Delivering a newborn with macrosomia (weighing more than 8 pounds, 13 ounces at birth) may be associated with higher risk of adverse outcomes, including perinatal death and injuries related to traumatic delivery, such as stuck shoulders (shoulder dystocia). A study in PLOS Medicine by Gordon Smith at the University of Cambridge and colleagues suggests that third trimester fetal ultrasound screening has the ability to identify more pregnancies with macrosomia.
The diagnostic effectiveness of ultrasound screening in predicting the delivery of a macrosomic infant, shoulder dystocia and associated neonatal morbidity is not well established. To better understand the relationship between estimated fetal weight (EFW), macrosomia, and perinatal complications, researchers systematically reviewed the literature from four different clinical databases. The authors then analyzed 41 studies involving 112,034 non-high risk patients who had undergone a third trimester ultrasound screening as part of universal screening.
The authors found that a third trimester ultrasonic EFW showing increased risk of a large baby reliably predicted delivery of a macrosomic infant. However, a larger EFW was not strongly associated with the risk of shoulder dystocia in low and medium-risk pregnancies. The study was limited by variation in included studies representing differences in screening in various countries.
Numed, a well established company in business since 1975 provides a wide range of service options including time & material service, PM only contracts, full service contracts, labor only contracts & system relocation. Call 800 96 Numed for more info.
According to the authors, "We recommend caution prior to introducing universal third trimester screening for macrosomia as it would increase the rates of intervention, with potential iatrogenic harm, without clear evidence that it would reduce neonatal morbidity".
Peer reviewed; Systematic review; Humans
In your coverage please use this URL to provide access to the freely available paper: http://journals.plos.org/plosmedicine/article?id=10.1371/journal.pmed.1003190
Funding: This study was funded by the National Institute for Health Research (NIHR) Health Technology Assessment programme, grant number 15/105/01. The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.
Competing Interests: I have read the journal's policy and the authors of this manuscript have the following competing interests: AAM, NS, PB, JGT, and SCR have no competing interests to declare. US reports grants from NIHR Cambridge Biomedical Research Centre during the conduct of the study. GCS is a member of the Editorial Board of PLOS Medicine. GCS reports grants and personal fees from GlaxoSmithKline Research and Development, Ltd., grants from Sera Prognostics, Inc., nonfinancial support from Illumina, Inc., and personal fees from Roche Diagnostics, Ltd., outside the submitted work. In addition, GCS and US have a patent in preparation for a novel predictive test for fetal size pending. AP reports personal fees from educational events/lectures, clinical services in the private sector and from Consultancy via Oxford University Innovation, royalties from published works, and editorial work for UOG and BJOG, outside the submitted work.
Citation: Moraitis AA, Shreeve N, Sovio U, Brocklehurst P, Heazell AEP, Thornton JG, et al. (2020) 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. PLoS Med 17(10): e1003190. https://doi.org/10.1371/journal.pmed.1003190