The Impact on Birth Outcomes of Sonographic Fetal Weight Estimation in Neonatal Macrosomia

Abstract

Objective Our objective was to examine the association between sonographic estimated fetal weight (EFW) and obstetrical and neonatal outcomes in women with neonatal macrosomia.

Study Design This study, conducted at a tertiary university-affiliated hospital from 2017 to 2021, compared obstetrical and neonatal outcomes between two groups of women who delivered macrosomic newborns (actual birth weight ≥ 4,000 g): (1) those with EFW ≥ 3,800 g (suspected impending macrosomia) and (2) those with EFW < 3,800 g (unsuspected impending macrosomia).

Results During the study period, 854 women with neonatal macrosomia attempted vaginal delivery. Only 9.2% had a sonographic EFW ≥ 4,000 g. Among women with EFW ≥3,800 g (n = 317) compared with EFW < 3,800 g (n = 537), the cesarean delivery (CD) rate was higher (17.0 vs. 10.5%, p = 0.004) and the operative delivery rate was lower (3.2 vs. 0.6%, p = 0.015). Among primiparous women, the CD rate was higher among those with EFW ≥ 3,800 versus <3,800 g (37.3 vs. 23.2%, p = 0.033). EFW ≥3,800 g was associated with CD, regardless of predelivery body mass index, parity, diabetes mellitus, maximal fetal weight at previous deliveries, actual birth weight, and labor induction (p = 0.014). EFW ≥3,800 g and diabetes mellitus were independent predictors of CD. Among women with EFW ≥3,800 g and diabetes mellitus, the risk of CD was double that of those without diabetes and with EFW ≥ 3,800 g (31.4% vs. 15.2%, p = 0.02), although their actual birth weights were similar. Obstetrical and neonatal outcomes were similar between those with sonographic EFW ≥3,800 and < 3,800 g.

Conclusion Larger EFW increased CD risk among pregnancies with actual neonatal macrosomia. Antenatally suspected macrosomia might alter labor management due to concerns for potential complications, especially when associated with primiparity, diabetes mellitus, or maternal obesity. The increase in the CD rate did not show an association with improved maternal and neonatal outcomes.

Key Points

• Antenatally suspected macrosomia might alter labor management due to concerns about complications.

• Larger EFW increased cesarean delivery risk among pregnancies with actual neonatal macrosomia.

• The increase in the cesarean delivery rate was not associated with improved outcomes.

Keywords

sonographic estimated fetal weight - macrosomic newborns - cesarean delivery - primiparity - diabetes mellitus - maternal obesity

Authors' Contributions

The project development was led by I.S. and M.F.W., while K.N. contributed to the project development. I.M. was responsible for data collection, while R.A.S. conducted the data analysis. Additionally, A.B. also contributed to data collection. L.L. provided critical review of the manuscript.

Ethical Approval

Research involving human participants and/or animals—our study was performed in compliance with the Declaration of Helsinki. The protocol of the study was approved by the local Institutional Review Board (Helsinki Committee) of the Galilee Medical Center, Nahariya, Israel (date of approval 6 July 2020, number of approval 0113-20-NHR). Informed consent—the need for written informed consent was waived because of the retrospective nature of the study.

Publication History

Received: 26 November 2023

Accepted: 05 April 2024

Article published online:
02 May 2024

• References

• 1 Martin JA, Hamilton BE, Osterman MJK, Driscoll AK, Drake P. Births: final data for 2017. Natl Vital Stat Rep 2018; 67 (08) 1-50
• 2 Macrosomia: ACOG Practice Bulletin, Number 216. Obstet Gynecol 2020; 135 (01) e18-e35
• 3 Jenner ZB, O'Neil Dudley AE, Mendez-Figueroa H, Ellis VS, Chen HY, Chauhan SP. Morbidity associated with fetal macrosomia among women with diabetes mellitus. Am J Perinatol 2018; 35 (05) 515-520
• 4 Beta J, Khan N, Khalil A, Fiolna M, Ramadan G, Akolekar R. Maternal and neonatal complications of fetal macrosomia: systematic review and meta-analysis. Ultrasound Obstet Gynecol 2019; 54 (03) 308-318
• 5 Larad R, Ishaque U, Korb D. et al. Evaluation of obstetric management of women with macrosomic foetuses in two Level 3 maternity hospitals in France and identification of predictive factors for obstetric and neonatal complications. Eur J Obstet Gynecol Reprod Biol 2022; 274: 34-39
• 6 Dittkrist L, Vetterlein J, Henrich W. et al. Percent error of ultrasound examination to estimate fetal weight at term in different categories of birth weight with focus on maternal diabetes and obesity. BMC Pregnancy Childbirth 2022; 22 (01) 241
• 7 Krispin E, Dreyfuss E, Fischer O, Wiznitzer A, Hadar E, Bardin R. Significant deviations in sonographic fetal weight estimation: causes and implications. Arch Gynecol Obstet 2020; 302 (06) 1339-1344
• 8 Dimassi K, El Cadhi Y, Sahnoune R. et al. Performance de l'estimation échographique du poids fœtal réalisée par les internes de spécialité le jour de l'accouchement. [Accuracy of ultrasound estimated fetal weight performed by residents at delivery day] J Gynecol Obstet Biol Reprod (Paris) 2015; 44 (07) 632-638
• 9 Dollberg S, Haklai Z, Mimouni FB, Gorfein I, Gordon ES. Birth weight standards in the live-born population in Israel. Isr Med Assoc J 2005; 7 (05) 311-314
• 10 Peleg D, Warsof S, Wolf MF, Perlitz Y, Shachar IB. Counseling for fetal macrosomia: an estimated fetal weight of 4,000 g is excessively low. Am J Perinatol 2015; 32 (01) 71-74
• 11 Vitner D, Bleicher I, Kadour-Peero E, Lipworth H, Sagi S, Gonen R. Does prenatal identification of fetal macrosomia change management and outcome?. Arch Gynecol Obstet 2019; 299 (03) 635-644
• 12 Stubert J, Peschel A, Bolz M, Glass Ä, Gerber B. Accuracy of immediate antepartum ultrasound estimated fetal weight and its impact on mode of delivery and outcome - a cohort analysis. BMC Pregnancy Childbirth 2018; 18 (01) 118
• 13 Melamed N, Yogev Y, Meizner I, Mashiach R, Ben-Haroush A. Sonographic prediction of fetal macrosomia: the consequences of false diagnosis. J Ultrasound Med 2010; 29 (02) 225-230
• 14 Little SE, Edlow AG, Thomas AM, Smith NA. Estimated fetal weight by ultrasound: a modifiable risk factor for cesarean delivery?. Am J Obstet Gynecol 2012; 207 (04) 309.e1-309.e6
• 15 Smith GC, Moraitis AA, Wastlund D. et al. Universal late pregnancy ultrasound screening to predict adverse outcomes in nulliparous women: a systematic review and cost-effectiveness analysis. Health Technol Assess 2021; 25 (15) 1-190
• 16 Bushman ET, Thompson N, Gray M. et al. Influence of estimated fetal weight on labor management. Am J Perinatol 2020; 37 (03) 252-257
• 17 Dude AM, Davis B, Delaney K, Yee LM. Sonographic estimated fetal weight and cesarean delivery among nulliparous women with obesity. AJP Rep 2019; 9 (02) e127-e132
• 18 Vendittelli F, Rivière O, Bréart G. physicians of the AUDIPOG Sentinel Network. Is prenatal identification of fetal macrosomia useful?. Eur J Obstet Gynecol Reprod Biol 2012; 161 (02) 170-176
• 19 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
• 20 Walsh JM, McAuliffe FM. Prediction and prevention of the macrosomic fetus. Eur J Obstet Gynecol Reprod Biol 2012; 162 (02) 125-130
• 21 Lanowski JS, Lanowski G, Schippert C, Drinkut K, Hillemanns P, Staboulidou I. Ultrasound versus clinical examination to estimate fetal weight at term. Geburtshilfe Frauenheilkd 2017; 77 (03) 276-283
• 22 Preyer O, Husslein H, Concin N. et al. Fetal weight estimation at term - ultrasound versus clinical examination with Leopold's manoeuvres: a prospective blinded observational study. BMC Pregnancy Childbirth 2019; 19 (01) 122