Skip to content
Licensed Unlicensed Requires Authentication Published by De Gruyter May 29, 2019

Comparison of automated vs. manual measurement to estimate fetal weight in isolated polyhydramnios

  • Hasan Eroglu , Gokcen Orgul EMAIL logo , Emine Avcı , Orhan Altınboga , Gokhan Karakoc and Aykan Yucel



To understand the impact of the measurement method to predict actual birthweight in pregnancies complicated with isolated polyhydramnios in the third trimester.


A prospective study was conducted with 60 pregnant women between the 37th and 40th weeks of gestation. Routine biometric measurements were obtained by two-dimensional (2D) ultrasonography. When a satisfactory image was obtained, the image was frozen to get two measurements. First, calipers were placed to get the manual measurement. Then automated measurement was captured by the ultrasonography machine in the same image. The fetal weight was estimated by using the Hadlock II formula.


The mean difference was found to be 0.03, −0.77, −0.02 and 0.17 for biparietal diameter (BPD), head circumference (HC), abdominal circumference (AC) and femur length (FL), respectively. Pearson’s correlation coefficient between automated and manual estimated fetal weights (EFWs) and the actual birthweight was 0.919 and 0.796, respectively. The mean difference between actual and manual EFW measurement values was 46.16 ± 363.81 g (range between −745 g and 685 g) (P = 0.330). Also, the mean difference between actual and automated EFW measurement values was found to be 31.98 ± 218.65 g (range between −378 g and 742 g) (P = 0.262). The Bland-Altman test results have shown that, 666 g lower or 759 g higher values were obtained when the measurement was performed manually. On the other hand, EFW results were 396 g lower or 460 g higher than the actual birthweight with automated measurement tools.


The accuracy rate of fetal weight estimation with ultrasonography is high for both automated and manual measurements. Automated tools have a higher success to predict the EFW.

Corresponding author: Gokcen Orgul, MD, Department of Perinatology, Etlik Zubeyde Hanim Women’s Health Care, Training and Research Hospital, University of Health Sciences, 06050 Yenimahalle, Ankara, Turkey, Tel.: +90 555 606 62 54

  1. Author contributions: All the authors have accepted responsibility for the entire content of this submitted manuscript and approved submission.

  2. Research funding: None declared.

  3. Employment or leadership: None declared.

  4. Honorarium: None declared.

  5. Competing interests: The funding organization(s) played no role in the study design; in the collection, analysis, and interpretation of data; in the writing of the report; or in the decision to submit the report for publication.


1. Kim ET, Singh K, Moran A, Armbruster D, Kozuki N. Obstetric ultrasound use in low and middle income countries: a narrative review. Reprod Health 2018;15:129.10.1186/s12978-018-0571-ySearch in Google Scholar PubMed PubMed Central

2. Yılmaz Z, Ozer O, Eroglu D, Yanik F, Sahin FI. Importance of routine ultrasonography in detecting fetal karyotype abnormalities in low risk pregnancies. Gynecol Obstet Reprod Med 2012;18:1–6.Search in Google Scholar

3. Mansour T, Oshiro B. Accuracy of sonographic fetal biometry measurements [26M]. Obstet Gynecol 2016;127:113S.10.1097/01.AOG.0000483465.54962.f0Search in Google Scholar

4. Fuchs F, Aouinti S, Souaied M, Keller V, Picot M-C, Fries N, et al. Association between amniotic fluid evaluation and fetal biometry: a prospective French “Flash” study. Sci Rep 2018;8:7093.10.1038/s41598-018-25497-3Search in Google Scholar PubMed PubMed Central

5. Hammami A, Mazer Zumaeta A, Syngelaki A, Akolekar R, Nicolaides KH. Ultrasonographic estimation of fetal weight: development of new model and assessment of performance of previous models. Ultrasound Obstet Gynecol 2018;52:35–43.10.1002/uog.19066Search in Google Scholar PubMed

6. Sheth T, Glantz JC. Third-trimester fetal biometry and neonatal outcomes in term and preterm deliveries. J Ultrasound Med 2016;35:103–10.10.7863/ultra.15.02040Search in Google Scholar PubMed

7. Abele H, Starz S, Hoopmann M, Yazdi B, Rall K, Kagan KO. Idiopathic polyhydramnios and postnatal abnormalities. Fetal Diag Ther 2012;32:251–5.10.1159/000338659Search in Google Scholar PubMed

8. Karahanoglu E, Ozdemirci S, Esinler D, Fadıloglu E, Asiltürk S, Kasapoglu T, et al. Intrapartum, postpartum characteristics and early neonatal outcomes of idiopathic polyhydramnios. J Obstet Gynaecol 2016;36:710–4.10.3109/01443615.2016.1148126Search in Google Scholar PubMed

9. Zalud I, Good S, Carneiro G, Georgescu B, Aoki K, Green L, et al. Fetal biometry: a comparison between experienced sonographers and automated measurements. J Matern Fetal Neonatal Med 2009;22:43–50.10.1080/14767050802415736Search in Google Scholar PubMed

10. Salim I, Cavallaro A, Ciofolo-Veit C, Rouet L, Raynaud C, Mory B, et al. Evaluation of automated tool for 2D fetal biometry. Ultrasound Obstet Gynecol 2018. Available at: in Google Scholar PubMed

11. Espinoza J, Good S, Russell E, Lee W. Does the use of automated fetal biometry improve clinical work flow efficiency? J Ultrasound Med 2013;32:847–50.10.7863/jum.2013.32.5.847Search in Google Scholar

12. Adeyekun AA, Awosanya GG. Relationship between amniotic fluid index and ultrasound estimated fetal weight in healthy pregnant African women. J Clin Imaging Sci 2013;3:2.10.4103/2156-7514.106614Search in Google Scholar

13. Barel O, Vaknin Z, Tovbin J, Herman A, Maymon R. Assessment of the accuracy of multiple sonographic fetal weight estimation formulas: a 10-year experience from a single center. J Ultrasound Med 2013;32:815–23.10.7863/jum.2013.32.5.815Search in Google Scholar

14. Barel O, Maymon R, Vaknin Z, Tovbin J, Smorgick N. Sonographic fetal weight estimation–is there more to it than just fetal measurements? Prenat Diagn 2014;34:50–5.10.1002/pd.4250Search in Google Scholar

15. Nabhan AF, Abdelmoula YA. Amniotic fluid index versus single deepest vertical pocket as a screening test for preventing adverse pregnancy outcome. Cochrane Database Syst 2008;3:1–22.10.1002/14651858.CD006593Search in Google Scholar

16. Practice Bulletin No. 175: Ultrasound in pregnancy. Obstet Gyn 2016;128:241–56.10.1097/AOG.0000000000001815Search in Google Scholar

17. Kolderup LB, Laros Jr RK, Musci TJ. Incidence of persistent birth injury in macrosomic infants: association with mode of delivery. Am J Obstet Gynecol 1997;177:37–41.10.1016/S0002-9378(97)70435-6Search in Google Scholar

18. Bernstein IM, Horbar JD, Badger GJ, Ohlsson A, Golan A, Network VO. Morbidity and mortality among very-low-birth-weight neonates with intrauterine growth restriction. Am J Obstet Gynecol 2000;182:198–206.10.1016/S0002-9378(00)70513-8Search in Google Scholar

19. Thomas J, Jeanty P, Peters 2nd R, Parrish Jr E. Automatic measurements of fetal long bones. A feasibility study. J Ultrasound Med 1991;10:381–5.10.7863/jum.1991.10.7.381Search in Google Scholar

20. van den Heuvel TL, Petros H, Santini S, de Korte CL, van Ginneken B. Automated fetal head detection and circumference estimation from free-hand ultrasound sweeps using deep learning in resource-limited countries. Ultrasound Med Biol 2019;45:773–85.10.1016/j.ultrasmedbio.2018.09.015Search in Google Scholar

21. Chalana V, Winter III TC, Cyr DR, Haynor DR, Kim Y. Automatic fetal head measurements from sonographic images. Acad Radiol 1996;3:628–35.10.1016/S1076-6332(96)80187-5Search in Google Scholar

22. Dashe JS, Pressman EK, Hibbard JU. SMFM Consult Series #46: evaluation and management of polyhydramnios. Am J Obstet Gynecol 2018;219:2–8.10.1016/j.ajog.2018.07.016Search in Google Scholar PubMed

23. Tosun M, Çelik H, Erdoğan Ö, Malatyalıoğlu E, Çetinkaya M, Altunsoy S. Incidence and sonographic detection of fetal anomalies in pregnancies complicated by polyhydramnios. Gynecol Obstet Reprod Med 2008;14:145–9.Search in Google Scholar

24. Desmedt EJ, Henry OA, Beischer NA. Polyhydramnios and associated maternal and fetal complications in singleton pregnancies. Br J Obstect Gynecol 1990;97:1115–22.10.1111/j.1471-0528.1990.tb02499.xSearch in Google Scholar PubMed

25. Magann EF, Doherty DA, Lutgendorf MA, Magann MI, Chauhan SP, Morrison JC. Peripartum outcomes of high-risk pregnancies complicated by oligo- and polyhydramnios: a prospective longitudinal study. J Obstet Gynaecol Res 2010;36:268–77.10.1111/j.1447-0756.2009.01145.xSearch in Google Scholar PubMed

26. Durbin SA, Lee CW, Parker VG. The effect of amniotic fluid index on the accuracy of sonographic estimated fetal weight. J Diagn Med Sonogr 2005;21:329–35.10.1177/8756479305278267Search in Google Scholar

27. Karahanoglu E, Altinboga O, Akpinar F, Gultekin IB, Ozdemirci S, Akyol A, et al. The effect of the amniotic fluid index on the accuracy of ultrasonographic-estimated fetal weight. Ultrasound Q 2017;33:148–52.10.1097/RUQ.0000000000000275Search in Google Scholar PubMed

28. Burd I, Srinivas S, Paré E, Dharan V, Wang E. Is sonographic assessment of fetal weight influenced by formula selection? J Ultrasound Med 2009;28:1019–24.10.7863/jum.2009.28.8.1019Search in Google Scholar PubMed

Supplementary Material

The online version of this article offers supplementary material (

Received: 2019-03-12
Accepted: 2019-04-22
Published Online: 2019-05-29
Published in Print: 2019-08-27

©2019 Walter de Gruyter GmbH, Berlin/Boston

Downloaded on 9.2.2023 from
Scroll Up Arrow