Predicting fetal weight by three-dimensional limb volume ultrasound (AVol/TVol) and abdominal circumference

Li Kang, Qing-Qing Wu, Li-Juan Sun, Feng-Yun Gao, Jing-Jing Wang, Li Kang, Qing-Qing Wu, Li-Juan Sun, Feng-Yun Gao, Jing-Jing Wang

Abstract

Background: Fetal weight is an important parameter to ensure maternal and child safety. The purpose of this study was to use three-dimensional (3D) limb volume ultrasound combined with fetal abdominal circumference (AC) measurement to establish a model to predict fetal weight and evaluate its efficiency.

Methods: A total of 211 participants with single pregnancy (28-42 weeks) were selected between September 2017 and December 2018 in the Beijing Obstetrics and Gynecology Hospital of Capital Medical University. The upper arm (AVol)/thigh volume (TVol) of fetuses was measured by the 3D limb volume technique. Fetal AC was measured by two-dimensional ultrasound. Nine cases were excluded due to incomplete information or the interval between examination and delivery >7 days. The enrolled 202 participants were divided into a model group (134 cases, 70%) and a verification group (68 cases, 30%) by mechanical sampling method. The linear relationship between limb volume and fetal weight was evaluated using Pearson Chi-squared test. The prediction model formula was established by multivariate regression with data from the model group. Accuracy of the model formula was evaluated with verification group data and compared with traditional formulas (Hadlock, Lee2009, and INTERGROWTH-21st) by paired t-test and residual analysis. Receiver operating characteristic curves were generated to predict macrosomia.

Results: AC, AVol, and TVol were linearly related to fetal weight. Pearson correlation coefficient was 0.866, 0.862, and 0.910, respectively. The prediction model based on AVol/TVol and AC was established as follows: Y = -481.965 + 12.194TVol + 15.358AVol + 67.998AC, R2adj = 0.868. The scatter plot showed that when birth weight fluctuated by 5% (i.e., 95% to 105%), the difference between the predicted fetal weight by the model and the actual weight was small. A paired t-test showed that there was no significant difference between the predicted fetal weight and the actual birth weight (t = -1.015, P = 0.314). Moreover, the residual analysis showed that the model formula's prediction efficiency was better than the traditional formulas with a mean residual of 35,360.170. The combined model of AVol/TVol and AC was superior to the Lee2009 and INTERGROWTH-21st formulas in the diagnosis of macrosomia. Its predictive sensitivity and specificity were 87.5% and 91.7%, respectively.

Conclusion: Fetal weight prediction model established by semi-automatic 3D limb volume combined with AC is of high accuracy, sensitivity, and specificity. The prediction model formula shows higher predictive efficiency, especially for the diagnosis of macrosomia.

Trial registration: ClinicalTrials.gov, NCT03002246; https://ichgcp.net/clinical-trials-registry/NCT03002246?recrs=e&cond=fetal&draw=8&rank=67.

Conflict of interest statement

None.

Copyright © 2021 The Chinese Medical Association, produced by Wolters Kluwer, Inc. under the CC-BY-NC-ND license.

Figures

Figure 1
Figure 1
Fractional AVol and TVol measurements by 3D ultrasound. (A) Obtain images of fetal limbs; (B) Activate 5D volumetric measurement kit; (C) Measurement of fractional AVol by 3D ultrasound; (D) Measurement of fractional TVol by 3D ultrasound. AVol: Arm volume; TVol: Thigh volume.
Figure 2
Figure 2
(A) The predictive value of TVol, AVol, and AC for macrosomia by ROC curve. (B) Hadlock4; (C) Hadlock3; (D) Hadlock4; (E) Lee2009 (TVol); (F) Lee2009 (AVol); (G) INTERGROWTH-21st; (H) Model established by this study with the actual fetal weight. Red dots: The actual fetal weight; Black dots: The predicted fetal weight; Green dots: The actual fetal weight with a 5% deviation. (I) The predictive value of the model and traditional formulas for macrosomia. AC: Abdominal circumference; AVol: Arm volume; ROC: Receiver operating characteristic; TVol: Thigh volume.

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