ORIGINAL ARTICLE   

Minerva Obstetrics and Gynecology 2023 Mar 21

DOI: 10.23736/S2724-606X.22.05167-3

Copyright © 2022 EDIZIONI MINERVA MEDICA

language: English

Bigger babies: what happens in real practice in a non-academic UK center? Detection accuracy and outcomes with induction

Ben SIMPSON ¹ ✉, Katie BARKER ², Laura PARNELL ³, Gareth J. WARING ^{1, 3}

¹ Clinical Academic Office, Faculty of Medical Sciences, Newcastle University, Newcastle upon Tyne, UK; ² Department of Obstetrics and Gynecology, Northumbria Healthcare NHS Foundation Trust, Newcastle upon Tyne, UK; ³ Department of Maternal-Fetal Medicine, Royal Victoria Infirmary, Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, UK

BACKGROUND: There is emerging evidence of improved outcomes with induction of labour for pregnancies in which the baby is thought to be large. This trial identifies scan accuracy and the effect of intervention for pregnancies complicated by suspected large for gestational age (LGA) on customized chart outside an academic center.
METHODS: This is a retrospective cohort study of 3 groups of induced pregnancies; women with a suspected LGA fetus, women with diabetes (DM) and a control group (C) of women that underwent induction of labour on or after 280 days gestation. Data collection and analysis were prespecified. Scan accuracy and outcomes between the cohorts were compared.
RESULTS: Over 1 year there were 845 cases: LGA (128), DM (116) and control cases (601). Mean birthweights differed significantly. PPV of EFW for birthweight >90^th centile on GROW chart, WHO chart, and >4 kg was 0.35-0.40. Projected birthweight of >4 kg significantly better predicted itself (AUROC 0.70, 0.74 and 0.80). Mean scan error was -5.2% and +15.6% for DM and LGA. Shoulder dystocia and neonatal morbidity were not increased in LGA despite the significant increase in AVD 28/128, 21.9% vs. 99/601, 16.5%, aOR 2.20 (1.07-4.5). SVD was significantly less likely LGA vs. C at 69/128, 53.9% vs. 413/601, 68.7% aOR 0.38 (95% CI: 0.21-0.70).
CONCLUSIONS: Third trimester EFW for bigger babies was poorly predictive of macrosomia. Fetal outcomes were good but women selected and induced as LGA had higher rates of hemorrhage and intervention.

KEY WORDS: Delivery, obstetric; Fetal macrosomia; Ultrasonography; Labor, obstetric; Prenatal diagnosis