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estimated fetal weight (EFW) by Leopold’s maneuver at full term gestation Audrey Merriam, Matthew Hoffman, Anthony Sciscione, Siobhan McCarty Christiana Care Health System, Obstetrics and Gynecology, Newark, DE OBJECTIVE: Estimated fetal weight (EFW) by clinical examination has been a staple of obstetrical care; however, the impact of increasing maternal obesity on its precision has not been assessed. We sought to determine the impact of maternal BMI on the precision of estimated fetal weight by Leopold’s maneuver. STUDY DESIGN: Using the Consortium on Safe Labor database (an electronic database which coalesced the electronic records of 12 centers from the 9 ACOG districts), we identified women with singleton term ( 37 0/7 weeks) gestations with a BMI at time of delivery, EFW done at time of admission and infant birthweight recorded. The primary outcome was the accuracy of EFW versus birthweight. The exposure of interest was maternal BMI which for the purpose of this analysis was separated into 6 categories ( 20 kg/m2, 20 to 25kg/m2, 25 to 30kg/m2, 30 to 35kg/m2, 35 to 40kg/m2, 40 kg/m2). Univariable analysis was used to analyze the data. RESULTS: A total of 25,262 women with a mean BMI of 31.6 and fetal birthweight of 3390 grams were identified for inclusion in the study. The rates of birthweight being 10% greater than the EFW was statistically different between groups 0.001 ( % 20 kg/m2, % 20 to 25kg/m2, % 25 to 30kg/m2, % 30 to 35kg/m2, % 35 to 40kg/ m2, % 40 kg/m2). Despite their being a statistically significant difference of accuracy estimating fetal weight with different BMI categories the accuracy did not decrease linearly with increasing BMI for either overestimation or underestimation of EFW (Table). CONCLUSION: Although the EFW is affected by maternal BMI, increasing maternal BMI does not result in clinically over or underestimation of fetal weight. This study suggests that EFW can be used reliably in patients with varying BMIs. |
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