Abstract:
BACKGROUND:Although foetal macrosomia is a known risk factor for shoulder dystocia, foetal weight estimation by ultrasound is imprecise. METHODS:We analysed in a retrospective, single-centre study whether the combination of foetal sonographic parameters and maternal parameters could improve the prediction of foetal macrosomia and whether on the basis of this findings the prediction of shoulder dystocia in foetal macrosomia could be enhanced. Likelihood ratios for sonographic parameters have been assessed and have been used to calculate post-test-probabilities for fetal macrosomia. All vaginal singleton deliveries with cephalic presentation >or=37+0 week of gestation in the period 1994-2005 (n=8 576) have been analysed. Shoulder dystocia has been observed in 136 cases (1.6%). RESULTS:In multivariate analysis the strongest predictor for shoulder dystocia was foetal macrosomia (>or= 4000 g), odds ratio=4.04 (95% confidence interval 2.71-6.05), next to diabetes 2.43 (1.14-5.17), obesity (BMI >or=30 kg/m (2)) 1.55 (1.02-2.46), and foetal head circumference (>35 cm) 1.51 (1.02-2.24). Foetal sonographic parameters showed likelihood ratios up to 6.93. The accuracy of shoulder dystocia predictions in cases of birth weight >or=4,500 g improved only slightly from 0.2-3.3%. DISCUSSION:The accuracy of the estimation of foetal macrosomia has been improved by combining ultrasonography with prepartal maternal risk factors.
journal_name
Z Geburtshilfe Neonatoljournal_title
Zeitschrift fur Geburtshilfe und Neonatologieauthors
Stein W,Delfy A,Schmidt Sdoi
10.1055/s-0029-1225643subject
Has Abstractpub_date
2009-10-01 00:00:00pages
180-5issue
5eissn
0948-2393issn
1439-1651journal_volume
213pub_type
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