In the realm of antepartum fetal surveillance, ultrasound plays a crucial role, especially in estimating fetal weight (EFW). Over the years, various formulas utilizing different fetal biometrics like abdominal circumference (AC), femur length (FL), head circumference (HC), and biparietal diameter (BPD) have been proposed for EFW calculations. These formulas have been extensively studied in different scenarios such as small for gestational age, large for gestational age, macrosomia, fetal gender, and multiple gestation.
Preterm premature rupture of membranes (PPROM) is a condition affecting a small percentage of pregnancies, necessitating specialized care and monitoring. Management typically involves admission, antibiotic therapy, regular vital signs monitoring, and periodic tests like non-stress tests and ultrasounds. However, the effectiveness of EFW formulas in the context of PPROM has been a topic of debate, with limited studies addressing this issue comprehensively.
In a recent retrospective cohort study spanning from 2005 to 2017, researchers evaluated the accuracy of 21 sonographic EFW formulas in women with singleton gestations and PPROM. The study cohort comprised 565 women admitted to a tertiary center, with EFW measurements taken within 14 days of delivery. Notably, the mean gestational age at admission was 26.8 weeks, with delivery occurring at 28.2 weeks on average.
The study found that most EFW formulas exhibited a strong correlation with actual birth weight, with the Ott (1986) formula emerging as the most accurate among the tested formulas. This formula, incorporating AC, FL, and HC measurements, demonstrated the highest proportion of estimates within 10% of birth weight and the lowest Euclidean distance. Interestingly, the commonly used Hadlock IV formula also performed well, with over 70% of estimates falling within 15% of actual birth weight.
Previous research has shown varying results regarding the accuracy of EFW formulas in PPROM cases. Studies conducted decades ago indicated that EFW accuracy in PPROM cases was comparable to those with intact membranes, albeit with smaller sample sizes. More contemporary studies have echoed similar findings, albeit with differences in sample sizes and gestational ages at delivery.
While the Ott formula emerged as the most accurate in this study, the differences in performance among the top-ranking formulas were marginal. The Hadlock IV formula, widely integrated into ultrasound machines, demonstrated consistent accuracy regardless of fetal gender or amniotic fluid levels. These findings provide valuable insights for clinicians managing pregnancies complicated by PPROM, offering reassurance on the reliability of commonly used EFW formulas in this specific setting.
Despite the study’s robust methodology and standardized management protocols, limitations such as its retrospective design and lack of certain demographic data may impact the generalizability of the findings. Further research is warranted to delve deeper into the nuances of EFW accuracy in diverse clinical scenarios and to refine our understanding of fetal weight estimation through ultrasound in the context of PPROM.
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