Ben-Haroush Avi, Yogev Yariv, Hod Moshe
Perinatal Division, WHO Collaborating Center for Perinatal Care, Department of Obstetrics and Gynecology, Rabin Medical Center, Beilinson Campus, Petah Tiqva, Israel.
J Perinat Med. 2004;32(2):113-21. doi: 10.1515/JPM.2004.021.
To review the literature on the accuracy of sonographic estimated fetal weight (EFW) in diabetic pregnancies, specifically on its role in the prediction and clinical management of fetal macrosomia.
An English language literature search of Medline listings was performed to review the recently published data on sonographic fetal weight estimation in diabetic pregnancies and suspected fetal macrosomia.
Ultrasound biometry used to detect macrosomia is characterized by low sensitivity, low positive predictive value, and high negative predictive value. Serial sonographic measurements and the use of additional examiners can increase the positive predictive value. Regardless of the formula used, the accuracy of the sonographic estimate decreases with increasing birth weight. Three-dimensional ultrasound and magnetic resonance imaging techniques are still investigational. To date, none of the management algorithms developed for selective interventions that are based on the sonographic EFW have demonstrated any efficacy in reducing the incidence of either shoulder dystocia or brachial plexus injury.
The true value of ultrasonography in the management of fetal macrosomia may be its ability to rule out the diagnosis. Ultrasound-derived fetal weight estimates alone are not sufficient grounds for deciding the route of delivery. To assess the risk of macrosomia, other known risk factors should also be taken into account. To determine the mode of delivery, the clinical fetal weight estimate, subjective maternal weight estimate, and clinical assessment of pelvic capacity should be added to the sonographic fetal weight estimate, with consideration of the risk factors for macrosomia.
回顾关于糖尿病妊娠中超声估计胎儿体重（EFW）准确性的文献，特别是其在巨大胎儿预测和临床管理中的作用。
对Medline列表进行英文文献检索，以回顾最近发表的关于糖尿病妊娠和疑似巨大胎儿中超声胎儿体重估计的数据。
用于检测巨大胎儿的超声生物测量法具有低敏感性、低阳性预测值和高阴性预测值的特点。连续超声测量和增加检查人员可提高阳性预测值。无论使用何种公式，超声估计的准确性都会随着出生体重的增加而降低。三维超声和磁共振成像技术仍处于研究阶段。迄今为止，基于超声EFW制定的用于选择性干预的管理算法，均未显示出在降低肩难产或臂丛神经损伤发生率方面有任何效果。
超声在巨大胎儿管理中的真正价值可能在于其排除诊断的能力。仅超声得出的胎儿体重估计不足以作为决定分娩方式的依据。为评估巨大胎儿风险，还应考虑其他已知风险因素。为确定分娩方式，应在超声胎儿体重估计的基础上，增加临床胎儿体重估计、产妇主观体重估计以及骨盆容量的临床评估，并考虑巨大胎儿的风险因素。
