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Macrosomia Prediction Using Ultrasound Fetal Abdominal Circumference of 35 Centimeters or More

From the Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Louisiana State University Medical Center, Shreveport, Louisiana, and Department of Obstetrics and Gynecology, College of Medicine, University of South Florida, Tampa, Florida.

Address reprint requests to: William N. Spellacy, MD, Suite 514, 4 Columbia Drive, Tampa, FL 33606

Objective: To determine if birth weights greater than 4000 g can be predicted by ultrasound measurements of abdominal circumferences.

Methods: In 1996, 254 newborns delivered at Tampa General Hospital weighed at least 4000 g, 84 of whom had ultrasound examinations within 2 weeks of delivery. Those were compared with 84 neonates with recent ultrasounds who weighed less than 4000 g. Data were abstracted retrospectively from maternal medical records.

Results: The best linear predictor of birth weight was ultrasound measurement of abdominal circumference (AC), which had a correlation coefficient of 0.95. An AC measurement of 35 cm or more predicted 93% of macrosomic infants. Among 177 macrosomic infants born vaginally, 23 (13%) had shoulder dystocia. In that group, induction of labor was associated with a greater than three-fold increase in risk of shoulder dystocia (odds ratio [OR] 3.4, 95% confidence interval [CI] 1.4, 8.2; P < .01). Labor augmentation was not associated with increased risk of shoulder dystocia.

Conclusion: Abdominal circumference measurements were useful in screening for suspected macrosomia. An AC measurement of 35 cm or more identified more than 90% of macrosomic infants who were at risk for shoulder dystocia. Induction of labor in macrosomic patients increased the risk of shoulder dystocia.

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