Effect of birth weight on adverse obstetric outcomes in vaginal birth after cesarean delivery.

摘要

We read with interest the article by Jastrow et al, which concluded that "estimated fetal weight should be included in the decision-making process for all women contemplating a trial of labor after cesarean delivery." It is our opinion that this recommendation is unhelpful.First, this was an observational trial that examined correlations between obstetric outcomes and birth weight (determined after delivery). To assume that the same associations apply to estimated fetal weight (determined antenatally) is flawed. It is well recognized that ultrasound for estimated fetal weight has limited diagnostic accuracy, and standard ultrasound techniques to diagnose macrosomia have high false-positive rates. The authors refer to techniques for assessment of estimated fetal weight using three-dimensional ultrasonography, but these have not been validated in large studies.