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Diagnostic Performance of a Combined Fetal Soft-Tissue Index for Prediction of Macrosomia in Term Pregnancies: An Observational Study

Author(s) Dr. Saqib Pervez, Dr. Mohammad Aleem, Dr. Ekansh Rathoria, Dr. Richa Rathoria, Dr. Khan Aleena Mansur, Dr. Sameer
Country India
Abstract Background
Accurate estimation of fetal weight is a crucial component of antenatal care, as deviations from normal fetal growth are associated with increased perinatal morbidity and mortality. Conventional ultrasound-based fetal weight estimation relies primarily on skeletal biometric parameters, which may not adequately reflect fetal nutritional status, particularly in cases of macrosomia. Sonographic assessment of fetal soft-tissue thickness provides additional information on fetal fat and muscle mass and may enhance the antenatal detection of macrosomia.
Objective
To evaluate the diagnostic performance of fetal mid-thigh (MTSTT), mid-arm (MASTT), and abdominal (ASTT) soft-tissue thickness, individually and as a combined Soft Tissue Index (STI = MTSTT + ASTT), for the prediction of fetal macrosomia (birth weight >4000 g) in term pregnancies.
Methods
This observational cross-sectional study was conducted over 18 months in the Departments of Radiodiagnosis, Obstetrics and Gynaecology, and Paediatrics at Hind Institute of Medical Sciences, Ataria, Sitapur, India. A total of 133 term singleton pregnancies (37–40 weeks) with cephalic presentation were included. Ultrasound was performed within 48 hours of delivery (GE Logiq F8, 5 MHz convex probe). MTSTT, MASTT, and ASTT were each measured three times and averaged; estimated fetal weight (EFW) was calculated using Hadlock's formula from biparietal diameter, head circumference, abdominal circumference (AC), and femur length (FL). Receiver operating characteristic (ROC) and binary logistic regression analyses (SPSS version 23) were used to assess prediction of macrosomia.
Results
Mean gestational age was 38.2 ± 1.0 weeks and mean EFW was 3120 ± 395.6 g. Mean MTSTT, MASTT, and ASTT were 15.2 ± 2.0 mm, 13.1 ± 2.1 mm, and 12.3 ± 2.0 mm, respectively. All three parameters correlated significantly with EFW (MTSTT r = 0.72; ASTT r = 0.67; MASTT r = 0.64; all p < 0.001). On ROC analysis for macrosomia, MTSTT showed the highest individual accuracy (AUC 0.89; cutoff ≥17.5 mm; sensitivity 88.2%; specificity 84.1%), followed by ASTT (AUC 0.86; cutoff ≥15.5 mm; sensitivity 85.7%; specificity 80.4%) and MASTT (AUC 0.84; cutoff ≥16.0 mm; sensitivity 81.5%; specificity 77.6%; all p < 0.001). On logistic regression, MTSTT ≥17.5 mm was the strongest predictor of macrosomia (OR 5.20, 95% CI 2.1–11.8, p < 0.001), followed by AC ≥330 mm (OR 3.84, 95% CI 1.7–8.6, p = 0.001) and FL ≥75 mm (OR 2.96, 95% CI 1.3–6.9, p = 0.007). A combined Soft Tissue Index (STI = MTSTT + ASTT) at a cutoff of ≥30 mm gave the highest overall diagnostic performance (sensitivity 89.1%; specificity 85.4%; AUC 0.91; p < 0.001).
Conclusion
Fetal soft-tissue thickness, particularly MTSTT, showed strong correlation with EFW and good discriminative performance for macrosomia. A combined Soft Tissue Index (MTSTT + ASTT) outperformed individual parameters on point estimates of AUC, sensitivity, and specificity. These sonographic soft-tissue parameters may serve as adjuncts to conventional biometry for antenatal identification of macrosomia, although the small number of macrosomic cases in this cohort (n = 7) warrants cautious interpretation and external validation before clinical adoption.
Keywords Fetal macrosomia; Soft tissue thickness; Mid-thigh soft tissue thickness; Soft Tissue Index; Ultrasound; Fetal weight estimation.
Field Medical / Pharmacy
Published In Volume 7, Issue 5, September-October 2026
Published On 2026-09-18
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E-ISSN 3048-7641
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