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

Robinson, Rebecca; Walker, Kate F.; White, Victoria A.; Bugg, George J.; Snell, Kym I.E.; Jones, Nia W.

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.

Citation

Robinson, R., Walker, K. F., White, V. A., Bugg, G. J., Snell, K. I., & Jones, N. W. (2020). The test accuracy of antenatal ultrasound definitions of fetal macrosomia to predict birth injury: a systematic review. European Journal of Obstetrics and Gynecology and Reproductive Biology, 246, P79-85. https://doi.org/10.1016/j.ejogrb.2020.01.019

• Journal Article Type: Article
• Acceptance Date: Jan 15, 2020
• Online Publication Date: Jan 16, 2020
• Publication Date: Mar 1, 2020
• Deposit Date: Apr 6, 2020
• Publicly Available Date: Jan 17, 2021
• Journal: European Journal of Obstetrics & Gynecology and Reproductive Biology
• Print ISSN: 0301-2115
• Publisher: Elsevier
• Peer Reviewed: Peer Reviewed
• Volume: 246
• Pages: P79-85
• DOI: https://doi.org/10.1016/j.ejogrb.2020.01.019
• Keywords: Obstetrics and Gynaecology; Reproductive Medicine
• Public URL: https://nottingham-repository.worktribe.com/output/3753205
• Publisher URL: https://www.ejog.org/article/S0301-2115(20)30027-0/pdf#secsect0005