Improving the Ultrasound and Clinical Diagnosis of Macrosomia to Reduce the Primary Cesaerean Delivery Rate

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James F. Pelegano, MD, MS

Jason Baxter, MD


The primary cesarean delivery rate in the United States has been climbing. One reason to perform a cesarean delivery is an estimated pre-delivery rate greater than 4500 grams. This estimated weight is obtained through either clinical examination or ultrasound. Overestimation of the weight can lead to unnecessary cesarean deliveries. On multiple occasions, obstetricians have performed cesarean deliveries for ultrasound-diagnosed macrosomia only to find the true weight to be far below 4000 grams. This project was designed to determine if a discrepancy exists between the admitting diagnosis of macrosomia and the true delivery weight in a community hospital. The project was further designed to evaluate whether feedback to the physicians and sonographers, would improve future accuracy in estimating fetal weights at delivery. Finally, it was hoped that armed with this knowledge, the department could lower the cesarean delivery rate by reducing the number of primary cesarean deliveries performed for macrosomia. All members of the department were contacted and invited to an initial brainstorming meeting. This was followed by monthly review meetings. Physicians were sent monthly report cards describing their cesarean delivery rates and comparing them to the rest of the department. In order to educate the physicians and sonographers, letters were sent out monthly to each obstetrician and sonographer listing the admitting estimated fetal weight (EFW) and actual delivery weight of all infants delivered with a weight equal to or greater than 4000 grams or an admitting diagnosis of macrosomia. We markedly improved physician compliance in documenting admitting EFW as well as improving physician awareness, of their own and their colleagues’ cesarean delivery rates. Despite the above achievements, we failed to achieve any significant change in the primary cesarean delivery rate. In addition, we incidentally found discrepancies between all four of the hospital’s data collecting systems used in this study.

Presentation: 35 minutes