Universal third-trimester ultrasonic screening using fetal macrosomia in the prediction of adverse perinatal outcome: A systematic review and meta-analysis of diagnostic test accuracy
Publication: PLOS Medicine
Alexandros A. Moraitis, Norman Shreeve, Ulla Sovio, Peter Brocklehurst, Alexander E. P. Heazell, Jim G. Thornton, Stephen C. Robson, Aris Papageorghiou, Gordon C. Smith
13 October 2020
Summary:
Delivering a large baby (usually defined as above 4Kg or 90th birth weight centile) has been associated with complications such shoulder dystocia – after the vaginal delivery of the head, the baby’s shoulder gets stuck behind the mother’s pubic bone. This could lead to the baby with fractured bones and lack of oxygen during the delivery. There may be then a potential need for emergency caesarean section and neonatal unit admission.
Predicting the delivery of a large baby can be difficult and there is currently no standard screening programme to predict these complications.
Screening more than 100,000 patients, Cambridge researchers found that offering a scan to all women at 36 weeks could increase the detection of delivering a large baby and the prediction was more effective for very large babies (above 4.5Kg). However, the screening could not identify shoulder dystocia to the same effect or enough evidence to predict which babies could have other complications.
More evidence is needed on the benefit of introducing another ultrasound for all women, to help identify any potential problems before labour as well as predict large babies.
