Can Sonographic Fetal Biometry Predict Adverse Perinatal Outcome?

Abstract

Objective To evaluate the association of sonographic fetal biometry (sonographic head circumference (soHC), sonographic abdominal circumference (soAC), estimated fetal weight (EFW)) with mode of delivery and adverse perinatal outcome.

Methods Singleton pregnancies with a gestational age ≥ 37 weeks and an ultrasound examination with complete biometric parameters within 7 days before delivery were retrospectively included. The association between soHC, soAC, EFW and fetal (5-min Apgar < 7, pH < 7.1, neonatal intensive care unit (NICU) admission, shoulder dystocia (ShD)) and maternal (obstetric intervention (OI): caesarean or vaginal operative delivery, obstetric anal sphincter injury syndrome (OASIS), postpartum hemorrhage (pph)) adverse outcomes were analyzed using univariate and multivariate logistic regression analyses.

Results 12 396 women were included and 3479 (28.07 %) needed an OI. Multivariate analyses demonstrated significant contributions for the prediction of OI by soHC and soAC, whereas EFW did not reach significance. The highest OR was shown for soHC (1087, p < 0.001). ShD occurred in 73 (0.59 %) of the deliveries. Multivariate analyses showed that significant contributions for the prediction of ShD were provided only by soAC (OR 1460, p = 0.007). For the other maternal and neonatal adverse outcome parameters, no significant association with the biometric measurements could be demonstrated in the multivariate analyses. The overall detection rates for the prediction of adverse perinatal outcome by the different biometric parameters and EFW were poor.

Conclusion Obstetric management decisions should not be based solely on measurements of biometric parameters or EFW.

Zusammenfassung

Ziel Das Ziel dieser Studie war es, die Zusammenhänge zwischen sonografischer Biometrie (sonografischer Kopfumfang (soHC), Abdomenumfang (so AC), geschätztes fetales Gewicht (EFW)), Entbindungsmodus und perinatalem Outcome zu untersuchen.

Methoden Es wurden retrospektiv Einlingsgraviditäten ≥ 37 Schwangerschaftswochen mit fetaler Schädellage mit einer vollständigen fetalen Biometrie innerhalb sieben Tagen vor Entbindung eingeschlossen. Die Assoziationen zwischen soHC, soAC, EFW und fetalem (5-min Apgar < 7, pH < 7,1, Verlegung in die Kinderklinik (NICU), Schulterdystokie (ShD)) und maternalem (geburtshilfliche Intervention (OI): Sectio caesarea (CD) oder vaginal-operative Entbindung, höhergradige Geburtsverletzung (OASIS), postpartale Hämorrhagie (pph)) Outcome wurden anhand von uni- und multivariaten logistischen Regressionsanalysen untersucht.

Ergebnisse 12 396 Frauen wurden eingeschlossen, von denen 3479 (28,07 %) per OI entbanden. Die multivariaten Analysen zeigten einen signifikanten Zusammenhang zwischen einer Entbindung per OI und dem soHC und soAC. Für EFW konnte kein signifikanter Zusammenhang nachgewiesen werden. Die höchste OR wurde für den soHC gezeigt (1087, p < 0,001). Eine ShD zeigte sich in 73 Geburten (0,59 %). Die multivariaten Analysen ergaben ausschließlich für soAC (OR 1460, p = 0,007) einen signifikanten Zusammenhang zur SD. Die Untersuchung der anderen maternalen oder neonatalen Outcomeparameter blieb ohne signifikantes Ergebnis. Die Detektionsraten zur Vorhersage des perinatalen Outcomes durch die verschiedenen sonografischen Parameter waren niedrig.

Schlussfolgerung Das geburtshilfliche Vorgehen sollte nicht ausschließlich auf der Grundlage von sonografisch erhobenen biometrischen Parametern oder dem sonografisch geschätzten Fetalgewicht getroffen werden.

Key words

ultrasound - fetal weight estimation - biometric parameters - mode of delivery - adverse perinatal outcome

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