The journal of maternal-fetal & neonatal medicine : the official journal of the European Association of Perinatal Medicine, the Federation of Asia and Oceania Perinatal Societies, the International Society of Perinatal Obstetricians · 2026
Accuracy of ultrasound-derived estimated fetal weight in a cohort of periviable births.
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Judge-Golden Colleen, Kuehn Sally, Ellestad Sarah, Dotters-Katz Sarah, Craig Amanda M
Аннотация
OBJECTIVE: As neonatal resuscitation is offered at increasing extremes of prematurity, ultrasound-derived estimated fetal weight (EFW) is a crucial data point in patient counseling. We aimed to evaluate the accuracy of EFW compared to birthweight (BW) among periviable neonates, and identify factors associated with accuracy.
METHODS: Medical records were abstracted for all neonates born between 22 weeks 0/7 days and 24 weeks 6/7 days at a single tertiary center between January 2013 and May 2024. Liveborn, non-anomalous neonates with an ultrasound-derived EFW within 7 days of delivery were included. The primary outcome was absolute percent difference between Hadlock 3 EFW and BW ("accuracy"), with BW as the primary predictor. Multivariable linear mixed effects regression was performed including maternal BMI and variables associated with accuracy in univariate analyses at p < 0.1.
RESULTS: 141 neonates from 129 pregnancies were included. Median gestational age at delivery was 23 4/7 weeks, median BW was 560 g [IQR 480, 640], and median time from EFW to delivery was 2 days [IQR 1-3 days]. Over half (55%) of pregnant individuals had BMI >30. Median accuracy was 7.1% [IQR 2.9%, 12.2%]. EFW was within 10%, 15% and 20% of BW in 65.3%, 82.3% and 92.2% of cases, respectively. In univariate analyses, decreasing BW was associated with reduced accuracy (β = -0.012 [-0.02, -0.0002], p = 0.04), and multiple gestations were associated with increased accuracy (median accuracy 3.1% among fetuses with a twin versus 7.9% among singletons; p = 0.002). Maternal BMI was not associated with accuracy (p = 0.08). In multivariable analyses accounting for multiple gestations, BW remained inversely associated with accuracy (β = -0.014 [-0.027, -0.001], p = 0.03). Oligohydramnios was also associated with reduced accuracy (β = 3.47 [1.03, 5.91], p = 0.005).
CONCLUSIONS: Hadlock ultrasound-derived EFW is an overall reasonable predictor of BW among periviable deliveries, but demonstrated reduced accuracy among extremely low birthweight neonates and in the setting of oligohydramnios.
METHODS: Medical records were abstracted for all neonates born between 22 weeks 0/7 days and 24 weeks 6/7 days at a single tertiary center between January 2013 and May 2024. Liveborn, non-anomalous neonates with an ultrasound-derived EFW within 7 days of delivery were included. The primary outcome was absolute percent difference between Hadlock 3 EFW and BW ("accuracy"), with BW as the primary predictor. Multivariable linear mixed effects regression was performed including maternal BMI and variables associated with accuracy in univariate analyses at p < 0.1.
RESULTS: 141 neonates from 129 pregnancies were included. Median gestational age at delivery was 23 4/7 weeks, median BW was 560 g [IQR 480, 640], and median time from EFW to delivery was 2 days [IQR 1-3 days]. Over half (55%) of pregnant individuals had BMI >30. Median accuracy was 7.1% [IQR 2.9%, 12.2%]. EFW was within 10%, 15% and 20% of BW in 65.3%, 82.3% and 92.2% of cases, respectively. In univariate analyses, decreasing BW was associated with reduced accuracy (β = -0.012 [-0.02, -0.0002], p = 0.04), and multiple gestations were associated with increased accuracy (median accuracy 3.1% among fetuses with a twin versus 7.9% among singletons; p = 0.002). Maternal BMI was not associated with accuracy (p = 0.08). In multivariable analyses accounting for multiple gestations, BW remained inversely associated with accuracy (β = -0.014 [-0.027, -0.001], p = 0.03). Oligohydramnios was also associated with reduced accuracy (β = 3.47 [1.03, 5.91], p = 0.005).
CONCLUSIONS: Hadlock ultrasound-derived EFW is an overall reasonable predictor of BW among periviable deliveries, but demonstrated reduced accuracy among extremely low birthweight neonates and in the setting of oligohydramnios.