Which is the most accurate formula to estimate fetal weight in women with severe preterm preeclampsia?

Abstract

Objective. To identify the most accurate formula to estimate fetal weight (EFW) from ultrasound parameters in severe preterm preeclampsia.

Methods. In a prospective study, serial ultrasound assessments were performed in 123 women with severe preterm preeclampsia. The EFW, calculated for 111 live born, normal, singleton fetuses within 7 days of delivery using 38 published formulae, was compared to the actual birth weight (ABW). Accuracy was assessed by correlations, mean (absolute and signed) (%) errors, % correct predictions within 5–20% of ABW and limits of agreement.

Results. Accuracy was highly variable. Most formulae systematically overestimated ABW. Five Hadlock formulae utilizing three or four variables and Woo 3 formula had the highest accuracy and did not differ significantly (mean absolute % errors 6.8–7.2%, SDs 5.3–5.8%, > 75% of estimations within 10% of ABW and 95% limits of agreement between -18/20% and +14/15%). They were not negatively affected by clinical variables but had some inconsistency in bias over the ABW range. All other formulae, including those targeted for small, preterm or growth restricted fetuses, were inferior and/or affected by multiple clinical variables.

Conclusion. In this GA window, Hadlock formulae using three or four variables or Woo 3 formula can be recommended.

Keywords:

• Fetal weight estimation
• ultrasound
• preterm preeclampsia

Acknowledgments

The authors thank Mrs. D. Grové for assistance with data management and analysis and Mrs. E. Carstens for recruitment and data collection.