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Estimation of fetal weight in twins: a new mathematical model
S Ong1, A P Smith, A Fitzmaurice
1Ultrasound Department and The Dugald Baird Centre, Aberdeen Maternity Hospital, UK.
Objectives:
Evaluation of new mathematical formula (Femur 4) derived from a twin population to estimate fetal weight in twins using ultrasound. Comparison of Femur 4 is with conventional mathematical models.
Design:
Retrospective analysis of ultrasonic measurements of 297 twin babies from 24 to 40 weeks of gestation who were born within 10 days of ultrasound examination.
Setting:
Aberdeen Maternity Hospital.
Methods:
With ultrasonic measurements obtained from twin babies, estimated fetal weight was calculated using the mathematical models of Campbell, Shepard and Hadlock. The calculations were repeated for the model of Femur 4. All models were compared against Femur 4.
Results:
The coefficient of determination of the linear regression between the actual and predicted weight was highest for Femur 4 (0.852). Femur 4 had the highest proportion of babies with estimated weights within 10% of actual birthweight (71.4%). In babies who weighed between 2000 and 3000 g, Femur 4 had the least systematic and random error of -1.69 and 8.96, respectively. For babies below the 10th centile for weight, Femur 4 had comparable positive and negative predictive values of 76.0% and 92.3%, respectively. Femur 4 was equally poor at predicting growth discordancy with positive and negative predictive values of 70.0% and 86.5% only.
Conclusion:
Femur 4 requires measurements of femur length and abdominal circumference only, hence avoiding the need to obtain difficult head measurements which is a common problem in twins. It is a good model for estimation of fetal weight in twins. However, prediction of growth discordancy remains problematic.