Department of Obstetrics and Gynaecology, University Teaching Hospital Tauernklinikum Zell am See, Paracelsusstrasse 8, A-5700, Zell am See, Austria.
Department of Obstetrics and Gynaecology, Division of General Gynaecology and Gynaecologic Oncology, Medical University of Vienna, Waehringer Guertel 18-20, A-1090, Vienna, Austria.
BMC Pregnancy Childbirth. 2019 Apr 11;19(1):122. doi: 10.1186/s12884-019-2251-5.
Fetal weight estimation is of key importance in the decision-making process for obstetric planning and management. The literature is inconsistent on the accuracy of measurements with either ultrasound or clinical examination, known as Leopold's manoeuvres, shortly before term. Maternal BMI is a confounding factor because it is associated with both the fetal weight and the accuracy of fetal weight estimation. The aim of our study was to compare the accuracy of fetal weight estimation performed with ultrasound and with clinical examination with respect to BMI.
In this prospective blinded observational study we investigated the accuracy of clinical examination as compared to ultrasound measurement in fetal weight estimation, taking the actual birth weight as the gold standard. In a cohort of all consecutive patients who presented in our department from January 2016 to May 2017 to register for delivery at ≥37 weeks, examination was done by ultrasound and Leopold's manoeuvres to estimate fetal weight. All examiners (midwives and physicians) had about the same level of professional experience. The primary aim was to compare overall absolute error, overall absolute percent error, absolute percent error > 10% and absolute percent error > 20% for weight estimation by ultrasound and by means of Leopold's manoeuvres versus the actual birth weight as the given gold standard, namely separately for normal weight and for overweight pregnant women.
Five hundred forty-three patients were included in the data analysis. The accuracy of fetal weight estimation was significantly better with ultrasound than with Leopold's manoeuvres in all absolute error calculations made in overweight pregnant women. For all error calculations performed in normal weight pregnant women, no statistically significant difference was seen in the accuracy of fetal weight estimation between ultrasound and Leopold's manoeuvres.
Data from our prospective blinded observational study show a significantly better accuracy of ultrasound for fetal weight estimation in overweight pregnant women only as compared to Leopold's manoeuvres with a significant difference in absolute error. We did not observe significantly better accuracy of ultrasound as compared to Leopold's manoeuvres in normal weight women. Further research is needed to analyse the situation in normal weight women.
胎儿体重估算是产科计划和管理决策过程中的关键。文献对于在接近足月时使用超声或临床检查（称为 Leopold 手法）进行测量的准确性存在不一致。母体 BMI 是一个混杂因素，因为它与胎儿体重和胎儿体重估计的准确性都有关。我们的研究目的是比较超声和临床检查在 BMI 方面的胎儿体重估计准确性。
在这项前瞻性、盲法观察性研究中，我们以实际出生体重为金标准，比较了超声测量与临床检查在胎儿体重估计中的准确性。在 2016 年 1 月至 2017 年 5 月期间，我们对在我们部门登记分娩的所有连续患者进行了研究，这些患者在 37 周以上时进行了超声和 Leopold 手法检查以估计胎儿体重。所有检查者（助产士和医生）都具有大致相同的专业经验。主要目的是比较超声和 Leopold 手法在估计体重时的总体绝对误差、总体绝对百分比误差、绝对百分比误差>10%和绝对百分比误差>20%与实际出生体重作为金标准的情况，分别针对正常体重和超重孕妇进行比较。
543 例患者纳入数据分析。在所有超重孕妇的绝对误差计算中，超声对胎儿体重估计的准确性明显优于 Leopold 手法。在所有正常体重孕妇的误差计算中，超声和 Leopold 手法在胎儿体重估计的准确性方面没有统计学差异。
我们前瞻性、盲法观察性研究的数据显示，仅在超重孕妇中，与 Leopold 手法相比，超声对胎儿体重估计的准确性显著提高，绝对误差存在显著差异。在正常体重女性中，我们没有观察到超声比 Leopold 手法具有显著更高的准确性。需要进一步研究来分析正常体重女性的情况。
