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Am J Perinatol 2015; 32(10): 968-972
DOI: 10.1055/s-0035-1545664
Original Article
Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

Ultrasonographic Fetal Weight Estimation: Should Macrosomia-Specific Formulas Be Utilized?

Blake Porter
1   Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, University of Missouri, Kansas City, Missouri
,
Cherry Neely
2   Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, University of Alabama at Birmingham, Alabama
,
Jeff Szychowski
2   Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, University of Alabama at Birmingham, Alabama
3   Department of Biostatistics, University of Alabama at Birmingham, Alabama
,
John Owen
2   Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, University of Alabama at Birmingham, Alabama
› Author Affiliations
Further Information

Publication History

07 August 2014

08 January 2015

Publication Date:
02 March 2015 (online)

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Abstract

Objective This study aims to derive an estimated fetal weight (EFW) formula in macrosomic fetuses, compare its accuracy to the 1986 Hadlock IV formula, and assess whether including maternal diabetes (MDM) improves estimation.

Study Design Retrospective review of nonanomalous live-born singletons with birth weight (BWT) ≥ 4 kg and biometry within 14 days of birth. Formula accuracy included: (1) mean error (ME = EFW − BWT), (2) absolute mean error (AME = absolute value of [1]), and (3) mean percent error (MPE, [1]/BWT × 100%). Using loge BWT as the dependent variable, multivariable linear regression produced a macrosomic-specific formula in a “training” dataset which was verified by “validation” data. Formulas specific for MDM were also developed.

Results Out of the 403 pregnancies, birth gestational age was 39.5 ± 1.4 weeks, and median BWT was 4,240 g. The macrosomic formula from the training data (n = 201) had associated ME = 54 ± 284 g, AME = 234 ± 167 g, and MPE = 1.6 ± 6.2%; evaluation in the validation dataset (n = 202) showed similar errors. The Hadlock formula had associated ME = −369 ± 422 g, AME = 451 ± 332 g, MPE = −8.3 ± 9.3% (all p < 0.0001). Diabetes-specific formula errors were similar to the macrosomic formula errors (all p = NS).

Conclusions With BWT ≥ 4 kg, the macrosomic formula was significantly more accurate than Hadlock IV, which systematically underestimates fetal/BWT. Diabetes-specific formulas did not improve accuracy. A specific formula should be considered when macrosomia is suspected.

Keywords

macrosomia - estimated fetal weight - macrosomia formula - ultrasound - ultrasound estimate

Note

This research was presented in abstract form at the 34th Annual Meeting of the Society of Maternal-Fetal Medicine; February 2014; New Orleans, LA.


 

  • References

  • 1 Boyd ME, Usher RH, McLean FH. Fetal macrosomia: prediction, risks, proposed management. Obstet Gynecol 1983; 61 (6) 715-722
    PubMedGoogle Scholar
  • 2 American College of Obstetricians and Gynecologists. ACOG Practice Bulletin: Number 22, November 2000: Macrosomia. Obstet Gynecol 2000; 96 (5)
    PubMedGoogle Scholar
  • 3 Gyurkovits Z, Kálló K, Bakki J , et al. Neonatal outcome of macrosomic infants: an analysis of a two-year period. Eur J Obstet Gynecol Reprod Biol 2011; 159 (2) 289-292
    CrossrefPubMedGoogle Scholar
  • 4 Spellacy WN, Miller S, Winegar A, Peterson PQ. Macrosomia—maternal characteristics and infant complications. Obstet Gynecol 1985; 66 (2) 158-161
    PubMedGoogle Scholar
  • 5 Ezegwui HU, Ikeako LC, Egbuji C. Fetal macrosomia: obstetric outcome of 311 cases in UNTH, Enugu, Nigeria. Niger J Clin Pract 2011; 14 (3) 322-326
    CrossrefPubMedGoogle Scholar
  • 6 Handa VL, Danielsen BH, Gilbert WM. Obstetric anal sphincter lacerations. Obstet Gynecol 2001; 98 (2) 225-230
    CrossrefPubMedGoogle Scholar
  • 7 Henriksen T. The macrosomic fetus: a challenge in current obstetrics. Acta Obstet Gynecol Scand 2008; 87 (2) 134-145
    CrossrefPubMedGoogle Scholar
  • 8 Caughey AB. Obstetric ultrasound for estimated fetal weight: is the information more harm than benefit?. Am J Obstet Gynecol 2012; 207 (4) 239-240
    CrossrefPubMedGoogle Scholar
  • 9 Rouse DJ, Owen J, Goldenberg RL, Cliver SP. The effectiveness and costs of elective cesarean delivery for fetal macrosomia diagnosed by ultrasound. JAMA 1996; 276 (18) 1480-1486
    CrossrefPubMedGoogle Scholar
  • 10 Chauhan SP, Gherman R, Hendrix NW, Bingham JM, Hayes E. Shoulder dystocia: comparison of the ACOG practice bulletin with another national guideline. Am J Perinatol 2010; 27 (2) 129-136
    Article in Thieme ConnectPubMedGoogle Scholar
  • 11 Zhang X, Decker A, Platt RW, Kramer MS. How big is too big? The perinatal consequences of fetal macrosomia. Am J Obstet Gynecol 2008; 198 (5) 517.e1-517.e6
    CrossrefPubMedGoogle Scholar
  • 12 Okonofua FE, Ayangade SO, Chan RC, O'Brien PM. A prospective comparison of clinical and ultrasonic methods of predicting normal and abnormal fetal growth. Int J Gynaecol Obstet 1986; 24 (6) 447-451
    CrossrefPubMedGoogle Scholar
  • 13 Kayem G, Grangé G, Bréart G, Goffinet F. Comparison of fundal height measurement and sonographically measured fetal abdominal circumference in the prediction of high and low birth weight at term. Ultrasound Obstet Gynecol 2009; 34 (5) 566-571
    CrossrefPubMedGoogle Scholar
  • 14 Farrell T, Holmes R, Stone P. The effect of body mass index on three methods of fetal weight estimation. BJOG 2002; 109 (6) 651-657
    CrossrefPubMedGoogle Scholar
  • 15 Hoopmann M, Abele H, Wagner N, Wallwiener D, Kagan KO. Performance of 36 different weight estimation formulae in fetuses with macrosomia. Fetal Diagn Ther 2010; 27 (4) 204-213
    CrossrefPubMedGoogle Scholar
  • 16 Hadlock FP, Harrist RB, Sharman RS, Deter RL, Park SK. Estimation of fetal weight with the use of head, body, and femur measurements—a prospective study. Am J Obstet Gynecol 1985; 151 (3) 333-337
    CrossrefPubMedGoogle Scholar
  • 17 Kurmanavicius J, Burkhardt T, Wisser J, Huch R. Ultrasonographic fetal weight estimation: accuracy of formulas and accuracy of examiners by birth weight from 500 to 5000 g. J Perinat Med 2004; 32 (2) 155-161
    CrossrefPubMedGoogle Scholar
  • 18 Campbell S, Wilkin D. Ultrasonic measurement of fetal abdomen circumference in the estimation of fetal weight. Br J Obstet Gynaecol 1975; 82 (9) 689-697
    CrossrefPubMedGoogle Scholar
  • 19 Shepard MJ, Richards VA, Berkowitz RL, Warsof SL, Hobbins JC. An evaluation of two equations for predicting fetal weight by ultrasound. Am J Obstet Gynecol 1982; 142 (1) 47-54
    CrossrefPubMedGoogle Scholar
  • 20 Merz E, Lieser H, Schicketanz KH, Härle J. [Intrauterine fetal weight assessment using ultrasound. A comparison of several weight assessment methods and development of a new formula for the determination of fetal weight]. Ultraschall Med 1988; 9 (1) 15-24
    Article in Thieme ConnectPubMedGoogle Scholar
  • 21 Melamed N, Yogev Y, Meizner I, Mashiach R, Pardo J, Ben-Haroush A. Prediction of fetal macrosomia: effect of sonographic fetal weight-estimation model and threshold used. Ultrasound Obstet Gynecol 2011; 38 (1) 74-81
    CrossrefPubMedGoogle Scholar
  • 22 Combs CA, Rosenn B, Miodovnik M, Siddiqi TA. Sonographic EFW and macrosomia: is there an optimum formula to predict diabetic fetal macrosomia?. J Matern Fetal Med 2000; 9 (1) 55-61
    CrossrefPubMedGoogle Scholar
  • 23 Poon LC, Karagiannis G, Stratieva V, Syngelaki A, Nicolaides KH. First-trimester prediction of macrosomia. Fetal Diagn Ther 2011; 29 (2) 139-147
    CrossrefPubMedGoogle Scholar
  • 24 Boisvert MR, Koski KG, Burns DH, Skinner CD. Early prediction of macrosomia based on an analysis of second trimester amniotic fluid by capillary electrophoresis. Biomarkers Med 2012; 6 (5) 655-662
    CrossrefPubMedGoogle Scholar
  • 25 Kuc S, Wortelboer EJ, Koster MP, de Valk HW, Schielen PC, Visser GH. Prediction of macrosomia at birth in type-1 and 2 diabetic pregnancies with biomarkers of early placentation. BJOG 2011; 118 (6) 748-754
    CrossrefPubMedGoogle Scholar
  • 26 Papageorghiou AT, Sarris I, Ioannou C , et al; International Fetal and Newborn Growth Consortium for the 21st Century. Ultrasound methodology used to construct the fetal growth standards in the INTERGROWTH-21st Project. BJOG 2013; 120 (Suppl. 02) 27-32 , v
    CrossrefPubMedGoogle Scholar