Clinical and sonographic estimation of fetal weight performed during labor by residents

OBJECTIVE: This study was undertaken to assess the accuracy of both clinical and sonographic estimations of the fetal weight (EFW) performed during the active phase of labor by residents. METHODS: The study protocol consisted of achieving clinical, followed by sonographic EFW by the admitting resident during the active phase of labor. Patients who had an EFW (clinical or sonographic) within the last 2 weeks were excluded from the study. In addition, the effect of the following variables on the accuracy of the EFW were examined: maternal age, maternal weight and body mass index, parity, the Bishop score before obtaining the EFW, gestational age, birth weight, and the postgraduate year of the examiner. The Pearson correlation, chi2 test, and Student t test were the statistical analyses used. We also calculated the sensitivity, specificity, and positive and negative predictive values for clinical and sonographic EFW for detecting macrosomia (birth weight > or = 4000 g). RESULTS: A total of 192 patients participated in this study. The coefficient of correlation between the clinical and sonographic EFW and the actual birth weight was 0.59 (P < .0001) and 0.65 (P < .0001), respectively. Clinical EFW was correct (within +/-10%) in 72% of the cases and the sonographic EFW was correct (within +/-10%) in 74% of the cases. However, the sensitivity of predicting birth weight of 4 kg or more was only 50% for both clinical and sonographic EFW, with 95% and 97% specificity, respectively. None of the clinical variables that were tested were significantly associated with the accuracy of the EFW. CONCLUSION: Both clinical and sonographic EFW performed during the active phase of labor by residents correlate with the actual birth weight but have poor sensitivity in detecting macrosomic fetuses. Sonographic EFWs offer no advantage over clinical EFWs.