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The test accuracy of antenatal ultrasound definitions of fetal macrosomia to predict birth injury: A systematic review.

The test accuracy of antenatal ultrasound definitions of fetal macrosomia to predict birth injury: A systematic review. Thumbnail


Abstract

OBJECTIVES: To determine which ultrasound measurement for predicted fetal macrosomia most accurately predicts adverse delivery and neonatal outcomes. STUDY DESIGN: Four biomedical databases searched for studies published after 1966. Randomised trials or observational studies of women with singleton pregnancies, resulting in a term birth who have undergone an index test of interest measured and recorded as predicted fetal macrosomia =28 weeks. Adverse outcomes of interest included shoulder dystocia, brachial plexus injury (BPI) and Caesarean section. RESULTS: Twenty-five observational studies (13,285 participants) were included. For BPI, the only significant positive association was found for Abdominal Circumference (AC) to Head Circumference (HC) difference > 50?mm (OR 7.2, 95 % CI 1.8-29). Shoulder dystocia was significantly associated with abdominal diameter (AD) minus biparietal diameter (BPD) = 2.6?cm (OR 4.2, 95 % CI 2.3-7.5, PPV 11 %) and AC > 90th centile (OR 2.3, 95 % CI 1.3-4.0, PPV 8.6 %) and an estimated fetal weight (EFW) > 4000?g (OR 2.1 95 %CI 1.0-4.1, PPV 7.2 %). CONCLUSIONS: Estimated fetal weight is the most widely used ultrasound marker to predict fetal macrosomia in the UK. This study suggests other markers have a higher positive predictive value for adverse outcomes associated with fetal macrosomia.

Acceptance Date Jan 15, 2020
Publication Date Jan 16, 2020
Publicly Available Date Mar 28, 2024
Journal European Journal of Obstetrics & Gynecology and Reproductive Biology
Print ISSN 0301-2115
Publisher Elsevier
Pages 79 - 85
DOI https://doi.org/10.1016/j.ejogrb.2020.01.019
Keywords Fetal macrosomia; Shoulder dystocia; Ultrasound markers
Publisher URL https://doi.org/10.1016/j.ejogrb.2020.01.019

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