Obesity and the challenges of ultrasound fetal abnormality diagnosis

Tsai, Pai-Jong Stacy; Loichinger, Matthew; Žalud, Ivica

doi:10.1016/j.bpobgyn.2014.08.011

Cited by 100 publications

(33 citation statements)

References 37 publications

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“…The present prospective observational cohort study evaluated the reproducibility of fetal biometric measurements among patients at Evidence from randomized trials and meta-analyses has failed to demonstrate that a routine third-trimester screening for fetal growth restriction among low-risk pregnancies improves maternal and fetal outcomes compared with clinical evaluation alone. 5 It could be argued that the results of these studies have limited contemporary validity owing to the use of outdated surrogates for fetal growth, Despite several studies having evaluated the mean error among fetal weight estimates from third trimester ultrasonography, 7-9 the present study was, to the best of our knowledge, the first to evaluate the reproducibility of third-trimester fetal biometric ultrasonography measurements among patients with high BMI compared with patients with normal BMI. A previous study 14 did evaluate the reproducibility of ultrasonography measurements in a cohort of patients with a wide range of pregnancy durations.…”

Section: Discussionmentioning

confidence: 87%

“…Evidence from randomized trials and meta‐analyses has failed to demonstrate that a routine third‐trimester screening for fetal growth restriction among low‐risk pregnancies improves maternal and fetal outcomes compared with clinical evaluation alone . It could be argued that the results of these studies have limited contemporary validity owing to the use of outdated surrogates for fetal growth, and older ultrasonography equipment or protocols, where diagnosis of fetal growth restriction elicited no change in patient management.…”

Section: Discussionmentioning

confidence: 99%

“…Ultrasonography examinations are technically more difficult in patients who are obese compared with those with a normal BMI . Few studies have evaluated the accuracy of ultrasonography weight estimation in the third trimester in obese patients.…”

Section: Introductionmentioning

confidence: 99%

“…Ultrasonography examinations are technically more difficult in patients who are obese compared with those with a normal BMI. 5 Few studies have evaluated the accuracy of ultrasonography weight estimation in the third trimester in obese patients. Moreover, some studies 6,7 have suggested that the accuracy of ultrasonography estimates of fetal weight were not influenced significantly by maternal BMI whereas others 8,9 have concluded that the absolute percentage error for estimates was lower among patients of normal weight and that, consequently, maternal obesity decreased the accuracy of sonographic fetal weight estimation.…”

Section: Introductionmentioning

confidence: 99%

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Impact of maternal weight on the intra‐observer and inter‐observer reproducibility of fetal ultrasonography measurements in the third trimester

Policiano

Mendes

Fonseca

et al. 2017

Intl J Gynecology & Obste

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Objective: To evaluate the effect of maternal weight on the intra-and inter-observer reproducibility of third-trimester ultrasonography fetal measurements. Methods:The present prospective study, performed at a tertiary hospital, enrolled patients at between 35 +0 weeks and 36 +6 weeks of singleton pregnancies between January 1, 2015, and July 1, 2016. Fetal ultrasonography measurements were evaluated twice by a first observer and a third time by a second observer. Intra-and interobserver consistency were analyzed using the Cronbach α reliability coefficient, and measurement reproducibility was compared with patients stratified by a body mass index (BMI, calculated as weight in kilograms divided by the square of height in meters) of below 25 or at least 25. Results:The study included 197 patients (133 with BMI <25 and 64 with BMI ≥25).Among patients with a BMI below 25, the reliability coefficients for bi-parietal diameter, head circumference, abdominal circumference, and femur length measurements were 0.97, 0.95, 0.98, and 0.96, respectively, for intra-observer consistency, and were 0.97, 0.93, 0.98, and 0.95, respectively, for inter-observer consistency. Among patients with a BMI of at least 25, these values were 0. 97, 0.96, 0.98, and 0.97, respectively, for intra-observed consistency, and 0.97, 0.94, 0.98, and 0.96, respectively, for inter-observer consistency. Conclusion:High intra-and inter-observer reproducibility was observed for third-trimester fetal ultrasonography measurements, including for patients who were overweight. K E Y W O R D SFetal biometry; Intra-and inter-observer reproducibility; Obesity; Third trimester ultrasound

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Section: Discussionmentioning

confidence: 87%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Impact of maternal weight on the intra‐observer and inter‐observer reproducibility of fetal ultrasonography measurements in the third trimester

Policiano

Mendes

Fonseca

et al. 2017

Intl J Gynecology & Obste

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“…The challenge of fetal anatomic assessments in obese patients has been studied extensively, with reduced rates of completion of anatomic surveys, [4][5][6] lower detection rates, and increased residual risk of fetal anomalies due to suboptimal anatomy visualization, particularly in the setting of pregestational diabetes. 7 Similarly studies have demonstrated suboptimal ultrasound (US) visualization of the 4-chamber view, outflow tracts, or both during fetal echocardiography in obese women. 8 The International Society of Ultrasound in Obstetrics and Gynecology recommends fetal cardiac screening in low-risk fetuses between 18 and 22 weeks' menstrual age with a scan including the visceral situs, 4-chamber, and outflow tract views.…”

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confidence: 99%

Can Ultrasound in Early Gestation Improve Visualization of Fetal Cardiac Structures in Obese Pregnant Women?

Majeed

Abuhamad

Romary

et al. 2018

J of Ultrasound Medicine

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Objectives To determine whether ultrasound (US) imaging of obese pregnant women in early gestation improves fetal cardiac visualization. Methods We report a prospective longitudinal trial comparing late first‐ and early second‐trimester US to traditional second‐trimester US for fetal cardiac screening in maternal obesity. All study participants received US for fetal cardiac screening at a gestational age of 13 weeks to 15 weeks 6 days using a transvaginal or transabdominal approach (UST1). All patients also underwent a traditional transabdominal examination at 20 to 22 weeks (UST2). If UST2 failed to complete the cardiac visualization, a follow up examination (second UST2) was performed 2 to 4 weeks later. Imaging was considered complete if the visceral situs, 4 chambers, outflow tracts, and 3 vessels were visualized. The completion rates between UST1 and UST2 were the primary outcomes. A power analysis (85%) and sample size calculation (n = 145) were performed. Results A total of 152 pregnancies met study criteria. Completion rates of cardiac screening were 77% for UST1 and 70% for UST2 (P = .143). This comparison reached statistical significance in patients with a body mass index of greater than 40 kg/m2 (UST1 [69%] versus UST2 [38%]; P = .001). Sixty‐two percent of patients with a body mass index of greater than 40 kg/m2 required second UST2. The highest fetal cardiac screening completion rate was achieved when UST1 was combined with UST2 (96.1%). In 1 fetus, congenital heart disease was detected at UST1 and later confirmed. Conclusions This study represents the largest prospective trial assessing early‐gestation US for fetal cardiac screening in the setting of maternal obesity. In obese pregnancies, the addition of early‐gestation US to the 20‐ to 22‐week US substantially improves the visualization of fetal cardiac anatomy.

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Management of prepregnancy, pregnancy, and postpartum obesity from the FIGO Pregnancy and Non‐Communicable Diseases Committee: A FIGO (International Federation of Gynecology and Obstetrics) guideline

McAuliffe

Killeen

Jacob

et al. 2020

Intl J Gynecology & Obste

114

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Obstetricians and gynecologists are well positioned to influence population health through maternity and women's health services. Obesity is common in women of reproductive age and the prevalence is rising in both low-/middle-income and high-income countries 1. Obesity affects requirements for assessment, monitoring, and intervention and can impact maternal and child outcomes. Obstetricians and gynecologists require guidance on the care of women of reproductive age with obesity at all time points related to pregnancy, including how to address modifiable risk factors such as diet and physical activity. Many guidelines have been developed to date, although they vary in scope, methodology, and individual recommendations. FIGO's Committee Guideline for the Management of Prepregnancy, Pregnancy, and Postpartum Obesity (Table 1) reviews good clinical practice recommendations (Table 2-4) from previously published international documents. It serves as a practical resource to support obstetricians and gynecologists in the management of This is an open access article under the terms of the Creative Commons Attribution License, which permits use, distribution and reproduction in any medium, provided the original work is properly cited.

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Obesity and the challenges of ultrasound fetal abnormality diagnosis

Cited by 100 publications

References 37 publications

Impact of maternal weight on the intra‐observer and inter‐observer reproducibility of fetal ultrasonography measurements in the third trimester

Impact of maternal weight on the intra‐observer and inter‐observer reproducibility of fetal ultrasonography measurements in the third trimester

Can Ultrasound in Early Gestation Improve Visualization of Fetal Cardiac Structures in Obese Pregnant Women?

Management of prepregnancy, pregnancy, and postpartum obesity from the FIGO Pregnancy and Non‐Communicable Diseases Committee: A FIGO (International Federation of Gynecology and Obstetrics) guideline

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