2085907 Comparison of Point-Of-Care Obstetrical Ultrasonography to Actual Fetal Weight: A Quality of Care Assessment

  • Kirkwood A
  • Gagliardi C
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Abstract

Objectives: Competency in point-of-care ultrasonography has emerged as a critical skill set for many practitioners. In the Labor and Delivery Unit (L{&}D), resident physicians routinely perform point-of-care ultrasonography for rapid assessment of the fetus. Clinical decisions can be altered by these examinations, making quality assessment of pointof- care ultrasonography a patient care priority. To assess accuracy of point-of-care ultrasound examinations (US), estimation of fetal weight performed on patients in labor by resident examiners were compared to actual delivery weight. Methods: Resident physicians obtained an estimated fetal weight (EFW) by both ultrasonography (Hadlock formula for estimating fetal weights) and Leopolds Maneuvers (LM) on 270 laboring patients meeting inclusion criteria. Fetal weights obtained by both methods were compared to actual birth weight using one-way ANOVA for correlated samples; significance was set at p {<} 0.05. The study had 85{%} power to detect a 20{%} difference. Regression analysis was used to assess correlation and generate a model incorporating additional variables. Results: No significant difference was found between the actual birth weight (mean 3240g) and EFWs by either US (mean 3254 g), or by LM (mean 3236 g), p = 0.459. However, regression analysis demonstrated US is a better predictor of actual fetal weight (R2=0.61) than LM (R2=0.55). Moreover, the inclusion of maternal, fetal and resident characteristics in the regression model (LM, BMI, placental location, resident year, etc) increased the predictive value of ultrasound determined fetal weight (R2=0.66). Conclusions: As a single predictor, point-of-care ultrasound exams provided a better estimation of actual fetal weight than LM. A multivariate regression model showed small but statistically significant effects of operator experience (PGY year), as well as maternal and fetal characteristics. However, the clinical significance of these additions to the regression model was negligible. Point-of-care ultrasound by resident physicians is an accurate tool for estimating fetal weights in patients and serves as a valuable adjunct to clinical decision making in L{&}D.

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Kirkwood, A., & Gagliardi, C. (2015). 2085907 Comparison of Point-Of-Care Obstetrical Ultrasonography to Actual Fetal Weight: A Quality of Care Assessment. Ultrasound in Medicine & Biology, 41(4), S135. https://doi.org/10.1016/j.ultrasmedbio.2014.12.529

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