Antepartum detection of macrosomic fetus: The effect of misdiagnosis
Keywords:
Diagnosis, sonography, macrosomia, shoulder dystociaAbstract
aim: To determine the effect of misdiagnosis of macrosomia on maternal and perinatal outcomes.methods : We conducted a retrospective study ,between January 2007 and December 2008 of women (n = 464) who delivered singleton neonates with actual birth weight over 4000g and in whom fetal weight was estimated, by both methods :sonographic and clinical, up to 3 days before delivery.Statistical comparisons were made between patients in whom fetal macrosomia was predicted : «prediction » group (n=336)and those in whom it was not « non prediction »group (n=128) for outcome variables.
results : The cesarean delivery was performed in 35.9% in « non predicted » group, and in 35.7% in the « predicted » group.The difference was not statistically significant. Failure to detect macrosomia was associated with higher rates of maternal and fetal complications in the group « non predicted » compared with the group « predicted » :perineal trauma,post partum hemorrhage, 5- minute Apgar scores less than 7, and shoulder dystocia, mostly related to the higher rate of surgical vaginal deliveries.
Conclusions : The misdiagnosis of fetal macrosomia substantially did not modify the cesarean section rate but leads to increase the maternal and neonatal complications.
Downloads
References
Walsh JM, Kandamany N, Ni Shuibhne N, Power H, Murphy JF, O'Herlihy C. Neonatal brachial plexus injury: comparison of incidence and antecedents between 2 decades. Am J Obstet Gynecol 2011;204:324.e1-.e6.
Baskett TF, Allen AC. Perinatal implications of shoulder dystocia. Obstet Gynecol 1995;86:14-7.
Boulet SL, Alexander GR, Salihu HM, Pass M. Macrosomic births in the United States: determinants, outcomes, and proposed grades of risk. Am J Obstet Gynecol 2003;188:1372-8.
Hadlock FP, Harrist RB, Fearneyhough TC, Deter RL, Park SK, Rossavik IK. Use of femur length/abdominal circumference ratio in detecting the macrosomic fetus. Radiology 1985;154:503-5.
Deter RL, Hadlock FP. Use of ultrasound in the detection of macrosomia: a review. J Clin Ultrasound 1985; 13:519-24.
Sandmire HF. Whither ultrasonic prediction of fetal macrosomia? Obstet Gynecol 1993; 82:860-62.
Chauhan SP, West DJ, Scardo JA, Boyd JM, Joiner J, Hendrix NW. Antepartum detection of macrosomic fetus: clinical versus sonographic, including soft-tissue measurements. Obstet Gynecol 2000; 95:639-42.
Coomarasamy A, Connock M, Thornton J, Khan KS. Accuracy of ultrasound biometry in the prediction of macrosomia: a systematic quantitative review. BJOG 2005; 112:1461-66.
O'Reilly-Green C, Divon M. Sonographic and clinical methods in the diagnosis of macrosomia. Clin Obstet Gynecol 2000; 43:309-20.
Chauhan SP, Cowan BD, Magann EF, Bradford TH, Roberts WE, Morrison JC. Intrapartum detection of a macrosomic fetus: clinical versus 8 sonographic models. Aust NZ J Obstet Gynaecol 1995; 35:266-70.
Johnstone FD, Prescott RJ, Steel JM, Mao JH, Chambers S, Muir N. Clinical and ultrasound prediction of macrosomia in diabetic pregnancy. Br J Obstet Gynaecol 1996; 103:747- 54.
Chauhan SP, Hendrix NW, Magann EF, Morrison JC, Kenney SP, Devoe LD. Limitations of clinical and sonographic estimates of birth weight: experience with 1034 parturients. Obstet Gynecol 1998; 91:72-77.
Chauhan SP, Hendrix NW, Magann EF, Morrison JC, Jenney SP, Devoe LD. Limitations of clinical and sonographic estimates of birth weight: experience with 1034 parturients. Obstet Gynecol 1998;91:72-7.
Levine AB, Lockwood CJ, Brown B, Lapinski R, Berkowitz RL. Sonographic diagnosis of the large for gestational age fetus at term: does it make a difference? Obstet Gynecol 1992; 79:55-58.
Parry S, Severs CP, Sehdev HM, Macones GA, White LM, Morgan MA. Ultrasonographic prediction of fetal macrosomia: association with cesarean delivery. J Reprod Med 2000; 45:17-22.
Nir Melamed, Yariv Yogev, Israel Meizner, Reuven Mashiach, Avi Ben- Haroush. Sonographic Prediction of Fetal Macrosomia The Consequences of False Diagnosis J Ultrasound Med 2010; 29:225-30.
American College of Obstetricians and Gynecologists. Fetal macrosomia. Washington: American College of Obstetricians and Gynecologists; Technical bulletin no 159.ACOG 1991
