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Lookup NU author(s): Dr Ben Simpson, Katie Barker, Dr Gareth Waring
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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 >90th 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.
Author(s): Simpson B, Barker K, Parnell L, Waring GJ
Publication type: Article
Publication status: Published
Journal: Minerva Obstetrics and Gynecology
Year: 2024
Volume: 76
Issue: 4
Pages: 305-311
Print publication date: 01/08/2024
Acceptance date: 02/04/2018
ISSN (print): 2724-606X
ISSN (electronic): 2724-6450
Publisher: Edizioni Minerva Medica
URL: https://doi.org/10.23736/S2724-606X.22.05167-3
DOI: 10.23736/S2724-606X.22.05167-3
PubMed id: 36943256
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