Dr Emily Beard1, Dr Megan Kelly2
1Gold Coast Health, Gold Coast, Australia, 2School of Medical, Indigenous and Health Sciences, University of Wollongong, Wollongong, Australia
Biography:
Dr Emily Beard MD, graduated from the University of Wollongong in 2015. She is currently a junior doctor at Gold Coast University Hospital working in Obstetrics & Gynaecology with aspirations to pursue that as her career path.
Abstract:
True foetal macrosomia is associated with several maternal and foetal complications, including shoulder dystocia, difficult births, and perineal trauma (1). The proposed interventions for reducing the risk of these complications include inducing labour or performing caesarean sections (2). However, accurate diagnosis during the prenatal period is crucial for implementing these interventions effectively. Diagnosis currently relies on standard foetal biometrics measured via ultrasound, which are limited in their general accuracy at predicting macrosomia, particularly in low-risk pregnancies (3). Diagnostic inaccuracies can impede decision-making, with underdiagnosis potentially leading to birth complications and poor management, while overdiagnosis can result in increased and unnecessary interventions.
A systematic review was conducted, appraising novel ultrasound-measured foetal biometrics aimed at increasing accuracy of macrosomic prenatal detection. Two medical databases were searched, inclusive of research published between 2017 to June 2023. Fifteen studies were identified that examined novel foetal biometrics, covering two-dimensional, three-dimensional and growth velocity measures that were found to increase accuracy over standard practice. Measures that showed promise for increased accuracy included visceral adipose tissue, epicardial fat thickness, and interventricular septal thickness . Three-dimensional biometrics were found to increase accuracy in low-risk populations but were less accurate in high-risk in some studies. Measures of growth velocity, commonly calculated from two to three successive ultrasounds, found that identifying foetuses with accelerated growth led to an increased accuracy of macrosomia diagnosis. Doppler ultrasonography, including vascular index and vascular flow index, whilst being significantly higher during the third trimester of determined macrosomic babies, did not prove to be strong predictors of macrosomia prenatally.
This study concluded that there are several novel ultrasound biometric techniques under investigation that will increase accuracy of antenatal macrosomic prediction with varying levels. These novel biometrics currently are limited by the time limitations of scans as well training of general sonographers in these specific measurements.
Keywords
macrosomia, large-for-gestational age, ultrasound, biometrics, fetal, sonography
References
1. Ng, S.-K., Olog, A., Spinks, A. B., Cameron, C. M., Searle, J., and McClure, R. J. (2010) ‘Risk factors and obstetric complications of large for gestational age births with adjustments for community effects: results from a new cohort study’, BMC Public Health, 10(460). doi: 10.1186/1471-2458-10-460.
2. Rossi, A., Mullin, P., and Prefumo, F. (2013) ‘Prevention, management, and outcomes of macrosomia: a systematic review of literature and meta-analysis’, Obstetrical and Gyncaecological Survey, 68(10), pp. 702–709. doi: 10.1097/01.ogx.0000435370.74455.a8.
3. Oliver, M., McNally, G., and Leader, L. (2013) ‘Accuracy of sonographic prediction of birth weight’, Australia and New Zealand Journal of Obstetrics and Gynaecology, 53(6), pp. 584–585. doi: 10.1111/ajo.12128.