Fetal cheek-to-cheek diameter in the prediction of mode of delivery

Objective The purpose of this study was to assess sonographic fetal cheek-to-cheek diameter (CCD) in predicting mode of delivery. Study design Two hundred sixty-four patients were considered in 2 parts. First, a retrospective analysis of 214 patients entered into a birth weight (BW) study. Measurements of the CCD, biparietal diameter (BPD), and BW, as well as labor data, were collected. Then a prospective study of patients at ≥38 weeks gestational age was conducted. Fetal weight (EFW) was estimated by routine measurements. Information regarding CCD was withheld from the delivering caregiver. Labor records were reviewed for BW and complications, defined as: instrumental delivery, cesarean section (C/S) for nonprogress of labor or “CPD,” and “difficult” vaginal delivery. The CCD, BW (both parts), or EFW (prospective part) and mode of delivery were compared. Results Abnormal CCD (>2SD above previously published norms for each GA) was closely associated with cesarean delivery, regardless of EFW. At term, risk of C/S with a CCD >7.9 cm was 94%. Conclusion Within limits, EFW alone has weak correlation with cesarean delivery. CCD, as a reflector of fetal adipose tissue, performs as well as actual BW and demonstrates good prediction for delivery by C/S.