Al-Obaidly Sawsan, Al-Ibrahim Abdullah, Saleh Najah, Al-Belushi Mariam, Al-Mansouri Zeena, Khenyab Najat
a Obstetrics and Gynecology Department , Hamad Medical Corporation, Feto-Maternal Medicine Unit , Doha , Qatar.
J Matern Fetal Neonatal Med. 2019 Apr;32(8):1275-1279. doi: 10.1080/14767058.2017.1404566. Epub 2017 Nov 22.
Several studies have highlighted the negative impact of maternal obesity on ultrasound accuracy for fetal weight estimation (EFW). However, the evidence is conflicting. We aimed in our study to find if the ultrasound accuracy for EFW would differ or decrease in obese and morbid obesity classes. We also studied the mode of delivery within the same cohort.
It is a retrospective study of obese patients with recorded BMI ≥30 kg/m, class I and II (BMI: 30-39.9 kg/m) compared with extreme obese class III (BMI ≥40 kg/m), who gave birth after 28-week gestation of viable singleton, who had an ultrasound within 7 d of delivery with reported normal amniotic fluid and no major fetal anomaly; the EFW was consistently measured through Hadlock regression formula in the period of 2014-2015 inclusive. Differences between the EFW and actual birth weight (ABW) were assessed by percentage error, accuracy in predictions within ±10% of error and the Pearson correlation coefficient were used to correlate EFW with the ABW. The study's secondary outcome was to study the mode of delivery and the rate of cesarean section in obese and morbid obese patients.
Total 106 cases fulfilled our criteria. Class I and II as the first group (n = 53). Class III as the second group (n = 53). Maternal and birth characteristics were similar. The Pearson correlation coefficient equal 1 in both groups. The overall mean absolute difference (MAD) in grams of the whole obese cohort was 242 ± 213. The MAD was 242 ± 202 and 242 ± 226 g for the first and second group, respectively (p = 1.0). The overall mean absolute percentage error (MAPE) in this obese cohort was 8%. The MAPE for the first and second group, respectively were 8 and 7% (p = 0.4). The overall rate of cesarean delivery was 60% (64/106) with no differences between the obese and morbid obese BMI classes. Sixty-six percentage (42/64) of these cesarean cases was for repeat cesarean section.
Despite what has been previously reported about the negative impact of maternal obesity on EFW accuracy, we could not demonstrate this relationship in our obese cohort (MAPE <10%). In addition, we could not illustrate a significant difference in ultrasound accuracy across various obesity classes. However, we found a significantly increased rate of delivery by repeated cesarean section in this obese cohort.
多项研究强调了母亲肥胖对胎儿体重估计（EFW）超声准确性的负面影响。然而，证据相互矛盾。我们的研究旨在确定肥胖和病态肥胖类别中EFW的超声准确性是否会有所不同或降低。我们还研究了同一队列中的分娩方式。
这是一项对BMI≥30 kg/m的肥胖患者进行的回顾性研究，将I级和II级（BMI：30 - 39.9 kg/m）与极度肥胖的III级（BMI≥40 kg/m）进行比较，这些患者在妊娠28周后分娩了存活的单胎，在分娩前7天内进行了超声检查，报告羊水正常且无重大胎儿异常；在2014年至2015年期间，通过Hadlock回归公式持续测量EFW。通过百分比误差评估EFW与实际出生体重（ABW）之间的差异，使用误差在±10%以内的预测准确性以及Pearson相关系数将EFW与ABW进行关联。该研究的次要结果是研究肥胖和病态肥胖患者的分娩方式及剖宫产率。
共有106例符合我们的标准。第一组为I级和II级（n = 53）。第二组为III级（n = 53）。母亲和出生特征相似。两组的Pearson相关系数均为1。整个肥胖队列以克为单位的总体平均绝对差（MAD）为242±213。第一组和第二组的MAD分别为242±202和242±226克（p = 1.0）。该肥胖队列的总体平均绝对百分比误差（MAPE）为8%。第一组和第二组的MAPE分别为8%和7%（p = 0.4）。剖宫产的总体发生率为60%（64/106），肥胖和病态肥胖BMI类别之间无差异。这些剖宫产病例中有66%（42/64）是再次剖宫产。
尽管先前有报道称母亲肥胖对EFW准确性有负面影响，但在我们的肥胖队列中（MAPE <10%），我们未能证明这种关系。此外，我们未能说明不同肥胖类别之间超声准确性存在显著差异。然而，我们发现该肥胖队列中再次剖宫产的分娩率显著增加。
