Validation of Sonographic Fetal Weight Estimators Among Term Parturients in Uganda

Abstract BackgroundAccuracy of fetal weight estimation by ultrasound is essential in making decisions on the time and mode of delivery. There are many proposed formulas for fetal weight estimation such as Hadlock 1, Hadlock 2, Hadlock 3, Hadlock 4 and Shepard. What best applies to the Ugandan population isn’t known since no validation of any of the formulas has been done before. The primary aim of this study was to determine the accuracy of sonographic estimation of fetal weight using five most commonly used formulas, and analyze formula variations for different weight ranges. MethodsThis was a hospital based prospective cohort study at Mulago National Referral Hospital, Kampala, Uganda. A total of 356 pregnant women who consented and were within three days of birth, prenatal ultrasound fetal weight determined by measuring the biparietal diameter, head circumference, abdominal circumference, femoral length, and then was compared with actual birth weight. ResultsThe overall accuracy of Hadlock 1, Hadlock 2, Hadlock 3, Hadlock 4 and Shepard formula were 66.9%, 73.3%, 77.3%, 78.4% and 69.7% respectively. All Hadlocks showed significant mean difference between weight estimates and actual birth weight (p<0.01) whereas Shepard formula did not [p - 0.2], when no stratification of fetal weights was done. However, all Hadlocks showed a none significant (p-values > 0.05) mean difference between weight estimates and actual birth weight when the actual birth weight was ≥4000.0gms. Shepard weight estimates showed a none significant mean difference when actual birth weight was <4000gms. Bland-Altman graphs also showed a better agreement of weight estimated by Shepard formula and actual birth weights. ConclusionAll the five formulas were accurate at estimating actual birth weights within 10% accuracy. However, this accuracy varied with the fetal birth weight. Shepard was more accurate in estimating actual birth weights <4000grams whereas all Hadlocks were more accurate when the actual birthweight was ≥ 4000grams.