Diagnostic clinique et échographique des macrosomies fœtales supérieures à 4 500 g

Fetal macrosomia is a high-risk situation for both mother and fetus, a major preoccupation of obstetricians and radiologists. The risk of complications depends to a large extent on the degree of fetal macrosomia and the quality of prenatal and neonatal care. Fetal macrosomia greater than 4500 g is seen in approximately 1.5% of births and is considered a major problem because of the high frequency of complications and the absence of predictive factors. Indeed, prenatal clinical and ultrasound fetal weight estimation are the main methods available to predict fetal weight and are considered an important element to decide on the best method of delivery in fetal macrosomia. However, these methods are burdened by errors and imprecision, which are closely and positively correlated to the degree of fetal macrosomia. In addition, contradictions between clinical and ultrasound methods can be seen. This situation is observed particularly in diabetic women. To improve the accuracy of ultrasound fetal weight estimation, different indexes and formulas have been developed with variable degrees of sensitivity and specificity. In this paper, the advantages and disadvantages of clinical and sonographic prediction of fetal macrosomia are reviewed.