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BMC Pregnancy and Childbirth

, 19:122 | Cite as

Fetal weight estimation at term – ultrasound versus clinical examination with Leopold’s manoeuvres: a prospective blinded observational study

  • Oliver PreyerEmail author
  • Heinrich Husslein
  • Nicole Concin
  • Anna Ridder
  • Maciej Musielak
  • Christian Pfeifer
  • Willi Oberaigner
  • Peter Husslein
Open Access
Research article
Part of the following topical collections:
  1. Labor, delivery, and postpartum health

Abstract

Background

Fetal weight estimation is of key importance in the decision-making process for obstetric planning and management. The literature is inconsistent on the accuracy of measurements with either ultrasound or clinical examination, known as Leopold’s manoeuvres, shortly before term. Maternal BMI is a confounding factor because it is associated with both the fetal weight and the accuracy of fetal weight estimation. The aim of our study was to compare the accuracy of fetal weight estimation performed with ultrasound and with clinical examination with respect to BMI.

Methods

In this prospective blinded observational study we investigated the accuracy of clinical examination as compared to ultrasound measurement in fetal weight estimation, taking the actual birth weight as the gold standard.

In a cohort of all consecutive patients who presented in our department from January 2016 to May 2017 to register for delivery at ≥37 weeks, examination was done by ultrasound and Leopold’s manoeuvres to estimate fetal weight. All examiners (midwives and physicians) had about the same level of professional experience.

The primary aim was to compare overall absolute error, overall absolute percent error, absolute percent error > 10% and absolute percent error > 20% for weight estimation by ultrasound and by means of Leopold’s manoeuvres versus the actual birth weight as the given gold standard, namely separately for normal weight and for overweight pregnant women.

Results

Five hundred forty-three patients were included in the data analysis. The accuracy of fetal weight estimation was significantly better with ultrasound than with Leopold’s manoeuvres in all absolute error calculations made in overweight pregnant women. For all error calculations performed in normal weight pregnant women, no statistically significant difference was seen in the accuracy of fetal weight estimation between ultrasound and Leopold’s manoeuvres.

Conclusions

Data from our prospective blinded observational study show a significantly better accuracy of ultrasound for fetal weight estimation in overweight pregnant women only as compared to Leopold’s manoeuvres with a significant difference in absolute error. We did not observe significantly better accuracy of ultrasound as compared to Leopold’s manoeuvres in normal weight women. Further research is needed to analyse the situation in normal weight women.

Keywords

Prospective blinded observational study Ultrasound Estimated fetal weight Body mass index Clinical examination Fetal weight estimation Leopold’s manoeuvres Normal weight Overweight 

Abbreviations

AC

Abdominal circumference

AC

Abdominal circumference

BMI

Body mass index

BPD

Biparietal diameter

BW

Birth weight

CI

Confidence intervals

CTG

Cardiotocography

EFW

Estimated fetal weight

FL

Femur length

g

grams

HC

Head circumference

IRB

Institutional review board

SD

Standard deviation

TK

Tauernkliniken

Background

Accuracy of fetal weight estimation is of key importance in antenatal care, as well as in the planning and management of labour and mode of delivery [1, 2, 3, 4, 5, 6, 7, 8, 9].

In order to achieve more accurate prenatal fetal weight estimations and align these with a risk-optimizing mode of delivery, additional tools supporting the standard of use with ultrasound are needed.

The main ultrasonic methods used to calculate the weight of a fetus are based on measurement of fetal abdominal circumference (AC) and estimated fetal weight (EFW) using a formula first described by Hadlock et al. [10, 11], and the sufficient accuracy of this model has recently been proven [12].

Antenatal magnetic resonance imaging (MRI) [13] or soft-tissue measurements [14] have been shown to be of no benefit in improving the accuracy of fetal weight estimation.

Leopold’s manoeuvres have a long-standing tradition in obstetrics and midwifery and were first described by the German gynaecologist Christian Gerhard Leopold (1846–1911) in the journal “Archiv für Gynäkologie” in the 19th century [15]. By placing both hands on the woman’s abdomen the examiner can describe the position of the fetus as well as the level of the uterine fundus and thus detect a disproportion between fetus and the female pelvis. Experienced examiners are able to give a clinical estimation of fetal weight after performing Leopold’s manoeuvres including symphysis-fundal height and abdominal palpation [1].

Maternal body mass index (BMI) has been shown to affect the accuracy of EFW [16]. Clinicians should be aware of the limitation of sonographic fetal weight estimation, especially in obese patients, as maternal body mass index influences sonographic fetal weight estimation prior to scheduled delivery and the measurement deviation is greater in pregnant women with a BMI ≥ 25 [17, 18, 19].

We examined whether clinical assessment is an alternative when ultrasound is not available or can serve as a useful supplemental examination using the actual birth weight as the gold standard. The aim of our prospective blinded observational study was to evaluate the accuracy of fetal weight estimation performed with ultrasound and clinical examination, namely separately for normal weight and for overweight pregnant women.

Methods

Study population

In this prospective blinded observational study we investigated the accuracy of clinical Leopold’s manoeuvres as compared to ultrasound measurements in fetal weight estimation, with the actual birth weight as the gold standard.

This is a prospective blinded analysis of a cohort of all consecutive women giving birth, including vertex and breech, singleton gestations who presented for labour ≥37 weeks from January 2016 to May 2017 at our department.

To avoid selection bias and perform a real live evaluation, we examined all consecutive women registered for delivery and ultimately delivered at ≥37 weeks. No preterm deliveries prior to 37 weeks are done at our department, but are sent antenatally to a secondary referral centre. Therefore, there are no data on preterm deliveries in our data set.

Cases of both spontaneous labour and induction of labour were included as well as planned (primary) and unplanned (secondary) caesarean sections (see Table 1). No fetal abnormalities were detected in our group of pregnant women.
Table 1

Patient characteristics

 

n = 543

%

Maternal Age

29.2 ± 5.0

 

Primiparous

269

49.5

Multiparous

274

50.5

Mean gestational age at examination [Weeks ± SD in days]

37 + 3/7 (262 d) ± 6.8d

 

Mean gestational age at time of delivery [weeks ± SD in days]

39 + 2/7 (275 d) ± 8d

 

Mean actual birth weight [g]

3382.9 ± 400.2

 

Median time estimation to birth [in days ± SD]

15.6 ± 8

 

Mode of delivery

 Spontaneous vaginal delivery

342

63.0

 Operative vaginal delivery

45

8.3

 Caesarean section

156 (100%)

28.7

  Planned/Primary

57 (36.5%)

10.5

  Unplanned/Secondary (including failed induction of labour)

99 (63.5%)

18.2

Mean maternal BMI [kg/m2]

23.9 ± 4.8

 

 BMI < 25

379

69.8

 BMI 25–99

164

30.2

Spontaneous onset of labour

429

79.0

Induced onset of labour

114

21.0

Gestational diabetes

29

5.3

Pre-existing diabetes

2

0.4

Chronic or gestational hypertension

9

1.7

Preeclampsia

13

2.4

The results were documented systematically during and analysed after the study period. All data were analysed in anonymized form. We did not change the pre-existing routine examination.

Clinical setting and fetal weight estimation by ultrasound and Leopold’s manoeuvres

At our institution the standard of care consists of registering pregnant women for delivery around the 37th week of their pregnancy.

The clinical setting at registration for delivery is as follows: 1.) Patient’s history taken by examining midwife; 2.) Cardiotocography (CTG) for 30 min in pregnant women at risk; 3) basic obstetric vaginal and abdominal examination with Leopold’s manoeuvres by midwife and documentation of EFW (blinded to the physician (sonographer)); 4) ultrasound biometric measurements (GE© E6, 3.5-MHz abdominal transducer) of the fetus by the physician (one of six consultants or one of two residents) including EFW (blinded to the examining midwife) registered in a nationwide electronic documentary system (PIA/Viewpoint© by LB-Systems©); 5) pre-delivery discussion with the physician regarding possible risks and mode of delivery.

Both the midwife and the physician (sonographer) were blinded to the documentation of the weight of prior babies, and pregnant women were asked not to disclose this information to avoid bias.

Every Friday, after the last delivery registration appointment of the week, the measurements were released for comparison. If discrepancies were noticed (> 500 g), these pregnant women were asked to return for re-counselling. Decisions were then based on the ultrasound measurements and their interpretation by a consultant.

Calculation by the ultrasound machine and the PIA/Viewpoint© system is based on Hadlock’s formula [10] including measurement of biparietal diameter (BPD), head circumference (HC), abdominal circumference (AC) and femur length (FL). The results are discussed in a shared decision-making process between the examiner and the mother/parents to plan the mode of delivery.

Fetal weight estimation by midwives using Leopold’s manoeuvres is provided as a point estimate rounded off to the nearest 100 g by the examining midwife.

All examiners, 13 midwives, six consultants and two residents had a level of professional experience of at least 3 years, as both residents were in their fourth and last year of residency. The range of experience among midwives was 5 years to up to 34 years (mean 16.6), among consultants and residents between four and 34 years (mean 11.8).

As previously mentioned, we did not change the pre-existing routine examination, and the midwives already performed Leopold’s manoeuvres as a non-invasive examination for fetal weight estimation before we started our study. The institutional review board (IRB) decision was obtained from the Tauernkliniken GmbH IRB before recruitment for the full trial began in December 2015 (Ref.nr. IRB TK 01_10/2015). All women gave verbal informed consent to participate, which was recorded in the patient’s records.

Maternal demographics as well as pregnancy and neonatal outcome information were extracted from electronic medical records (PIA/Viewpoint© by LB-Systems©).

In order to extrapolate EFW (Leopold and US) from the examination on the date of birth registration to the actual date of birth, we used the complementary percentile curve for the Austrian population (separately available for girls and boys) (Heim et al., unpublished data).

BMI was evaluated for its impact on clinical estimation of fetal weight. Maternal BMI was calculated from height (self-reported) and weight (measured) at the time of admission and was divided into sub-categories of < 25 kg/m2 and ≥ 25 kg/m2.

Gestational age at registration for delivery was evaluated in intervals of 37 to 39 6/7 weeks, 40 to 40 6/7 weeks, and ≥ 41 weeks.

The outcome was to compare overall absolute error, overall absolute percent error, absolute percent error > 10% and absolute percent error > 20% for weight estimation by ultrasound and by Leopold’s manoeuvres versus the actual birth weight as the given gold standard. The estimations and extrapolations were performed according to validated methods to the best of our knowledge. The median time between estimation and birth is shown in Table 1.

Statistical analysis

Baseline characteristics of the study cohort were reported using descriptive statistics.

We calculated the mean and standard deviation (SD) of maternal age (years), duration of pregnancy (weeks + 6/7 days), fetal weight at birth (grams), body mass index (BMI) (kg/m2), parity, mode of delivery (spontaneous, vaginal operative, Caesarean section), induction of labour and maternal risk factors (gestational diabetes, hypertension, preeclampsia) for univariate descriptive analysis (“patient characteristics”). Absolute errors (equal to the absolute value of the difference between the estimate and the observed weight at birth date) in the estimates were calculated, reporting the mean and SD for the Leopold and the US estimates. It seemed to be practice-relevant to report the proportion of cases with an absolute error ≥ 500 g [20]. Additionally, we report absolute percent errors (mean SD), absolute percent errors > 10% and absolute percent errors > 20%.

To test for differences in the absolute errors and the absolute percent errors between Leopold and ultrasound estimates we used the paired T test. For the proportion of absolute errors ≥500 g, absolute percent error > 10% and absolute percent error > 20% we used the McNemar test statistics for paired samples.

We conducted the above analysis separately for normal weight and for overweight pregnant women.

In order to investigate the effects of BMI on estimate errors, we performed a descriptive analysis as described above, namely separately for the two groups (using two sample tests instead of paired tests). We stratified the results for BMI for < 25 kg/m2 (normal weight) and ≥ 25 kg/m2 (overweight).

Normality test was applied first by visual inspection of the respective histograms and then formally by applying the Shapiro-Wilk Test.

All statistical analyses were performed using Stata/SE 13.1, Special Edition (College Station, TX, USA).

Results

Patient characteristics

A total of 547 pregnant women were eligible to be included, four pregnant women had to be excluded as they gave birth at a different department after registration at our department. Therefore, 543 pregnant women were included in the data analysis. Of the pregnant women in our cohort 5.3% had gestational diabetes. Due to mandatory gestational diabetes screening during pregnancy in Austria and a close follow-up after registration for delivery at our department, which may represent a situation different from that in other countries, we are able to state that these 5.3% pregnant women with gestational diabetes in our cohort were exactly monitored with blood sugar testing. Due to normal results in all 29 patients, who had either diet or insulin, the pregnancies with gestational diabetes in our cohort were comparable to normal pregnancies.

Patient characteristics can be found in Table 1.

Fetal weight estimation: ultrasound versus Leopold’s manoeuvres.

No statistically significant difference was seen in the accuracy of fetal weight estimation performed with Leopold’s manoeuvres versus ultrasound in any absolute error calculations of normal weight women giving birth. This can be seen from Table 2 at the time of delivery registration.
Table 2

Accuracy of both weight estimations regarding effective birth weight in all normal weight pregnant women

EFW

Leopold’s manoeuvres

Ultrasound

p value

Absolute error [g]

279 ± 225

257 ± 204

0.0696a

Absolute error > 500g [%]

17.2

12.9

0.0805b

Absolute % error [g]

8.6 ± 7.5

7.9 ± 6.5

0.051a

Absolute % error > 10% [%]

33.5

29.6

0.155b

Absolute % error > 20% [%]

7.1

6.9

1.0b

aPaired T test, bExact McNemar test

A statistically significant difference in the accuracy of fetal weight estimation was observed in favour of ultrasound in all absolute error calculations performed in overweight women giving birth. This can be seen from Table 3 at the time of delivery registration.
Table 3

Accuracy of both weight estimations regarding actual birth weight in all overweight pregnant women

EFW

Leopold’s manoeuvres

Ultrasound

p value

Absolute error [g]

343 ± 250

245 ± 190

<0.001a

Absolute error > 500g [%]

22.6

9.1

0.0002b

Absolute % error [g]

10.1 ± 7.8

7.3 ± 6.1

<0.001a

Absolute % error > 10% [%]

42.1

24.4

0.0002b

Absolute % error > 20% [%]

12.8

4.3

0.0026b

aPaired T test, bExact McNemar test

A statistically significant difference in the accuracy of fetal weight estimation was observed in favour of ultrasound in all absolute error calculations performed in all women giving birth. This can be seen from Table 4 at the time of delivery registration.
Table 4

Accuracy of both weight estimations regarding actual birth weight in all pregnant women

EFW

Leopold’s manoeuvres

Ultrasound

p value

Absolute error [g]

298 ± 235

254 ± 200

<0.001a

Absolute error > 500g [%]

18.8

11.8

0.0003b

Absolute % error [g]

9.1 ± 7.6

7.7 ± 6.4

<0.001a

Absolute % error > 10% [%]

36.1

28.0

0.0004b

Absolute % error > 20% [%]

8.8

6.1

0.036b

aPaired T test, bExact McNemar test

Density of distribution of estimated fetal weight as compared to actual birthweight established by ultrasound versus palpation is shown in Fig. 1. The data in the present study show that the estimates made by the examiners, whether physicians or midwives, whether with ultrasound or clinical palpation, were close together in normal weight women.
Fig. 1

Estimated fetal weight from the time of examination in relation to the actual birth weight

Fetal weight estimations of normal weight and overweight women with either Leopold’s manoeuvres or ultrasound displaying absolute error, absolute error > 500 g, absolute percent error, absolute error > 10% and absolute error > 20%, including 95% confidence intervals (± 95% CI) are shown in detail in Fig. 2a-e.
Fig. 2

a) Absolute error of estimated fetal weight (± 95% CI), b) Absolute error > 500 g of estimated fetal weight (± 95% CI), c) Absolute % error of estimated fetal weight (± 95% CI), d) Absolute % error > 10 % of estimated fetal weight (± 95% CI), e) Absolute % error > 20% of estimated fetal weight (± 95% CI) in normal weight and overweight women with Leopold´s maneuvers or ultrasound

Discussion

Main findings

In this prospective blinded observational study we found a statistically significant difference in the accuracy of fetal weight estimation in favour of ultrasound in all absolute error calculations performed in overweight women giving birth, however no statistically significant difference in normal weight women giving birth.

With regard to the mode of delivery and exact timing in the event that it is necessary to induce labour, the accuracy of fetal weight estimation is of key importance in the obstetrician’s decision-making process shared with the expectant mother and has been a matter of discussion for many years [21].

A deviation of 500 g could have a significant impact on the shared decision-making process, particularly with regard to cut-off levels given in international guidelines [20, 21].

Interpretation in light of other evidence

First, our study demonstrates a statistically significant difference in the accuracy of fetal weight estimation in favour of ultrasound in all absolute error calculations made in overweight women giving birth. With regard to an absolute error > 500 g that is clinically relevant for the obstetric decision-making process, a significant difference was evident between the two methods when used in overweight pregnant women.

These results are in line with previously published data [22, 23, 24].

Second, no statistically significant difference was seen in the accuracy of fetal weight estimation obtained with Leopold’s manoeuvres versus ultrasound in absolute error calculations performed in normal weight women giving birth.

The most established way to estimate fetal weight is the ultrasound method, as previously described [10, 11, 12] and most commonly performed with three measurements fitted into an algorithm designed by Hadlock et al. [10]. Other approaches like MRI or soft-tissue measurements have proved to not be of added benefit [13, 14].

International percentile curves for EFW, calculated after studies of fetuses in Anglo-Saxon countries and used to check the week-adapted weight of the unborn fetuses worldwide, may not be the right strategy because they pursue a one-size-fits-all policy in approaching what is too large or too small [25, 26].

Very recently Nicolaides et al. [27] published a study aiming to develop fetal and neonatal population weight charts. The rationale was that reference ranges of EFW are representative for the whole population, while the traditional approach of deriving birth-weight (BW) charts is misleading, because a large proportion of babies born preterm arises from pathological pregnancy [27]. The study qualified that the desire for a single international standard for all countries is not appropriate [27]. This has been demonstrated in different studies before by likely differences in percentile curves as a consequence of underlying differences in the study populations [28, 29].

The long-standing, mainly midwifery-based tradition of clinical weight estimation by means of Leopold’s manoeuvres is a non-invasive approach to fetal weight estimation that is used when ultrasound is not available [1, 15].

The conclusions published in the literature regarding fetal weight estimation are inconsistent, with some studies favouring ultrasound measurement [30, 31, 32, 33, 34]. Goetzinger et al. reported a lack of accuracy in fetal weight estimation when using Leopold’s manoeuvres [35]. Several prospective studies were able to show advantages of clinical palpation like Leopold’s manoeuvres in predicting fetal macrosomia [14, 26, 36, 37], and the accuracy of fetal weight estimation when using ultrasound biometry has been shown to be no better than that of Leopold’s manoeuvres [21]. Still other studies report an advantage for them for fetal weight estimation [38, 39, 40, 41, 42, 43, 44].

High incongruence of study designs and the difference in approaches regarding time of examination, extrapolation of absolute error in matters of actual birth weight, examiner’s experience etc. might explain the variety of different results obtained.

As several studies have shown body mass index (BMI) to affect the accuracy of EFW [16, 17, 18, 19], we decided to stratify between normal weight and overweight pregnant women in our cohort.

We found a significant difference between ultrasound and clinical palpation with Leopold’s manoeuvres regarding fetal weight estimation in overweight pregnant women.

The difficulty of obstetric ultrasound examinations mostly grows with increasing maternal BMI due to diminished visualization, but its impact on fetal weight estimation is described controversially in the existing literature [19, 22, 23].

Furthermore, we found no significant difference between clinical palpation with Leopold’s manoeuvres and ultrasound for fetal weight estimation in normal weight pregnant women.

Our study included women who gave birth within the mean time of 13 days after fetal weight estimation. Some study data and systematic review results show that the most accurate estimates can be expected between four and 7 days before delivery [45, 46, 47]. Nevertheless, we did not change our management procedures and estimated fetal weight pragmatically at registration for delivery. Furthermore, fetal weight estimation at term is suspected of doing more harm than good and is the matter of ongoing peer discussion very recently [48].

In this connection we used the most recent Austrian percentile curves for the expected actual birth weight (Heim et al., in submission) and compared them with the actual birth weight to validate the measurement results. Several studies previously showed that Hadlock’s formula is the most consistently used for normal clinical cohorts [12, 49].

Strengths and limitations

The strengths of our study are that we present prospective data resulting from a pragmatic assessment of pregnant women as they arrived at our department for delivery, representing a normal life situation. Furthermore, the stratification of normal weight and overweight women regarding the effect of BMI on the accuracy of EFW is the major contribution of our study to the existing literature. In the analysis we included all consecutive women giving birth at our department, thus avoiding a selection bias.

A limitation of our study is the borderline significance of errors in the group of normal weight pregnant women, which might become significant for a larger pool of patients.

We did not investigate inter-observer variation. The time interval between estimation and delivery represents the real life clinical setting at our department.

Conclusions

The data obtained in our prospective blinded observational study show ultrasound to have a significantly better accuracy in fetal weight estimation in overweight pregnant women than Leopold’s manoeuvres. However, no statistically significant difference between the two methods was observed in normal weight pregnant women.

The clinical method using Leopold’s manoeuvres might be useful in countries with poor infrastructure and thus poor availability of ultrasound devices.

Notes

Acknowledgements

We acknowledge the services of Mary Heaney Margreiter for professional language editing.

Funding

None.

Availability of data and materials

All data generated or analysed during this study are included in this published article (Results section and tables within the manuscript).

Authors’ contributions

Conception: OP, HH, NC, CP, WO, PH. Planning: OP, HH, NC, CP, WO, PH. Execution: OP, AR, MM, WO. Analysis: CP, WO. Writing up the manuscript: OP, HH, NC, WO. Critical revision of the manuscript: OP, HH, NC, AR, MM, CP, WO, PH. All authors read and approved the final manuscript.

Ethics approval and consent to participate

The institutional review board (IRB) decision was obtained from the Tauernkliniken GmbH IRB before recruitment for the full trial began in December 2015 (Ref.nr. IRB TK 01_10/2015). All women gave verbal informed consent to participate, which was recorded in the patients’ records. The ethics committee formally approved the verbal informed consent.

Consent for publication

Not applicable since data were anonymized and no data on a specific participant are presented.

Competing interests

The authors declare that they have no competing interests.

Publisher’s Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

References

  1. 1.
    Ray EM, Alhusen JL. The suspected Macrosomic fetus at term: a clinical Dilemma. J Midwifery Womens Health. 2016;61:263–9.  https://doi.org/10.1111/jmwh.12414.CrossRefPubMedGoogle Scholar
  2. 2.
    Frick AP, Syngelaki A, Zheng M, Poon LC, Nicolaides KH. Prediction of large-for-gestational-age neonates: screening by maternal factors and biomarkers in the three trimesters of pregnancy. Ultrasound Obstet Gynecol. 2016;47:332–9.  https://doi.org/10.1002/uog.15780.CrossRefPubMedGoogle Scholar
  3. 3.
    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.  https://doi.org/10.1067/mob.2003.302.CrossRefPubMedGoogle Scholar
  4. 4.
    Bjørstad AR, Irgens-Hansen K, Daltveit AK, Irgens LM. Macrosomia: mode of delivery and pregnancy outcome. Acta Obstet Gynecol Scand. 2010;89:664–9.  https://doi.org/10.3109/00016341003686099.CrossRefPubMedGoogle Scholar
  5. 5.
    King JR, Korst LM, Miller DA, Ouzounian JG. Increased composite maternal and neonatal morbidity associated with ultrasonographically suspected fetal macrosomia. J Matern Fetal Neonatal Med. 2012;25:1953–9.  https://doi.org/10.3109/14767058.2012.674990.CrossRefPubMedGoogle Scholar
  6. 6.
    Zhang X, Decker A, Platt RW, Kramer MS. How big is too big? The perinatal consequences of fetal macrosomia. Am J Obstet Gynecol. 2008;198:517.e1–6.  https://doi.org/10.1016/j.ajog.2007.12.005.CrossRefGoogle Scholar
  7. 7.
    Esakoff TF, Cheng YW, Sparks TN, Caughey AB. The association between birthweight 4000 g or greater and perinatal outcomes in patients with and without gestational diabetes mellitus. Am J Obstet Gynecol. 2009;200:672.e1–4.  https://doi.org/10.1016/j.ajog.2009.02.035.CrossRefGoogle Scholar
  8. 8.
    Gupta N, Kiran TU, Mulik V, Bethel J, Bhal K. The incidence, risk factors and obstetric outcome in primigravid women sustaining anal sphincter tears. Acta Obstet Gynecol Scand. 2003;82:736–43.  https://doi.org/10.1034/j.1600-0412.2003.00179.x.CrossRefPubMedGoogle Scholar
  9. 9.
    Casey BM, Schaffer JI, Bloom SL, Heartwell SF, McIntire DD, Leveno KJ. Obstetric antecedents for postpartum pelvic floor dysfunction. Am J Obstet Gynecol. 2005;192:1655–62.  https://doi.org/10.1016/j.ajog.2004.11.031.CrossRefPubMedGoogle Scholar
  10. 10.
    Hadlock FP, Harrist RB, Sharman RS, Deter RL, Park SK. Estimation of fetal weight with the use of head, body, and femur measurements--a prospective study. Am J Obstet Gynecol. 1985;151:333–7 PMID: 3881966.CrossRefGoogle Scholar
  11. 11.
    Deter RL, Hadlock FP. Use of ultrasound in the detection of macrosomia: a review. J Clin Ultrasound. 1985;13:519–24. PMID: 3934213.CrossRefGoogle Scholar
  12. 12.
    Hammami A, Mazer Zumaeta A, Syngelaki A, Akolekar R, Nicolaides KH. Ultrasonographic estimation of fetal weight: development of new model and assessment of performance of previous models. Ultrasound Obstet Gynecol. 2018;52:35–43.  https://doi.org/10.1002/uog.19066.CrossRefPubMedGoogle Scholar
  13. 13.
    Malin GL, Bugg GJ, Takwoingi Y, Thornton JG, Jones NW. Antenatal magnetic resonance imaging versus ultrasound for predicting neonatal macrosomia: a systematic review and meta-analysis. Br J Obstet Gynaecol. 2016;123:77–88.  https://doi.org/10.1111/1471-0528.13517.CrossRefGoogle Scholar
  14. 14.
    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 PMID: 10775720.PubMedGoogle Scholar
  15. 15.
    Leopold G, Spörlin N. Die Leitung der regelmäßigen Geburten nur durch äußere Untersuchung. Arch Gynakol. 1894;45:337–68. (German).CrossRefGoogle Scholar
  16. 16.
    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;77:276–83.  https://doi.org/10.1055/s-0043-102406.CrossRefPubMedPubMedCentralGoogle Scholar
  17. 17.
    Paganelli S, Soncini E, Comitini G, Palomba S, La Sala GB. Sonographic fetal weight estimation in normal and overweight/obese healthy term pregnant women by gestation-adjusted projection (GAP) method. Arch Gynecol Obstet. 2016;293:775–81.  https://doi.org/10.1007/s00404-015-3910-z.CrossRefPubMedGoogle Scholar
  18. 18.
    Aksoy H, Aksoy Ü, Karadağ Öİ, Yücel B, Aydın T, Babayiğit MA. Influence of maternal body mass index on sonographic fetal weight estimation prior to scheduled delivery. J Obstet Gynaecol Res. 2015;41:1556–61.  https://doi.org/10.1111/jog.12755.CrossRefPubMedGoogle Scholar
  19. 19.
    Fox NS, Bhavsar V, Saltzman DH, Rebarber A, Chasen ST. Influence of maternal body mass index on the clinical estimation of fetal weight in term pregnancies. Obstet Gynecol. 2009;113:641–5.  https://doi.org/10.1097/AOG.0b013e3181998eef.CrossRefPubMedGoogle Scholar
  20. 20.
    S1-Leitlinie DGGG: Vorgehen bei Terminüberschreitung und Übertragung. AWMF 015/65 (Leitliniensammlung der DGGG), 2018. https://www.awmf.org/leitlinien/detail/ll/015-065.html. (German).
  21. 21.
    American College of Obstetricians and Gynecologists’ Committee on Practice Bulletins—Obstetrics. Practice bulletin no. 173: fetal Macrosomia. Obstet Gynecol. 2016;128:1191–2.  https://doi.org/10.1097/AOG.0000000000001767.CrossRefGoogle Scholar
  22. 22.
    Field NT, Piper JM, Langer O. The effect of maternal obesity on the accuracy of fetal weight estimation. Obstet Gynecol. 1995;86:102–7.  https://doi.org/10.1016/0029-7844(95)00096-A.CrossRefPubMedGoogle Scholar
  23. 23.
    Farrell T, Holmes R, Stone P. The effect of body mass index on three methods of fetal weight estimation. Br J Obstet Gynaecol. 2002;109:651–7.  https://doi.org/10.1111/j.1471-0528.2002.01249.x.CrossRefGoogle Scholar
  24. 24.
    Heer IM, Kumper C, Vogtle N, Muller-Egloff S, Dugas M, Strauss A. Analysis of factors influencing the ultrasonic fetal weight estimation. Fetal Diagn Ther. 2008;23:204–10.  https://doi.org/10.1159/000116742.CrossRefPubMedGoogle Scholar
  25. 25.
    Reboul Q, Delabaere A, Luo ZC, Nuyt AM, Wu Y, Chauleur C, et al. Prediction of small-for-gestational-age neonate by third-trimester fetal biometry and impact of ultrasound-delivery interval. Ultrasound Obstet Gynecol. 2017;49:372–8.  https://doi.org/10.1002/uog.15959.CrossRefPubMedGoogle Scholar
  26. 26.
    Grantz KL, Kim S, Grobman WA, Newman R, Owen J, Skupski D, et al. Fetal growth velocity: the NICHD fetal growth studies. Am J Obstet Gynecol. 2018;219:285.e1–285.e36.  https://doi.org/10.1016/j.ajog.2018.05.016.CrossRefGoogle Scholar
  27. 27.
    Nicolaides KH, Wright D, Syngelaki A, Wright A, Akolekar R. Fetal Medicine Foundation fetal and neonatal population weight charts. Ultrasound Obstet Gynecol. 2018;52:44–51.  https://doi.org/10.1002/uog.19073.CrossRefPubMedGoogle Scholar
  28. 28.
    Stirnemann J, Villar J, Salomon LJ, Ohuma E, Ruyan P, Altman DG, International Fetal and Newborn Growth Consortium for the 21st Century (INTERGROWTH-21st); Scientific Advisory Committee; Steering Committees; INTERGROWTH-21st; INTERBIO-21st; Executive Committee; In addition for INTERBIO 21st; Project Coordinating Unit; Data Analysis Group; Data Management Group; In addition for INTERBIO 21st; Ultrasound Group; In addition for INTERBIO-21st:; Anthropometry Group; In addition for INTERBIO-21st:; Laboratory Processing Group; Neonatal Group; Environmental Health Group; Neurodevelopment Group; Participating countries and local investigators; In addition for INTERBIO-21st:; In addition for INTERBIO-21st, et al. International estimated fetal weight standards of the INTERGROWTH-21(st) Project. Ultrasound Obstet Gynecol. 2017;49:478–86.  https://doi.org/10.1002/uog.17347.CrossRefPubMedPubMedCentralGoogle Scholar
  29. 29.
    Kiserud T, Piaggio G, Carroli G, Widmer M, Carvalho J, Neerup Jensen L, et al. The World Health Organization fetal growth charts: a multinational longitudinal study of ultrasound biometric measurements and estimated fetal weight. PLoS Med. 2017;14:e1002220.  https://doi.org/10.1371/journal.pmed.1002220.CrossRefPubMedPubMedCentralGoogle Scholar
  30. 30.
    Nguyen T, Hawkins CJ, Amon E, Gavard J. Effect of maternal weight on accuracy of maternal and physician estimate of fetal weight. J Reprod Med. 2013;58:200–4. PMID: 23763003.PubMedGoogle Scholar
  31. 31.
    Hirata GI, Medearis AL, Horenstein J, Bear MB, Platt LD. Ultrasonographic estimation of fetal weight in the clinically macrosomic fetus. Am J Obstet Gynecol. 1990;162:238–42.  https://doi.org/10.1016/0002-9378(90)90857-4.CrossRefPubMedGoogle Scholar
  32. 32.
    Shamley KT, Landon MB. Accuracy and modifying factors for ultrasonographic determination of fetal weight at term. Obstet Gynecol. 1994;84:926–30 PMID: 7970471.PubMedGoogle Scholar
  33. 33.
    Dar P, Weiner I, Sofrin O, Sachs GS, Bukovsky I, Arieli S. Clinical and sonographic fetal weight estimates in active labor with ruptured membranes. J Reprod Med. 2000;45:390–4. PMID: 10845172.PubMedGoogle Scholar
  34. 34.
    Chien PF, Owen P, Khan KS. Validity of ultrasound estimation of fetal weight. Obstet Gynecol. 2000;95:856–60 PMID: 10831981.PubMedGoogle Scholar
  35. 35.
    Goetzinger KR, Odibo AO, Shanks AL, Roehl KA, Cahill AG. Clinical accuracy of estimated fetal weight in term pregnancies in a teaching hospital. J Matern Fetal Neonatal Med. 2014;27:89–93.  https://doi.org/10.3109/14767058.2013.806474.CrossRefPubMedGoogle Scholar
  36. 36.
    Chauhan SP, Cowan BD, Magann EF, Bradford TH, Roberts WE, Morrison JC. Intrapartum detection of a macrosomic fetus: clinical versus 8 sonographic models. Aust N Z J Obstet Gynaecol. 1995;35:266–70.  https://doi.org/10.1111/j.1479-828X.1995.tb01978.x.CrossRefPubMedGoogle Scholar
  37. 37.
    Weiner Z, Ben-Shlomo I, Beck-Fruchter R, Goldberg Y, Shalev E. Clinical and ultrasonographic weight estimation in large for gestational age fetus. Eur J Obstet Gynecol Reprod Biol. 2002;105:20–4.  https://doi.org/10.1016/S0301-2115(02)00140-9.CrossRefPubMedGoogle Scholar
  38. 38.
    Khani S, Ahmad-Shirvani M, Mohseni-Bandpei MA, Mohammadpour-Tahmtan RA. Comparison of abdominal palpation, Johnson's technique and ultrasound in the estimation of fetal weight in northern Iran. Midwifery. 2011;27:99–103.  https://doi.org/10.1016/j.midw.2009.10.005.CrossRefPubMedGoogle Scholar
  39. 39.
    Mehdizadeh A, Alaghehbandan R, Horsan H. Comparison of clinical versus ultrasound estimation of fetal weight. Am J Perinatol. 2000;17:233–6.  https://doi.org/10.1055/s-2000-10003.CrossRefPubMedGoogle Scholar
  40. 40.
    Hendrix NW, Grady CS, Chauhan SP. Clinical vs. sonographic estimate of birth weight in term parturients. A randomized clinical trial. J Reprod Med. 2000;45:317–22. PMID: 10804488.PubMedGoogle Scholar
  41. 41.
    Titapant V, Chawanpaiboon S, Mingmitpatanakul K. A comparison of clinical and ultrasound estimation of fetal weight. J Med Assoc Thail. 2001;84:1251–7 PMID: 11800297.Google Scholar
  42. 42.
    Ashrafganjooei T, Naderi T, Eshrati B, Babapoor N. Accuracy of ultrasound, clinical and maternal estimates of birth weight in term women. East Mediterr Health J. 2010;16:313–7 PMID: 20795447.CrossRefGoogle Scholar
  43. 43.
    Baum JD, Gussman D, Wirth JC 3rd. Clinical and patient estimation of fetal weight vs. ultrasound estimation. J Reprod Med. 2002;47:194–8 PMID: 11933683.PubMedGoogle Scholar
  44. 44.
    Noumi G, Collado-Khoury F, Bombard A, Julliard K, Weiner Z. Clinical and sonographic estimation of fetal weight performed during labor by residents. Am J Obstet Gynecol. 2005;192:1407–9.  https://doi.org/10.1016/j.ajog.2004.12.043.CrossRefPubMedGoogle Scholar
  45. 45.
    Barel O, Vaknin Z, Tovbin J, Herman A, Maymon R. Assessment of the accuracy of multiple sonographic fetal weight estimation formulas: a 10-year experience from a single center. J Ultrasound Med. 2013;32:815–23.  https://doi.org/10.7863/ultra.32.5.815.CrossRefPubMedGoogle Scholar
  46. 46.
    Curti A, Zanello M, De Maggio I, Moro E, Simonazzi G, Rizzo N, et al. Multivariable evaluation of term birth weight: a comparison between ultrasound biometry and symphysis-fundal height. J Matern Fetal Neonatal Med. 2014;27:1328–32.  https://doi.org/10.3109/14767058.2013.858241.CrossRefPubMedGoogle Scholar
  47. 47.
    Souka AP, Papastefanou I, Michalitsi V, Pilalis A, Kassanos D. Specific formulas improve the estimation of fetal weight by ultrasound scan. J Matern Fetal Neonatal Med. 2014;27:737–42.  https://doi.org/10.3109/14767058.2013.837877.CrossRefPubMedGoogle Scholar
  48. 48.
    Thilaganathan B. Ultrasound fetal weight estimation at term may do more harm than good. Ultrasound Obstet Gynecol. 2018;52:5–8.  https://doi.org/10.1002/uog.19110.CrossRefPubMedGoogle Scholar
  49. 49.
    Dudley NJ. A systematic review of the ultrasound estimation of fetal weight. Ultrasound Obstet Gynecol. 2005;25:80–9.  https://doi.org/10.1002/uog.1751.CrossRefPubMedGoogle Scholar

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© The Author(s). 2019

Open AccessThis article is distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.

Authors and Affiliations

  • Oliver Preyer
    • 1
    Email author
  • Heinrich Husslein
    • 2
  • Nicole Concin
    • 3
  • Anna Ridder
    • 4
  • Maciej Musielak
    • 1
  • Christian Pfeifer
    • 5
  • Willi Oberaigner
    • 5
    • 6
  • Peter Husslein
    • 7
  1. 1.Department of Obstetrics and GynaecologyUniversity Teaching Hospital Tauernklinikum Zell am SeeZell am SeeAustria
  2. 2.Department of Obstetrics and Gynaecology, Division of General Gynaecology and Gynaecologic OncologyMedical University of ViennaViennaAustria
  3. 3.Department of Obstetrics and GynaecologyMedical University of InnsbruckInnsbruckAustria
  4. 4.Paracelsus Medical UniversitySalzburgAustria
  5. 5.Department of Clinical Epidemiology of the Tyrolean State Hospitals LtdCancer Registry of Tyrol, Tirolkliniken GmbHInnsbruckAustria
  6. 6.Department of Public Health, Health Services Research and Health Technology Assessment, Institute of Public HealthMedical Decision Making and HTA, UMIT The Health & Life Sciences UniversityHall in TirolAustria
  7. 7.Department of Obstetrics and Gynaecology, Division of Obstetrics and Fetomaternal MedicineMedical University of ViennaViennaAustria

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