{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,5]],"date-time":"2026-10-05T21:04:48Z","timestamp":1791234288748,"version":"4.1.0"},"reference-count":19,"publisher":"Wiley","issue":"1","license":[{"start":{"date-parts":[[2024,1,2]],"date-time":"2024-01-02T00:00:00Z","timestamp":1704153600000},"content-version":"vor","delay-in-days":1,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"content-domain":{"domain":["obgyn.onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Ultrasound in Obstet &amp;amp; Gyne"],"published-print":{"date-parts":[[2024,1]]},"abstract":"<jats:title>ABSTRACT<\/jats:title><jats:sec><jats:title>Objective<\/jats:title><jats:p>To describe the perinatal outcome of fetuses predicted to be large\u2010for\u2010gestational age (LGA) on universal third\u2010trimester ultrasound in non\u2010diabetic pregnancies of women attempting vaginal delivery.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>This was a prospective population\u2010based cohort study of patients from a single tertiary maternity unit in the UK offering universal third\u2010trimester ultrasound and practicing expectant management of suspected LGA until 41\u201342\u2009weeks. All women with a singleton pregnancy and an estimated due date between January 2014 and September 2019 were included. Women delivering before 37\u2009weeks, those having a planned Cesarean delivery, those with pre\u2010existing or gestational diabetes, those with fetal abnormalities and those who did not undergo a third\u2010trimester scan were excluded from the assessment of perinatal outcome of cases with LGA predicted on ultrasound after implementation of the universal scan period. Association of LGA on universal third\u2010trimester ultrasound screening and perinatal adverse outcome was assessed, with the exposures of interest being estimated fetal weight (EFW) at the 90<jats:sup>th<\/jats:sup>\u201395<jats:sup>th<\/jats:sup>, &gt;\u200995<jats:sup>th<\/jats:sup> and &gt;\u200999<jats:sup>th<\/jats:sup> percentile. The reference group was composed of fetuses with EFW at the 30<jats:sup>th<\/jats:sup>\u201370<jats:sup>th<\/jats:sup> percentile. Analysis was performed using multivariate logistic regression. The evaluated adverse perinatal outcomes included a composite outcome of admission to neonatal intensive care unit, Apgar score &lt;\u20097 at 5\u2009min and arterial cord pH &lt;\u20097.1 (CAO1) and a composite outcome of stillbirth, neonatal death and hypoxic ischemic encephalopathy (CAO2). Secondary maternal outcomes were induction of labor, mode of delivery, postpartum hemorrhage, shoulder dystocia and obstetric anal sphincter injury.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>Cases with EFW &gt;\u200995<jats:sup>th<\/jats:sup> percentile on universal third\u2010trimester scan were at increased risk of CAO1 (adjusted odds ratio (aOR), 2.18 (95%\u2009CI, 1.69\u20132.80)) and CAO2 (aOR, 2.58 (95%\u2009CI, 1.05\u20136.34)). Cases with EFW at the 90<jats:sup>th<\/jats:sup>\u201395<jats:sup>th<\/jats:sup> percentile had a less pronounced increase in the risk of CAO1 (aOR, 1.35 (95%\u2009CI, 1.02\u20131.78)) and were not at increased risk of CAO2. All pregnancies with a fetus predicted to be LGA were at increased risk of all of the evaluated secondary maternal outcomes except for obstetric anal sphincter injury. The risk of adverse maternal outcome was typically higher with increasing EFW. <jats:italic>Post\u2010hoc<\/jats:italic> exploration of data suggested that shoulder dystocia had a limited contribution to composite adverse perinatal outcomes in LGA cases (population attributable fraction of 10.8% for CAO1 and 29.1% for CAO2).<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>Cases with EFW &gt;\u200995<jats:sup>th<\/jats:sup> percentile are at increased risk of severe adverse perinatal outcome, such as death and hypoxic ischemic encephalopathy. These findings should aid antenatal counseling regarding the associated risk and delivery options. \u00a9 2023 International Society of Ultrasound in Obstetrics and Gynecology.<\/jats:p><\/jats:sec>","DOI":"10.1002\/uog.26305","type":"journal-article","created":{"date-parts":[[2023,7,10]],"date-time":"2023-07-10T19:23:18Z","timestamp":1689016998000},"page":"98-104","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":17,"title":["Perinatal outcome of fetuses predicted to be large\u2010for\u2010gestational age on universal third\u2010trimester ultrasound in non\u2010diabetic pregnancy"],"prefix":"10.1002","volume":"63","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-4414-5186","authenticated-orcid":false,"given":"K.","family":"Robertson","sequence":"first","affiliation":[{"name":"Department of Fetal Medicine, John Radcliffe Hospital Oxford University Hospitals NHS Trust  Oxford UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"M.","family":"Vieira","sequence":"additional","affiliation":[{"name":"Department of Women and Children's Health, King's College London St Thomas' Hospital  London UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4462-112X","authenticated-orcid":false,"given":"L.","family":"Impey","sequence":"additional","affiliation":[{"name":"Department of Fetal Medicine, John Radcliffe Hospital Oxford University Hospitals NHS Trust  Oxford UK"},{"name":"Nuffield Department of Women's Reproductive Health, John Radcliffe Hospital Oxford University  Oxford UK"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2024,1,2]]},"reference":[{"key":"e_1_2_7_2_1","doi-asserted-by":"publisher","DOI":"10.1002\/uog.20279"},{"key":"e_1_2_7_3_1","doi-asserted-by":"publisher","DOI":"10.1097\/AOG.0000000000000388"},{"key":"e_1_2_7_4_1","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(15)00131-2"},{"key":"e_1_2_7_5_1","doi-asserted-by":"publisher","DOI":"10.1002\/uog.17491"},{"key":"e_1_2_7_6_1","volume-title":"Inducing labour","year":"2021"},{"key":"e_1_2_7_7_1","unstructured":"Healthcare Safety Investigation Branch.National Learning Report. Severe brain injury early neonatal death and intrapartum stillbirth associated with larger babies and shoulder dystocia.https:\/\/hsib\u2010kqcco125\u2010media.s3.amazonaws.com\/assets\/documents\/Severe_brain_injury_early_neonatal_death_and_intrapartum_stillbirth_with_larger_babies.pdf."},{"key":"e_1_2_7_8_1","doi-asserted-by":"publisher","DOI":"10.1016\/0002-9378(85)90298-4"},{"issue":"292","key":"e_1_2_7_9_1","first-page":"e1","article-title":"Comparison of estimated fetal weight percentiles near term for predicting extremes of birthweight percentile","volume":"224","author":"Sovio U","year":"2021","journal-title":"Am J Obstet Gynecol"},{"key":"e_1_2_7_10_1","volume-title":"management from preconception to the postnatal period","author":"Diabetes in pregnancy","year":"2020"},{"key":"e_1_2_7_11_1","doi-asserted-by":"publisher","DOI":"10.1111\/1471-0528.17395"},{"key":"e_1_2_7_12_1","doi-asserted-by":"publisher","DOI":"10.1371\/journal.pmed.1002228"},{"key":"e_1_2_7_13_1","doi-asserted-by":"publisher","DOI":"10.1371\/journal.pmed.1002902"},{"key":"e_1_2_7_14_1","first-page":"CD000938","article-title":"Induction of labour at or near term for suspected fetal macrosomia","volume":"2016","author":"Boulvain M","year":"2016","journal-title":"Cochrane Database Syst Rev"},{"key":"e_1_2_7_15_1","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(14)61904-8"},{"key":"e_1_2_7_16_1","doi-asserted-by":"publisher","DOI":"10.1097\/AOG.0b013e31825bd286"},{"key":"e_1_2_7_17_1","doi-asserted-by":"publisher","DOI":"10.1111\/ppe.12058"},{"key":"e_1_2_7_18_1","doi-asserted-by":"publisher","DOI":"10.1136\/bmjopen-2021-058176"},{"key":"e_1_2_7_19_1","doi-asserted-by":"publisher","DOI":"10.1371\/journal.pmed.1000289"},{"key":"e_1_2_7_20_1","doi-asserted-by":"publisher","DOI":"10.1186\/s13063-021-05141-8"}],"container-title":["Ultrasound in Obstetrics &amp; Gynecology"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/obgyn.onlinelibrary.wiley.com\/doi\/pdf\/10.1002\/uog.26305","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2024,4,2]],"date-time":"2024-04-02T06:06:58Z","timestamp":1712038018000},"score":1,"resource":{"primary":{"URL":"https:\/\/obgyn.onlinelibrary.wiley.com\/doi\/10.1002\/uog.26305"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2024,1]]},"references-count":19,"journal-issue":{"issue":"1","published-print":{"date-parts":[[2024,1]]}},"alternative-id":["10.1002\/uog.26305"],"URL":"https:\/\/doi.org\/10.1002\/uog.26305","archive":["Portico"],"relation":{},"ISSN":["0960-7692","1469-0705"],"issn-type":[{"value":"0960-7692","type":"print"},{"value":"1469-0705","type":"electronic"}],"subject":[],"published":{"date-parts":[[2024,1]]},"assertion":[{"value":"2023-03-02","order":0,"name":"received","label":"Received","group":{"name":"publication_history","label":"Publication History"}},{"value":"2023-06-21","order":1,"name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}},{"value":"2024-01-02","order":2,"name":"published","label":"Published","group":{"name":"publication_history","label":"Publication History"}}]}}