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Poster Session 2

Category: Ultrasound/Imaging

Poster Session 2

(516) Sonographic Misclassification of Fetal Growth and Its Influence on Delivery Decisions: Time for Improved Accuracy

Wednesday, February 11, 2026

3:30 PM - 5:00 PM

Presenting Author(s)

Itai Atar, MD, MPH

Resident
Lis Hospital for Women’s Health, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
Tel Aviv, Tel Aviv, Israel

Coauthor(s)

Einat n. Tako, MD

Resident
Lis Hospital for Women’s Health, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
Tel Aviv, Tel Aviv, Israel
Itamar Gilboa, MD

Lis Hospital for Women’s Health, Tel Aviv Sourasky Medical Center
Lis Hospital for Women’s Health, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
Daniel Gabbai, MD, MPH

Lis Hospital for Women’s Health, Tel Aviv Sourasky Medical Center
Lis Hospital for Women’s Health, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
MS

Michael Shenhav, MD

Lis Hospital for Women’s Health, Tel Aviv Sourasky Medical Center
Tel Aviv, Tel Aviv, Israel
YY

Yariv Yogev, MD

Lis Hospital for Women’s Health, Tel Aviv Sourasky Medical Center Gray Faculty of Medicine, Tel Aviv University, Israel
Lis Hospital for Women’s Health, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel

Submitting Author(s)

Emmanuel Attali, MD (he/him/his)

Head of Maternal Wards
Lis Hospital for Women’s Health, Tel Aviv Sourasky Medical Center
Lis Hospital for Women’s Health, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel

Objective:
To evaluate whether an estimated fetal weight (EFW) below the 10th percentile influences mode of delivery.

Study Design:
A retrospective cohort study of all women who underwent sonographic EFW at 36–37 weeks, within 7 days prior to delivery, at a university-affiliated tertiary center (2012–2025). Multiple gestations and non-viable fetuses were excluded. EFW and birth percentiles were calculated using the Hadlock curve. Women were categorized into: (1) Estimated and born appropriate for gestational age (AGA, reference); (2) Estimated small for gestational age (SGA; ≤10th percentile) but born AGA; (3) Estimated AGA but born SGA; and (4) Estimated and born SGA. Outcomes were compared using univariate and multivariable analyses.

Results:
1. Of 147,045 deliveries, 21,089 (14.3%) met the study's criteria: 17,044 (80.8%) were estimated and born AGA, 311 (1.5%) estimated SGA but born AGA, 1,826 (8.7%) estimated AGA but born SGA, and 1,908 (9.0%) estimated and born SGA.
2. The average EFW-to-delivery interval ranged from 4.75 to 6.5 days. Sensitivity and specificity for diagnosing SGA were 51.1% and 98.0%, respectively.
3. Compared with the reference group, all other groups had higher induction rates (26.1–38.0% vs. 22.1%), longer postpartum stays ( >5 days: 26.7–42.4% vs. 21.1%), and lower rates of gestational diabetes (7.6–14.5% vs. 19.5%) (all p< 0.001).
4. Operative vaginal deliveries, elective cesareans (CD), and CDs for non-reassuring fetal heart rate (NRFHR) were more common in non-reference groups (p≤0.04). SGA-born groups had higher intrapartum CD rates (5.7–6.0% vs. 4.6%). Most CDs were due to malpresentation or NRFHR.
5. After adjusting for induction and other factors, none of the non-reference groups independently predicted vacuum or intrapartum CD.

Conclusion:
SGA estimation, regardless of actual birth weight, was associated with more inductions, earlier delivery, and CD for NRFHR, but did not independently predict vacuum or intrapartum CD. Overestimation of risk may lead to unnecessary interventions and higher maternal burden.