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Geburtshilfe Frauenheilkd 2017; 77(03): 276-283
DOI: 10.1055/s-0043-102406
GebFra Science
Original Article
Georg Thieme Verlag KG Stuttgart · New York

Ultrasound versus Clinical Examination to Estimate Fetal Weight at Term

Vergleich von Ultraschall und klinischer Untersuchung zur fetalen Gewichtsschätzung am Geburtstermin
Jan-Simon Lanowski
Hanover Medical School, Department of Gynecology and Obstetrics, Hanover, Germany
,
Gabriele Lanowski
Hanover Medical School, Department of Gynecology and Obstetrics, Hanover, Germany
,
Cordula Schippert
Hanover Medical School, Department of Gynecology and Obstetrics, Hanover, Germany
,
Kristina Drinkut
Hanover Medical School, Department of Gynecology and Obstetrics, Hanover, Germany
,
Peter Hillemanns
Hanover Medical School, Department of Gynecology and Obstetrics, Hanover, Germany
,
Ismini Staboulidou
Hanover Medical School, Department of Gynecology and Obstetrics, Hanover, Germany
› Author Affiliations
Further Information

Publication History

received 29 October 2016
revised 22 January 2017

accepted 25 January 2017

Publication Date:
06 April 2017 (online)

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Abstract

Introduction At term, fetal weight estimation is an important factor for decisions about the delivery mode and the timing of labor induction. This study aimed to compare the accuracy of abdominal palpation with that of ultrasound performed by different examiners to estimate fetal weight. The study investigated whether differences in the examinersʼ training affected fetal weight estimates. The accuracy of the weight estimates made for fetuses with extreme birth weights was also evaluated. Finally, the accuracy of Johnsonʼs method and of Insler and Bernsteinʼs formula for estimating fetal weight were compared with the other two methods.

Methods This prospective study included singleton pregnancies between 37 weeks of gestation and 12 days post-term planned for vaginal delivery or cesarean section. Ultrasound and abdominal palpation using Leopoldʼs maneuvers were performed by examiners with different levels of professional experience. Fetal weight was additionally estimated using Insler and Bernsteinʼs formula and Johnsonʼs method. Statistical analysis calculated the accuracy of fetal weight estimates for the different examiners and the four methods.

Results A total of 204 women were included in the analysis. Trained ultrasound examiners were most accurate when estimating fetal weight compared with all other examiners. The comparison of all four methods showed that fetal weight was assessed most accurately with ultrasound. No learning curve could be established. BMI and advanced gestational age affected the accuracy of the estimated weight. The analysis showed that a greater deviation between estimated weight and actual weight occurred with all four methods for fetuses at either end of the extremes of fetal weight, i.e., with very low or very high birth weights.

Conclusion Fetal weight should be estimated using ultrasound. A good ultrasound training is essential.

Zusammenfassung

Einleitung Am Geburtstermin liefert die fetale Gewichtsschätzung wichtige Daten für die Entscheidungsfindung in Bezug auf den Entbindungsmodus und den Zeitpunkt der Geburtseinleitung. Ziel dieser Studie war es, die Genauigkeit zweier Methoden – der abdominellen Palpation und des Ultraschalls – bei der Schätzung des fetalen Gewichts zu vergleichen. Die Untersuchungen wurden jeweils von verschiedenen medizinischen Untersuchern durchgeführt. Es wurde untersucht, ob die unterschiedlichen Ausbildungsniveaus der Untersucher sich auf die Genauigkeit der fetalen Gewichtsschätzung auswirkten. Die Genauigkeit der Gewichtsschätzung bei Feten mit extrem hohem oder niedrigem Geburtsgewicht wurde ebenfalls ausgewertet. Schließlich wurde die Genauigkeit von Johnsons Methode und von Inslers und Bernsteins Formel zur Schätzung des fetalen Gewichts mit den anderen beiden Methoden verglichen.

Methoden Alle Einlingsschwangerschaften zwischen der 37. Schwangerschaftswoche und dem 12. Tag nach dem errechneten Geburtstermin, bei denen entweder eine vaginale Entbindung oder eine Sectio caesarea geplant waren, wurden in diese prospektive Studie aufgenommen. Die Ultraschalluntersuchung und die mithilfe von Leopold-Handgriffen durchgeführte abdominelle Palpation wurden von Untersuchern mit unterschiedlicher Berufserfahrung durchgeführt. Das fetale Gewicht wurde auch mithilfe der Formel von Insler und Bernstein sowie mit Johnsons Methode geschätzt. Die Genauigkeit der fetalen Gewichtsschätzung zwischen den verschiedenen Untersuchern sowie zwischen den 4 Methoden wurde statistisch verglichen.

Ergebnisse Insgesamt wurden 204 Frauen in die Studie eingeschlossen. Der Vergleich zeigte, dass von allen Untersuchern die Ultraschalluntersucher das fetale Gewicht am besten abschätzen konnten. Beim Vergleich der Schätzmethode stellte sich heraus, dass Ultraschall wiederum die genauesten Schätzungen lieferte. Die statistische Analyse konnte keine Lernkurve ermitteln. BMI und fortgeschrittenes Schwangerschaftsalter wirkten sich auf die Genauigkeit der Gewichtsschätzung aus. Bei allen 4 Methoden trat die größte Abweichung zwischen dem geschätzten und dem tatsächlichen Gewicht bei Feten mit entweder extrem hohem oder extrem niedrigem Gewicht auf.

Schlussfolgerung Das fetale Gewicht sollte mit Ultraschall geschätzt werden. Eine gute Ultraschallausbildung ist unerlässlich.

Key words

fetal weight estimation - ultrasound - clinical examination

Schlüsselwörter

fetale Gewichtsschätzung - Ultraschall - klinische Untersuchung
 

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