Regimens of fetal surveillance of suspected large-for-gestational-age fetuses for improving health outcomes

Culliney, Katherine AT; Parry, David; Brown, Julie; Crowther, Caroline A

doi:10.1002/14651858.cd011739

Cited by 3 publications

(6 citation statements)

References 26 publications

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“…shoulder dystocia leading to brachial plexus injury, as well as increased risk of maternal morbidity . The definition of macrosomia varies, but is usually defined as a birthweight >4000 or >4500 g. It is differentiated from, but closely related to, the concept of large‐for‐gestational‐age, which is a relative measure: weight greater than the 90th centile for a given gestational age . Macrosomia can only be definitively diagnosed by weighing the infant following delivery.…”

Section: Introductionmentioning

confidence: 99%

“…However, ultrasound scans can be used to estimate the fetal weight antenatally, although this approach is known to have low predictive value . There is no general agreement on how to manage macrosomia if it is suspected following ultrasound . Possible interventions include scheduling an elective Caesarean section (CS), or early induction of labour.…”

Section: Introductionmentioning

confidence: 99%

“…Furthermore, if given without clinical need, intervention may cause unnecessary harm, e.g. neonatal respiratory morbidity, and the increased maternal risks of CS …”

Section: Introductionmentioning

confidence: 99%

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The cost‐effectiveness of universal late‐pregnancy screening for macrosomia in nulliparous women: a decision analysis

Wastlund

Moraitis

Thornton

et al. 2019

BJOG

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Objective To identify the most cost‐effective policy for detection and management of fetal macrosomia in late‐stage pregnancy. Design Health economic simulation model. Setting All English NHS antenatal services. Population Nulliparous women in the third trimester treated within the UK NHS. Methods A health economic simulation model was used to compare long‐term maternal–fetal health and cost outcomes for two detection strategies (universal ultrasound scanning at approximately 36 weeks of gestation versus selective ultrasound scanning), combined with three management strategies (planned caesarean section versus induction of labour versus expectant management) of suspected fetal macrosomia. Probabilities, costs and health outcomes were taken from literature. Main outcome measures Expected costs to the NHS and quality‐adjusted life‐years (QALYs) gained from each strategy, calculation of net benefit and hence identification of most cost‐effective strategy. Results Compared with selective ultrasound, universal ultrasound increased QALYs by 0.0038 (95% CI 0.0012–0.0076), but also costs by £123.50 (95% CI 99.6–149.9). Overall, the health gains were too small to justify the cost increase given current UK thresholds cost‐effective policy was selective ultrasound coupled with induction of labour where macrosomia was suspected. Conclusions The most cost‐effective policy for detection and management of fetal macrosomia is selective ultrasound scanning coupled with induction of labour for all suspected cases of macrosomia. Universal ultrasound scanning for macrosomia in late‐stage pregnancy is not cost‐effective. Tweetable abstract Universal late‐pregnancy ultrasound screening for fetal macrosomia is not warranted.

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Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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The cost‐effectiveness of universal late‐pregnancy screening for macrosomia in nulliparous women: a decision analysis

Wastlund

Moraitis

Thornton

et al. 2019

BJOG

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“…Antenatal fetal surveillance in diabetic mothers is not established yet and various methods have been studied regarding sensitivity and specificity for detecting adverse neonatal outcome . Doppler measurements of fetal, placental and maternal vessel resistance indices have been studied extensively for fetal monitorization.…”

Section: Discussionmentioning

confidence: 99%

“…The goal of antenatal follow‐up in diabetic pregnant women is to control blood glucose levels, treat chronic complications and to monitor the fetus. Several methods such as nonstress test, amniotic fluid volume measurement, and biophysical profile testing have been used for the evaluation of fetal well‐being in these cases albeit with questionable benefits . The measurement of resistance indices of maternal, fetal and umbilical vessels by Doppler sonography (US) is a well‐established method that has been used for both diagnosis and management of intra uterine growth restriction .…”

Section: Introductionmentioning

confidence: 99%

Relationship between fetal peak systolic velocity in Middle cerebral artery and umbilical blood gas values and hemoglobin levels in diabetic pregnant women

Kütük

Dolanbay

Karasu

et al. 2018

J of Clinical Ultrasound

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Regimens of fetal surveillance of suspected large-for-gestational-age fetuses for improving health outcomes

Culliney

Parry

Brown

et al. 2016

Cochrane Database of Systematic Reviews

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We found no randomised controlled trials that assessed the effect of antenatal fetal surveillance regimens of a suspected LGA fetus on important health outcomes for the mother and baby.There has been a rise in the prevalence of LGA babies over the past few decades in many countries. Research is therefore required on regimens of antenatal surveillance of suspected LGA infants, in order to guide practice and improve the health outcomes for the mother and infant. In particular, randomised control trials to investigate whether serial antenatal clinic and ultrasound assessments of suspected LGA infants (including liquor volume and markers of fetal adiposity) would be useful, to assess whether surveillance methods improve health outcomes. In addition, as there are concerns that identifying suspected LGA fetuses may lead to unnecessary maternal anxiety, investigations and interventions, any such trial would need to assess the risks as well as benefits of regimens of fetal surveillance for suspected LGA fetuses.

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Regimens of fetal surveillance of suspected large-for-gestational-age fetuses for improving health outcomes

Cited by 3 publications

References 26 publications

The cost‐effectiveness of universal late‐pregnancy screening for macrosomia in nulliparous women: a decision analysis

The cost‐effectiveness of universal late‐pregnancy screening for macrosomia in nulliparous women: a decision analysis

Relationship between fetal peak systolic velocity in Middle cerebral artery and umbilical blood gas values and hemoglobin levels in diabetic pregnant women

Regimens of fetal surveillance of suspected large-for-gestational-age fetuses for improving health outcomes

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