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• W2148972265 abstract "ObjectiveTo test the performance of a sonographic estimation of “fetal asymmetry” in the prediction of shoulder dystocia (SD).Study designIn a prospective cohort study from November 1, 2003, to February 2, 2005, women having an ultrasound performed within 14 days of a singleton liveborn vaginal delivery ≥ 3400 grams were evaluated. A fetal asymmetry index was calculated by subtracting the biparietal diameter (BPD) from the abdominal diameter (AD, or AC/Π). This index was compared between deliveries complicated by SD and deliveries in which no SD occurred. An ROC curve was generated to determine the optimal cutoff for SD prediction. The performance of an elevated fetal asymmetry index was then compared to markers of fetal macrosomia for the prediction of SD.Results5,204 deliveries were reviewed and 332 met inclusion criteria. Of these, 23 (6.9%) were complicated by SD. The mean asymmetry index was significantly higher in the SD group (2.39 ± 0.55 cm) compared to the no SD group (1.97 ± 0.51 cm) (p= 0.0002). A fetal asymmetry index ≥ 2.6 cm was determined to optimally reflect “fetal asymmetry.” Above this cutoff, the risk of SD was 25% for unselected patients and 38.5% for those with diabetes. The Odds Ratio (95% CI) for SD with an elevated asymmetry index was 7.15 (2.89, 17.7). Compared to ultrasound measurements of macrosomia, only an elevated fetal asymmetry index predicted a significantly increased risk of SD (Table 1).ConclusionTabled 1Sonographic predictors of shoulder dystociaSens.Spec.PPVOR (95%CI)AD-BPD ≥ 2.6 cm0.440.900.257.15 (2.9,17.7)AC > 95%0.360.790.101.95 (0.6,6.1)EFW > 4 kg0.170.850.081.15 (0.4,3.5)EFW > 97%0.130.950.171.95 (0.5,6.1) Open table in a new tab ObjectiveTo test the performance of a sonographic estimation of “fetal asymmetry” in the prediction of shoulder dystocia (SD). To test the performance of a sonographic estimation of “fetal asymmetry” in the prediction of shoulder dystocia (SD). Study designIn a prospective cohort study from November 1, 2003, to February 2, 2005, women having an ultrasound performed within 14 days of a singleton liveborn vaginal delivery ≥ 3400 grams were evaluated. A fetal asymmetry index was calculated by subtracting the biparietal diameter (BPD) from the abdominal diameter (AD, or AC/Π). This index was compared between deliveries complicated by SD and deliveries in which no SD occurred. An ROC curve was generated to determine the optimal cutoff for SD prediction. The performance of an elevated fetal asymmetry index was then compared to markers of fetal macrosomia for the prediction of SD. In a prospective cohort study from November 1, 2003, to February 2, 2005, women having an ultrasound performed within 14 days of a singleton liveborn vaginal delivery ≥ 3400 grams were evaluated. A fetal asymmetry index was calculated by subtracting the biparietal diameter (BPD) from the abdominal diameter (AD, or AC/Π). This index was compared between deliveries complicated by SD and deliveries in which no SD occurred. An ROC curve was generated to determine the optimal cutoff for SD prediction. The performance of an elevated fetal asymmetry index was then compared to markers of fetal macrosomia for the prediction of SD. Results5,204 deliveries were reviewed and 332 met inclusion criteria. Of these, 23 (6.9%) were complicated by SD. The mean asymmetry index was significantly higher in the SD group (2.39 ± 0.55 cm) compared to the no SD group (1.97 ± 0.51 cm) (p= 0.0002). A fetal asymmetry index ≥ 2.6 cm was determined to optimally reflect “fetal asymmetry.” Above this cutoff, the risk of SD was 25% for unselected patients and 38.5% for those with diabetes. The Odds Ratio (95% CI) for SD with an elevated asymmetry index was 7.15 (2.89, 17.7). Compared to ultrasound measurements of macrosomia, only an elevated fetal asymmetry index predicted a significantly increased risk of SD (Table 1). 5,204 deliveries were reviewed and 332 met inclusion criteria. Of these, 23 (6.9%) were complicated by SD. The mean asymmetry index was significantly higher in the SD group (2.39 ± 0.55 cm) compared to the no SD group (1.97 ± 0.51 cm) (p= 0.0002). A fetal asymmetry index ≥ 2.6 cm was determined to optimally reflect “fetal asymmetry.” Above this cutoff, the risk of SD was 25% for unselected patients and 38.5% for those with diabetes. The Odds Ratio (95% CI) for SD with an elevated asymmetry index was 7.15 (2.89, 17.7). Compared to ultrasound measurements of macrosomia, only an elevated fetal asymmetry index predicted a significantly increased risk of SD (Table 1). ConclusionTabled 1Sonographic predictors of shoulder dystociaSens.Spec.PPVOR (95%CI)AD-BPD ≥ 2.6 cm0.440.900.257.15 (2.9,17.7)AC > 95%0.360.790.101.95 (0.6,6.1)EFW > 4 kg0.170.850.081.15 (0.4,3.5)EFW > 97%0.130.950.171.95 (0.5,6.1) Open table in a new tab" @default.
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• W2148972265 date "2005-12-01" @default.
• W2148972265 modified "2023-09-25" @default.
• W2148972265 title "Sonographic “fetal asymmetry” predicts shoulder dystocia" @default.
• W2148972265 doi "https://doi.org/10.1016/j.ajog.2005.10.132" @default.
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