Document Detail

Clinical and ultrasonographic weight estimation in large for gestational age fetus.
MedLine Citation:
PMID:  12270559     Owner:  NLM     Status:  MEDLINE    
OBJECTIVE: To examine prospectively the effect on pregnancy outcome of a management protocol, that adds ultrasonographic weight estimation in fetuses suspected clinically as large. STUDY DESIGN: Prospective follow up study of all singleton deliveries during a 1 year period. All patients underwent routine clinical estimation of fetal weight. When clinical estimation of fetal weight was > or = 3700 g, patients were referred for ultrasonographic estimation of fetal weight. When the latter was > or = 4000 g the patient was informed about the risks of birth trauma. Cesarean section was recommended only when > or = 4500 g. Ultrasonography was repeated every 4 days when possible. Predictive values of clinical and ultrasonographic estimations of fetal weight for diagnosing macrosomia, defined for the purpose of this study as 4000 g or more, and their effect on the rate of cesarean sections. RESULTS: Five hundred fifty-five (14.4%) out of 3844 singletons were estimated as 3700 g or more. Only 315 fetuses had ultrasonographic estimation of weight within 3 days of delivery. The sensitivity of clinical and ultrasonographic prediction of macrosomia was 68 and 58%, respectively. Cesarean section rate in newborns weighing 4000 g or more was 22% when macrosomia was clinically suspected compared to 11% when it was not (P<0.05). In fetuses estimated ultrasonographically as 4000 g or larger the cesarean section rate was doubled (50.7% versus 24.9%, P<0.05) compared to those estimated as smaller than 4000 g, although actual weight of 4500 g or more was recorded in 10.6 and 8.5% of these groups, respectively. There were no cases of shoulder dystocia in macrosomic babies when macrosomia was not detected by ultrasound compared to two cases of shoulder dystocia (2.7%) when macrosomia was detected by ultrasound. CONCLUSION: Antenatal suspicion of macrosomia increased the cesarean section rate while the associated improvement in pregnancy outcome remains questionable. The contribution of ultrasound, added to routine clinical estimation of fetal weight, was clinically insignificant apart from a further increase in cesarean section rate.
Zeev Weiner; Izhar Ben-Shlomo; Ronit Beck-Fruchter; Yael Goldberg; Eliezer Shalev
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Publication Detail:
Type:  Journal Article    
Journal Detail:
Title:  European journal of obstetrics, gynecology, and reproductive biology     Volume:  105     ISSN:  0301-2115     ISO Abbreviation:  Eur. J. Obstet. Gynecol. Reprod. Biol.     Publication Date:  2002 Oct 
Date Detail:
Created Date:  2002-09-24     Completed Date:  2003-04-15     Revised Date:  2004-11-17    
Medline Journal Info:
Nlm Unique ID:  0375672     Medline TA:  Eur J Obstet Gynecol Reprod Biol     Country:  Ireland    
Other Details:
Languages:  eng     Pagination:  20-4     Citation Subset:  IM    
Department of Obstetrics and Gynecology, Afula and the Rappaport Faculty of Medicine, Ha'Emek Medical Center, Technion-Israel Institute of Technology, Haifa, Israel.
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MeSH Terms
Cesarean Section
Delivery, Obstetric
Dystocia / epidemiology
Fetal Macrosomia / diagnosis*,  ultrasonography
Fetal Weight*
Gestational Age
Pregnancy Outcome
Prospective Studies
Sensitivity and Specificity
Ultrasonography, Prenatal*

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