Factors Affecting Clinical over and Underestimation of Fetal Weight—A Retrospective Cohort
Abstract
:1. Introduction
2. Methods
2.1. Data Collection
- Maternal demographics and medical history (age, gravidity, parity, height, weight, body mass index (BMI, kg/m2), maternal stature (short: height <10th percentile or tall: >90th percentile), rates of obesity (BMI > 30 kg/m2), smoking, chronic hypertension, pregestational diabetes mellitus (DM), gestational diabetes mellitus (GDM) [18], prior preterm deliveries, prior first or second trimester abortions and background morbidities).
- Data at presentation, including clinical and sonographic EFW [19], premature uterine contractions, preterm or premature rupture of membranes, vaginal bleeding, placental implantation site, fetal presentation, preeclampsia or gestational hypertension diagnosed according to international guidelines [20] and rates of polyhydramnios or oligohydramnios [21].
- Delivery characteristics: GA at delivery, onset of delivery (spontaneous/induced), use of epidural anesthesia, intrapartum fever (a measurement of maternal fever ≥38 degree Celsius during delivery or up to 24 h from delivery), amniotic fluid color, fetal sex, mode of delivery (normal vaginal delivery, VE, CD), indication for VE or CD and intrapartum maternal blood loss.
- All neonates were evaluated by a pediatrician immediately after delivery, or by a neonatologist if the birthweight was <2500 g. Neonatal outcome data collected were Apgar scores, umbilical cord pH, fetal macrosomia, neonatal birthweight (small for gestational age (SGA), average for gestational age (AGA) or large for gestational age (LGA), diagnosed according to local birth weight charts [22]. Neonatal diagnoses were determined by the pediatrician at delivery and during neonatal hospitalization, according to international standards, relevant blood samples and imaging.
2.2. Ethics Approval
2.3. Statistical Analysis
3. Results
3.1. Univariate Analysis
3.2. Multivariable Logistic Regression Analysis
3.3. Obstetric Implications of over or Underestimation
3.4. The Effect of BW Itself on EFW
3.5. Misclassification Due to over-and Underestimation of Neonatal BW
4. Discussion
4.1. Clinical Implications
4.2. Strengths and Limitations
5. Conclusions
Author Contributions
Funding
Institutional Review Board Statement
Informed Consent Statement
Data Availability Statement
Acknowledgments
Conflicts of Interest
Abbreviations
EFW | Clinically estimated fetal birth weight |
BW | Birth weight |
GA | Gestational age |
VE | Vacuum extraction |
IOL | Induction of labor |
CD | Cesarean delivery |
BMI | Body mass index |
DM | Diabetes mellitus |
GDM | Gestational diabetes mellitus |
SGA | Small for gestational age |
LGA | Large for gestational age |
Aga | Average for gestational age |
OR | Adjusted odds ratio |
CI | 95% confidence interval |
References
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Variable | Estimated Birthweight | |||
---|---|---|---|---|
Overestimation (n = 6695) | Accurate (n = 27,648) | p-Value | ||
Maternal age (years), mean + SD | 31.0 ± 5.5 | 31.0 ± 5.3 | 0.908 | |
Gestational age at delivery (weeks), mean + SD | 38.8 ± 1.4 | 39.3 ± 1.3 | <0.001 | |
Gestational week at delivery, per week (n, %) | <34 w | 17 (0.3%) | 44 (0.2%) | 0.125 |
34–36 + 6 w | 327 (4.9%) | 704 (2.6%) | <0.001 | |
≥37 w | 6351 (94.9%) | 26,000 (97.2%) | <0.001 | |
≥41 w | 657 (9.8%) | 3899 (14.6%) | <0.001 | |
Maternal BMI, kg/m2 (mean + SD) | 24.3 ± 4.0 | 23.9 ± 3.7 | <0.001 | |
Obesity (BMI > 30) (n, %) | 567 (16.3%) | 1670 (11.5%) | <0.001 | |
Maternal weight gain during pregnancy, kg, (mean + SD) | 11.87 ± 5.9 | 12.26 ± 6.0 | <0.001 | |
Maternal height, m (mean + SD) | 1.63 ± 0.05 | 1.63 ± 0.05 | <0.001 | |
Maternal height under 10th percentile (n, %) | 624 (9.3%) | 2171 (8.1%) | 0.001 | |
Maternal height above 90th percentile (n, %) | 554 (8.1%) | 2257 (8.4%) | 0.213 | |
Smoker (n, %) | 540 (8.1%) | 1392 (5.2%) | <0.001 | |
Nulliparity (n, %) | 3183 (47.5%) | 9353 (35.0%) | <0.001 | |
Previous cesarean delivery (among multiparas (n, %)) | 634 (18.4%) | 2340 (13.5%) | <0.001 | |
Gestational DM/DM (n, %) | 806 (12.0%) | 2926 (10.9%) | 0.011 | |
Preeclampsia/Hypertension (n, %) | 325 (4.9%) | 741 (2.8%) | <0.001 | |
Placental location (n, %) | Anterior | 2167 (54.6%) | 8520 (51.8%) | 0.001 |
Posterior | 1266 (31.9%) | 5743 (34.9%) | <0.001 | |
Previa/low lying | 11 (0.3%) | 45 (0.3%) | 0.967 | |
Other | 522 (13.2%) | 2141 (13.0%) | 0.807 | |
Fetal sex (n, %) | Male | 2902 (43.3%) | 13,608 (50.9%) | <0.001 |
Female | 3793 (56.7%) | 13,140 (49.1%) | ||
Fetal presentation (n, %) | Vertex | 6084 (97.5%) | 24,480 (98.6%) | <0.001 |
Breech | 147 (2.4%) | 309 (1.2%) | <0.001 | |
Transverse | 6 (0.1%) | 27 (0.1%) | 0.785 | |
Polyhydramnios (n, %) | 34 (0.5%) | 103 (0.4%) | 0.158 | |
Oligohydramnios (n, %) | 239 (3.6%) | 560 (2.1%) | <0.001 | |
Neonatal birth weight, mean + SD | 2838.5 ± 330.7 | 3307.9 ± 374.4 | <0.001 | |
Small for gestational age (n, %) | 1862 (27.8%) | 934 (3.5%) | <0.001 | |
Large for gestational age (n, %) | 26 (0.4%) | 2084 (7.8%) | <0.001 | |
Macrosomia (n, %) | 3 (0.0%) | 914 (3.4%) | <0.001 | |
Umbilical cord pH < 7 (n, %) | 26 (1.2%) | 80 (1.2%) | 0.866 | |
Umbilical cord pH < 7.1 (n, %) | 122 (5.4%) | 318 (4.8%) | 0.218 | |
5 min Apgar score <7 (n, %) | 22 (0.3%) | 91 (0.3%) | 0.884 | |
Neonatal composite outcome (Including hypoglycemia, hypothermia, meconium aspiration, non-invasive ventilation, phototherapy), (n, %) | 499 (9.2%) | 1543 (6.9%) | <0.001 |
Estimated Neonatal Birthweight | ||||
---|---|---|---|---|
Variable | Underestimated (n = 5172) | Accurate (n = 27,648) | p-Value | |
Maternal Age (years) mean + SD | 30.5 ± 5.2 | 31.0 ± 5.3 | <0.001 | |
Gestational age at delivery (weeks) mean + SD | 39.5 ± 1.3 | 39.3 ± 1.3 | <0.001 | |
Gestational week at delivery, per week (n, %) | <34 w | 12 (0.2%) | 44, (0.2%) | 0.288 |
34–36 + 6 w | 136 (2.6%) | 704 (2.6%) | 0.992 | |
≥37 w | 5024 (97.1%) | 26,000 (97.2%) | 0.795 | |
≥41 w | 968 (18.7%) | 3899 (14.6%) | <0.001 | |
Maternal BMI, kg/m2 (mean + SD) | 23.3 ± 3.3 | 23.9 ± 3.7 | <0.001 | |
Obesity (BMI > 30) (n, %) | 204 (7.4%) | 1670 (11.5%) | <0.001 | |
Maternal weight gain during pregnancy, kg (mean + SD) | 12.47 ± 6.2 | 12.26 ± 6.0 | 0.021 | |
Maternal height, m (mean + SD) | 1.63 ± 0.06 | 1.63 ± 0.05 | 0.036 | |
Maternal height under 10th percentile (n, %) | 404 (7.8%) | 2171 (8.1%) | 0.461 | |
Maternal height above 90th percentile (n, %) | 464 (9.0%) | 2257 (8.4%) | 0.209 | |
Smoking (n, %) | 200 (3.9%) | 1392 (5.2%) | <0.001 | |
Nulliparity (n, %) | 1410 (27.3%) | 9353 (35.0%) | <0.001 | |
Previous cesarean delivery (among multiparas (n, %) | 356 (9.5%) | 2340 (13.5%) | <0.001 | |
Gestational DM/DM (n, %) | 372 (7.2%) | 2926 (10.9%) | <0.001 | |
PET/HTN (n, %) | 124 (2.4%) | 741 (2.8%) | 0.134 | |
Placental location (n, %) | Anterior | 1602 (51.1%) | 8520 (51.8%) | 0.492 |
Posterior | 1136 (36.3%) | 5743 (34.9%) | 0.148 | |
Previa/low lying | 4 (0.1%) | 45 (0.3%) | 0.134 | |
Other | 391 (12.5%) | 2141 (13.0%) | 0.413 | |
Fetal sex (n, %) | Male | 3127 (60.5%) | 13,608 (50.9%) | <0.001 |
Female | 2045 (39.5%) | 13,140 (49.1%) | ||
Presentation (n, %) | Vertex | 4309 (98.4%) | 24,480 (98.6%) | 0.132 |
Breech | 65 (1.4%) | 309 (1.2%) | 0.236 | |
Transverse | 7 (0.1%) | 27 (0.1%) | 0.362 | |
Polyhydramnios (n, %) | 14 (0.3%) | 103 (0.4%) | 0.214 | |
Oligohydramnios (n, %) | 82 (1.6%) | 560 (2.1%) | 0.018 | |
Neonatal birth weight, mean + SD | 3656.0 ± 400.3 | 3307.9 ± 374.4 | <0.001 | |
SGA (n, %) | 26 (0.5%) | 934 (3.5%) | <0.001 | |
LGA (n, %) | 1524 (29.5%) | 2084 (7.8%) | <0.001 | |
Macrosomia (n, %) | 964 (18.6%) | 914 (3.4%) | <0.001 | |
3-4th degree perineal laceration (n, %) | 59 (1.1%) | 192 (0.7%) | 0.002 | |
Failed vacuum extraction (n, %) | 22 (0.4%) | 68 (0.3%) | 0.034 | |
Shoulder dystocia (n, %) | 70 (1.4%) | 163 (0.6%) | <0.001 |
Factors Associated with Overestimation of Neonatal Birthweight * | |||
---|---|---|---|
Adjusted Odds Ratio | 95% CI | p Value | |
Nulliparity | 1.95 | 1.76–2.16 | <0.001 |
Obesity (BMI > 30 kg/m2) | 1.52 | 1.33–1.74 | <0.001 |
Short stature (Maternal height below 10th percentile) | 1.35 | 1.17–1.56 | <0.001 |
Smoking | 1.60 | 1.33–1.93 | <0.001 |
Hypertensive disorders | 1.30 | 1.03–1.63 | 0.027 |
Oligohydramnios | 1.92 | 1.47–2.50 | <0.001 |
Male fetus | 1.44 | 1.30–1.58 | <0.001 |
Factors Associated with Underestimation of Neonatal Birthweight * | |||
Adjusted Odds Ratio | 95% CI | p Value | |
Gestational age (every added week) | 1.16 | 1.12–1.20 | <0.001 |
Increased Risk for 3rd-or 4th-Degree Perineal Lacerations (Adjusted for Diabetes Mellitus, Obesity (BMI > 30 kg/m2), Fetal Macrosomia) | Adjusted Odds Ratio | 95% CI | p Value |
---|---|---|---|
Underestimation of fetal birthweight | 1.59 | 1.05–2.43 | 0.030 |
Nulliparity | 3.37 | 2.37–4.80 | <0.001 |
Increased Risk for Shoulder Dystocia (adjusted for obesity (BMI > 30 kg/m2)) | Adjusted Odds Ratio | 95% CI | p Value |
Underestimation of fetal birthweight | 1.61 | 1.05–2.46 | 0.030 |
Diabetes mellitus | 2.06 | 1.32–3.22 | 0.002 |
Nulliparity | 3.37 | 2.37–4.80 | <0.001 |
Fetal macrosomia | 5.35 | 3.45–8.32 | <0.001 |
Increased Risk for Neonatal Composite Adverse Outcome * (adjusted for gestational age and neonatal birthweight) | Adjusted Odds Ratio | 95% CI | p Value |
Overestimation of fetal birthweight | 1.15 | 1.02–1.30 | 0.023 |
Nulliparity | 1.61 | 1.46–1.76 | <0.001 |
Increased Risk for Induction of Labor | Adjusted Odds Ratio | 95% CI | p Value |
Overestimation of fetal birthweight | 1.30 | 1.21–1.40 | <0.001 |
Gestational age at delivery (every added week) | 1.25 | 1.22–1.28 | <0.001 |
Nulliparity | 1.93 | 1.83–2.04 | <0.001 |
Diabetes mellitus | 2.10 | 1.94–2.27 | <0.001 |
Hypertensive disorders | 4.57 | 3.98–5.25 | <0.001 |
Neonatal birthweight (every added kg) | 1.34 | 1.24–1.46 | <0.001 |
Increased Risk for Cesarean Delivery (adjusted for hypertensive disorders and gestational age) | Adjusted Odds Ratio | 95% CI | p Value |
Overestimation of fetal birthweight | 1.59 | 1.41–1.79 | <0.001 |
Nulliparity | 1.78 | 1.63–1.95 | <0.001 |
Diabetes mellitus | 1.41 | 1.24–1.60 | <0.001 |
Maternal obesity (BMI >30 kg/m2) | 1.44 | 1.27–1.63 | <0.001 |
Neonatal birthweight (every added kg) | 1.48 | 1.29–1.70 | <0.001 |
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Cohen, G.; Shalev-Ram, H.; Schreiber, H.; Weitzner, O.; Daykan, Y.; Kovo, M.; Biron-Shental, T. Factors Affecting Clinical over and Underestimation of Fetal Weight—A Retrospective Cohort. J. Clin. Med. 2022, 11, 6760. https://doi.org/10.3390/jcm11226760
Cohen G, Shalev-Ram H, Schreiber H, Weitzner O, Daykan Y, Kovo M, Biron-Shental T. Factors Affecting Clinical over and Underestimation of Fetal Weight—A Retrospective Cohort. Journal of Clinical Medicine. 2022; 11(22):6760. https://doi.org/10.3390/jcm11226760
Chicago/Turabian StyleCohen, Gal, Hila Shalev-Ram, Hanoch Schreiber, Omer Weitzner, Yair Daykan, Michal Kovo, and Tal Biron-Shental. 2022. "Factors Affecting Clinical over and Underestimation of Fetal Weight—A Retrospective Cohort" Journal of Clinical Medicine 11, no. 22: 6760. https://doi.org/10.3390/jcm11226760