No proven benefit of universal ultrasound screening for fetal macrosomia

Référence

Moraitis AA, Shreeve N, Sovio U, et al. Universal third-trimester ultrasonic screening using fetal macrosomia in the prediction of adverse perinatal outcome: A systematic review and meta-analysis of diagnostic test accuracy. PLoS Med 2020;17(10):e1003190.

Sommaire

This meta-analysis included 41 diagnostic test studies (including 112,034 patients) in which third-trimester ultrasound was used to predict neonatal macrosomia and neonatal outcomes associated with fetal macrosomia in low-risk or mixed-risk populations of women with singleton pregnancies. The authors included studies that were prospective or retrospective cohorts, with the exception of one randomized controlled trial. Macrosomia was defined as an estimated fetal weight greater than 4000 grams or greater than 90th percentile for gestational age, or an abdominal circumference greater than 36 cm or 90th percentile. The authors excluded studies of high-risk populations (eg, women with gestational diabetes) and any ultrasounds done during labor. They used methodology to calculate summary receiver operating characteristic curves, sensitivities, and likelihood ratios. The authors assessed risk from a perspective of near-term pregnancy (~ 36 weeks' gestation). Most studies were unmasked, which the authors assessed to be at high risk for bias. The summary sensitivity for predicting macrosomia was approximately 70%. The summary sensitivity for other meaningful neonatal outcomes could not be established. Studies of shoulder dystocia among infants born to mothers with an ultrasound result that predicted macrosomia showed a summary sensitivity of 22%, which is considered too low for meaningful clinical use. There were insufficient data regarding other adverse outcomes that have been associated with macrosomia, including neonatal intensive care admission, 5-minute Apgar score of less than 5, metabolic acidosis, neonatal hypoglycemia, and neonatal jaundice. The authors concluded that universal ultrasound screening for fetal macrosomia is not advised because of both the unproven benefit and the potential that ultrasound diagnosis of fetal macrosomia might lead to interventions that could cause iatrogenic harm.