Birth weight prediction by three-dimensional ultrasonography: fractional limb volume.

OBJECTIVE: To introduce fractional limb volume as a new ultrasonographic parameter, validate reliability of fractional limb volume measurements, develop new birth weight prediction models, and examine their practical utility for estimating fetal weight during late pregnancy.
METHODS: Healthy late-third-trimester fetuses were prospectively scanned by two- and three-dimensional ultrasonography within 4 days of delivery. Volume data sets were subsequently used to extract several standard ultrasonographic measurements. Fractional limb volumes of the upper arm and thigh were based on 50% of diaphyseal bone length. Intraclass correlation was used to analyze interobserver and intraobserver reliability of fractional limb volume measurements. Several weight prediction models were developed by linear regression analysis. New prediction models were prospectively compared with the Hadlock formula in 30 healthy late-third-trimester fetuses.
RESULTS: One hundred fetuses were scanned at a mean +/- SD menstrual age of 39.2 +/- 1.2 weeks. Intraclass correlation indicated a significant degree of interobserver and intraobserver reliability for fractional thigh volume. Fractional thigh volume (r = 0.86), fractional upper arm volume (r = 0.83), abdominal circumference (r = 0.83), and midthigh circumference (r = 0.82) were most highly correlated with birth weight. The best prediction model (abdominal circumference and fractional thigh volume) gave weight estimates that deviated from actual birth weight by -0.025% +/- 7.8%. For late-third-trimester fetuses, the Hadlock model yielded errors of 9.0% +/- 9.0%. Prospective testing confirmed superior performance of the new prediction model, which gave accuracy of 2.3% +/- 6.6% (Hadlock method, 8.4% +/- 8.7%). It correctly predicted 20 of 30 birth weights to within 5% of actual weight. By comparison, the Hadlock model predicted only 6 of 30 birth weights to within 5% of actual weight.
CONCLUSIONS: A new birth weight prediction model, based on fractional thigh volume and abdominal circumference, is reliable during the late third trimester. It provides a means for including soft tissue evaluation for birth weight prediction. This rapid technique avoids technical limitations that currently hinder the practical implementation of three-dimensional ultrasonography for estimating birth weight.