Percent error of ultrasound examination to estimate fetal weight at term in different categories of birth weight with focus on maternal diabetes and obesity

Background: Sonography based estimate of fetal weight is a considerable issue for delivery planning. The study evaluated the influence of diabetes, obesity, excess weight gain, fetal and neonatal anthropometrics on accuracy of estimated fetal weight with respect to the extent of the percent error of estimated fetal weight to birth weight for different categories. Methods: Multicenter retrospective analysis from 11,049 term deliveries and fetal ultrasound biometry performed within 14 days to delivery. Estimated fetal weight was calculated by Hadlock IV. Percent error from birth weight was determined for categories in 250 g increments between 2500 g and 4500 g. Estimated fetal weight accuracy was categorized as accurate +/- 10% - +/- 20% and > 20%. Results: Diabetes was diagnosed in 12.5%, obesity in 12.6% and weight gain exceeding IOM recommendation in 49.1% of the women. The percentage of accurate estimated fetal weight was not significantly different in the presence of maternal diabetes (70.0% vs. 71.8%, p = 0.17), obesity (69.6% vs. 71.9%, p = 0.08) or excess weight gain (71.2% vs. 72%, p = 0.352) but of preexisting diabetes (61.1% vs. 71.7%; p = 0.007) that was associated with the highest macrosomia rate (26.9%). Mean percent error of estimated fetal weight from birth weight was 2.39% +/- 9.13%. The extent of percent error varied with birth weight with the lowest numbers for 3000 g-3249 g and increasing with the extent of birth weight variation: 5% +/- 11% overestimation in the lowest and 12% +/- 8% underestimation in the highest ranges. Conclusion: Diabetes, obesity and excess weight gain are not necessarily confounders of estimated fetal weight accuracy. Percent error of estimated fetal weight is closely related to birth weight with clinically relevant over- and underestimation at both extremes. This work provides detailed data regarding the extent of percent error for different birth weight categories and may therefore improve delivery planning

Temporal trends in fetal mortality at and beyond term and induction of labor in Germany 2005-2012 : data from German routine perinatal monitoring

Purpose: While a variety of factors may play a role in fetal and neonatal deaths, postmaturity as a cause of stillbirth remains a topic of debate. It still is unclear, whether induction of labor at a particular gestational age may prevent fetal deaths. Methods: A multidisciplinary working group was granted access to the most recent set of relevant German routine perinatal data, comprising all 5,291,011 hospital births from 2005 to 2012. We analyzed correlations in rates of induction of labor (IOL), perinatal mortality (in particular stillbirths) at different gestational ages, and fetal morbidity. Correlations were tested with Pearson's product-moment analysis (α = 5 %). All computations were performed with SPSS version 22. Results: Induction rates rose significantly from 16.5 to 21.9 % (r = 0.98; p \ 0.001). There were no significant changes in stillbirth rates (0.28-0.35 per 100 births; r = 0.045; p = 0.806). Stillbirth rates 2009-2012 remained stable in all gestational age groups irrespective of induction. Fetal morbidity (one or more ICD-10 codes) rose significantly during 2005–2012. This was true for both children with (from 33 to 37 %, r = 0.784, p \ 0.001) and without (from 25 to 31 %, (r = 0.920, p \ 0.001) IOL. Conclusions: An increase in IOL at term is not associated with a decline in perinatal mortality. Perinatal morbidity increased with and without indiction of labor

Association between the cervical sliding sign and successful induction of labor in women with an unfavorable cervix: A prospective observational study

Objectives: To evaluate the role of the cervical sliding sign (CSS) in the prediction of the outcome of induction of labor (IOL). Study design: Two-center prospective observational cohort study involving a non-consecutive series of uncomplicated singleton term pregnancies, planned for IOL, with a fetus in cephalic presentation and unfavorable cervix as defined by a Bishop score ≤ 6. The Bishop score was evaluated by transvaginal digital examination and the cervical length and CSS by transvaginal ultrasound. The presence of CSS was defined as the sliding of the anterior cervical lip on the posterior one under gentle pressure of the transvaginal probe. The primary outcome of the study was successful vaginal delivery within 24 h. The secondary outcome was the induction-to-active-labor time. The interobserver agreement for the CSS was also evaluated. Results: Over a period of 12 months, 179 women were included. The CSS was found in 86 (48.0 %) patients and was associated with an increased likelihood of vaginal delivery within 24 h (60/86 or 69.8 % vs 27/93 or 29.0 %, P < 0.001) and a shorter induction-to-active-labor time (954 ± 618 min vs 1416 ± 660 min, P < 0.001). Multivariable regression analysis showed that the CSS was an independent predictor of vaginal delivery within 24 h (aOR 5.37, 95 % CI 2.26–12.75) and shorter induction-to-active-labor time interval (HR 1.81, 95 % CI 1.19–2.74). The interobserver variability based on intraclass correlation coefficient for the CSS was excellent (ICC = 0.90). Conclusion: In women undergoing IOL with an unfavorable cervix, the CSS is associated with a higher frequency of vaginal delivery within 24 h and a shorter induction-to-active-labor time

The sonographic measurement of the ratio between the fetal head circumference and the obstetrical conjugate is accurate in predicting the risk of labor arrest: results from a multicenter prospective study

Labor arrest is estimated to account for approximately one-third of all primary cesarean deliveries, and is associated with an increased risk of adverse maternal and perinatal outcomes. One of the main causes is the mismatch between the size of the birth canal and that of the fetus, a condition usually referred to as cephalopelvic disproportion

"A Pragmatic, Randomized Clinical Trial of Gestational Diabetes Screening"-eine interdisziplinäre Stellungnahme.

Die Diskussion um den besten Weg des Screenings auf Gestationsdiabetes hält international an und ist so relevant, dass in USA mit großem Aufwand eine Screeningstudie aufgelegt wurde. Im März 2021 wurde im New England Journal of Medicine (NEJM) eine großangelegte randomisierte Studie mit knapp 24.000 Schwangeren veröffentlicht, die das Outcome bei ein- versus zweizeitigem Screening auf Gestationsdiabetes untersuchte [1]. Das heißt, alleiniger 75 g oGTT versus 50 g Suchtest mit nachfolgendem OGTT nur bei auffälligem Suchtest. Die Auswertung ergab, dass GDM in der Gruppe mit einzeitigem Vorgehen häufiger diagnostiziert wurde als bei zweizeitigem (16,5 vs 8,5%). Es gab keinen signifikanten Unterschied zwischen den beiden Gruppen in der Rate an Neugeborenen mit large-for-gestational-age Geburtsgewicht (LGA) (8,9 vs 9,2%), schwangerschaftsinduziertem Hypertonus oder Präeklampsie (13,6 vs 13,5%), Entbindung per Sectio (24 vs 24,6%) und kombiniertem ungünstigen Outcome (Totgeburt, neonataler Tod und Schulterdystokie, Frakturen, Paresen). Da die Studie auch für unsere Diskussion in Deutschland relevant sein könnte, haben Experten der Deutschen Diabetes Gesellschaft (DDG), der Deutschen Gesellschaft für Gynäkologie und Geburtshilfe, der Hebammenwissenschaften und Beteiligte an der Erstellung der gültigen S3 Leitlinie zu Gestationsdiabetes (AWMF 015/008) sich entschlossen, ihre Einschätzung und eventuelle Konsequenzen für uns in einer Stellungnahme darzulegen