestational weight gain (GWG) and adverse neonatal outcome were cross‐sectional or retrospective. Many included patients are with gestational diabetes mellitus (GDM), which is a strong risk factor for this adverse outcome. There are no prospective studies on this topic in Malaysia. This study aimed to examine prospectively the effects of obesity in pregnancy and GWG, independent of GDM, on neonatal outcome. Methods Pregnant mothers in the first trimester, who presented to health clinics in Kuching, were screened. Mothers with existing diabetes mellitus or GDM were excluded using 75‐g oral glucose tolerance test during the first and second trimesters. Participants with the first trimester BMI ≥ 23 kg/m2 were recruited as overweight/obese group, whereas those with BMI 18.5–22.9 kg/m2 were taken as the comparison group. At every trimester visit, mothers' weights were recorded. Babies' birth weight and occurrence of adverse neonatal outcome were documented. Results There were 123 mothers recruited as overweight/obese group (mean BMI 29.0 kg/m2 ± 4.45) and 102 mothers as comparison group (mean BMI 20.4 kg/m2 ± 1.48). The number of low birth weight was similar between groups: 9.8% in overweight/obese group, 6.9% in the comparison group (p = 0.416). More than half of these babies were born to mothers with inadequate GWG (58.3% in obese group vs. 57.1% in control group, p = 0.077). There was no significant difference in the mean birth weight (3000 g ± 454.5 vs. 3038 g ± 340.8, p = 0.471), preterm delivery (8.13% vs. 3.92%, p = 0.193), and admission rate to neonatal intensive care unit (8.13% vs. 7.85%, p = 0.937) between groups. There was a positive correlation between the total GWG in overweight/obese group on baby's weight (r = 0.222, p = 0.013). Inadequate GWG was not correlated with lower birth weight (p = 0.052). Conclusions Obesity in pregnancy was not associated with poor neonatal outcome in this small sample of women in Malaysia. Total GWG showed a weak correlation with baby's birth weight in overweight/obese group.

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“…Concerning these risks, the French College of Obstetricians Gynecologists recommends an elective caesarean section for an estimated fetal weight greater than 4500 grams in case of gestational diabetes or scarred uterus, and 5000 grams in other cases. Thus the estimation of fetal weight (EFW) by ultrasound must be effective because the prenatal diagnosis of macrosomia by estimation on the EFW can lead to an unjustified elective caesarean section a posteriori [2]. The underestimation of a macrosomic may pose an obstetrical risk of severe perineal lesions, obstructed labor or dystocia [1].…”

Section: Introductionmentioning

confidence: 99%

Screening for Macrosomia at Term: Performances of Ultrasonographic Estimation of the Fetal Weight and the Use of the Uterine Height

Sellier¹

2017

OGIJ

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Objective: The aim of our study was to assess the performance for the detection of macrosomia at term of estimating fetal weight corrected by the growth effect (EFWc) measured by ultrasound, EFWC via measuring uterine height (UH), the waist circumference and higher uterine height threshold or equal to 37. Methods:It is a retrospective study of 233 patients whose newborn macrosomes were sampled. The estimated fetal weight (EFW) ultrasound was performed during the 41th week of amenorrhea, as the EFW by measuring waist circumference with the Warsof 's formula and EFW by measuring the uterine height according to the kayem's formula. These 3 estimates were corrected taking into account the growth effect. Results:The proportion of estimates with a margin of error of less than 10% was 61.3%, 50% and 68.4% respectively for the EFWc EFWUHc and EFWACc. ROC curves of the EFWc EFWUHc and EFWACc find the Aires under the curve (AUC) to 0.859, 0.783 and 0.856. The EFWc and EFWACc are significantly higher than for term screening for macrosomia compared to EFWUHc (p <0.001 and p <0.001 respectively). Conclusion:Measuring the EFWc and EFWACc are reliable and simple means for screening for macrosomia term, but will be improved.

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The Suspected Macrosomic Fetus at Term: A Clinical Dilemma

Cited by 9 publications

References 46 publications

Fetal weight estimation at term – ultrasound versus clinical examination with Leopold’s manoeuvres: a prospective blinded observational study

Fetal weight estimation at term – ultrasound versus clinical examination with Leopold’s manoeuvres: a prospective blinded observational study

The effect of obesity in pregnancy and gestational weight gain on neonatal outcome in glucose‐tolerant mothers

Screening for Macrosomia at Term: Performances of Ultrasonographic Estimation of the Fetal Weight and the Use of the Uterine Height

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