Sonographic abdominal circumference: dynamic versus static imaging

Ultrasonic fetal weight estimation: analysis of inter- and intra-observer variability

Standard ultrasound measurements were performed by two observers in 40 third-trimester fetuses. Observers were blinded to the results of the measurements. Estimated fetal weight (EFW) was calculated using two published formulae. The intra-observer standard deviation for EFW, assessed using one-way analysis of variance, was < 75 g for both observers. The 95% prediction intervals for inter-observer comparisons of EFW, calculated using the limits of agreement method, were -187.3 g to 139.8 g, and -159.9 g to 124.3 g, using the two formulae. The results suggest that measurements of EFW are reproducible. The prediction interval is comparable to the weekly fetal weight increment in normal fetuses.

A comparison of three methods of assessing inter-observer variation applied to ultrasonic fetal measurement in the third trimester

The inter-observer variation of fetal biparietal diameter, head circumference, abdominal circumference, and femoral length measured in the third trimester by ultrasound was studied by three different methods--coefficient of variation, correlation coefficient, and the 95% limits of agreement. The coefficients of variation were 1.6 to 3.7%, the correlation coefficients were 0.89 to 0.98 with P values of less than 0.001, yet the limits of agreement when applied to centile charts were found to be too wide to separate reliably small fetuses from those that were not small. We conclude that the limits of agreement is the preferred method of assessing inter-observer variation, and we suggest that future research into growth retardation move away from ultrasonic measurements of the fetus.

Fetal weight estimation in twin pregnancies

In this study the fetal weight was estimated by ultrasound measurements of the biparietal (BPD) and abdominal diameters (AD) in 154 consecutive twin pregnancies. In 80 twins an attempt to estimate fetal weight was made 0-4 days before delivery (26% of all twins examined). In 84% (67 infants) it was possible to estimate the fetal weight using the formula (0.0108 X AD1.72 X BPD0.99). 60% of the birth weights deviated less than 10% from the estimated fetal weight and 83% deviated less than 15%. The prediction error was nearly constant, expressed as percent of actual weight in the different weight groups (8.5-9.8%). In 19 LGA infants, 69% of the birth weights deviated less than 10% from the estimated fetal weight and 70% deviated less than 15%.

Ultrasonic prediction of birth weight in preterm fetuses: which formula is best?

Data from previous studies have suggested that birth weight prediction was enhanced by using formulas specifically derived from preterm fetuses. However, no prospective comparison of different formulas was performed. We obtained ultrasonic data on 61 pregnancies at risk for preterm delivery with a gestational age of 29.0 +/- 3.0 weeks (mean +/- SD). In all women birth weight was predicted within 7 days of delivery. Of the 61 pregnancies, 49 (80%), 41 (67%), 30 (49%), and 17 (28%) weighed less than 1750, 1500, 1250, and 1000 gm, respectively; 14 published formulas were compared for accuracy in predicting birth weight in these four categories. The formulas with the smallest absolute mean percent errors incorporated head and abdominal circumferences and femur length. The formula of Weiner et al., derived from low birth weight infants, produced the smallest absolute mean percent error and SD, 10.9% +/- 7.9%; this error was further reduced to 7.7% +/- 6.5% in infants weighing less than 750 gm. These findings suggest that birth weight in the preterm fetus is best predicted by a formula targeted to such a population.

Estimation of fetal weight in the third trimester by ultrasound

A method to estimate the intrauterine fetal weight by use of ultrasound measurements of the fetal biparietal diameter (BPD) and the abdominal diameter (AD) is presented. From a consecutive series of single pregnancies the 238 pregnancies (3% of the hospital population) with ultrasound measurements obtained within 4 days before delivery were used in the estimation of birth weight. In addition, the estimated formula was applied on a test material consisting of 100 similarly selected pregnancies from the same hospital. To evaluate the expected selection effects, the birth weight for gestational age in the study group was compared with birth weight for gestational age in the total population. The weight could be estimated as 0.0351 X AD1.65 X BPD0.69 X exp(0.00196 X gestational age). Thus, the actual birth weight was within 83-120% of the estimated weight (95% prediction limits), with a residual coefficient of variation of about 9%. The gestational age could be omitted without major influence on the weight prediction. When applying the formula on the test material, 70% of the actual weights deviated less than 10% from the estimated fetal weight, but a tendency towards a slight overestimation of the weight for light for gestational age infants was found.

Accuracy of an average ultrasonic laboratory in measurements of fetal biparietal diameter, head circumference and abdominal circumference

Twenty patients between 14 and 28 gestational weeks were scanned on three occasions during a single day by six operators with different ultrasonic experience (three use a compound scanner and three a real-time equipment). On each occasion every operator had to measure in a "blind" manner the fetal biparietal diameter (BPD), head circumference and abdominal circumference (HC and AC); a coded copy of head and abdominal circumference was subsequently measured by one of the members of the staff. Statistical analysis was carried out on the 1800 measurements, and it was concluded that the accuracy was not dissimilar from that reported by pilot studies. The reproducibility of the parameters studied did not change throughout pregnancy and real-time and compound scanner yielded homogeneous results.

Fetal weight estimation by real-time ultrasound measurement of biparietal and transverse trunk diameter

Measurements of biparietal diameter and transverse trunk diameter with the use of linear array real-time B-mode scanning were performed on 100 fetuses within 72 hours of delivery to evaluate the reliability of Hansmann and associates, nomogram in predicting fetal weight. Under optimal conditions, 82% of predicted birth weights were within 10% of actual birth weight with a mean error of 150 gm (6%) and a correlation coefficient of 0.98. Predictions were most accurate in fetuses weighing less than 1,500 gm and in the 2,000 to 4,000 gm group and were least accurate in the infant weighing less than 1,500 gm and in the 2,000 to 4,000 gm group and were least accurate in the infant weighing more than 4,000 gm. Once the accuracy of the method was determined, It was applied to 100 consecutive cases to evaluate the feasibility of this technique in clinical practice. Measurements were unobtainable in 15%, but in the remainder, predictions were of sufficient accuracy throughout the range of fetal weights to complement clinical assessment in the management of high-risk pregnancies. Seventy-four percent of predicted weights were within 10% of actual birth weight; the mean error was 165 gm (7.2%) and the correlation coefficient was 0.97.