title: A scoring system for detection of macrosomia and prediction of shoulder dystocia: a disappointment.
abstract: OBJECTIVE
  To develop a scoring system for the detection of a macrosomic fetus (birth weight (BW) >or= 4000 g) and predict shoulder dystocia among large for gestational age fetuses.
  
  
  METHODS
  We retrospectively identified all singletons with accurate gestational age (GA) that were large for GA (abdominal circumference (AC) or estimated fetal weight (EFW) >or= 90% for GA) at >or=37 weeks with delivery within three weeks. The scoring system was: 2 points for biparietal diameter, head circumference, AC, or femur length >or=90% for GA, or if the amniotic fluid index (AFI) was >or=24 cm; for biometric parameters <90% or with AFI <24 cm, 0 points. The predictive values for detection of shoulder dystocia were calculated.
  
  
  RESULTS
  Of the 225 cohorts that met the inclusion criteria the rate of macrosomia was 39% and among vaginal deliveries (n = 120) shoulder dystocia occurred in 12% (15/120; 95% confidence interval (CI) 7-20%). The sensitivity of EFW >or=4500 g to identify a newborn with shoulder dystocia was 0% (95% CI 0-21%), positive predictive values 0% (95% CI 0-46%), and likelihood ratio of 0. For a macrosomia score >6, the corresponding values were 20% (4-48%), 25% (5-57%) and 2.3.
  
  
  CONCLUSIONS
  Though the scoring system can identify macrosomia, it offers no advantage over EFW. The scoring system and EFW are poor predictors of shoulder dystocia.
authors.affiliation: Division of Maternal-Fetal Medicine, Aurora Health Care, West Allis, Wisconsin 53227, USA. suneet.chauhan@auorora.org
authors.forename: Suneet P
authors.initials: SP
authors.lastname: Chauhan
authors.forename: Nancy N
authors.initials: NN
authors.lastname: Lynn
authors.forename: Maureen
authors.initials: M
authors.lastname: Sanderson
authors.forename: Joyce
authors.initials: J
authors.lastname: Humphries
authors.forename: Jill H
authors.initials: JH
authors.lastname: Cole
authors.forename: James A
authors.initials: JA
authors.lastname: Scardo
mesh_terms: D004420:Dystocia / Q000209:etiology*; D005260:Female; D005320:Fetal Macrosomia / Q000175:diagnosis*; D006801:Humans; D011247:Pregnancy; D012189:Retrospective Studies; D012782:Shoulder