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Can Ultrasound in Early Gestation Improve Visualization of Fetal Cardiac Structures in Obese Pregnant Women?
- Source :
-
Journal of ultrasound in medicine : official journal of the American Institute of Ultrasound in Medicine [J Ultrasound Med] 2019 Aug; Vol. 38 (8), pp. 2057-2063. Date of Electronic Publication: 2018 Dec 18. - Publication Year :
- 2019
-
Abstract
- Objectives: To determine whether ultrasound (US) imaging of obese pregnant women in early gestation improves fetal cardiac visualization.<br />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.<br />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/m <superscript>2</superscript> (UST1 [69%] versus UST2 [38%]; P = .001). Sixty-two percent of patients with a body mass index of greater than 40 kg/m <superscript>2</superscript> 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.<br />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.<br /> (© 2018 by the American Institute of Ultrasound in Medicine.)
- Subjects :
- Adult
Female
Fetal Heart diagnostic imaging
Fetal Heart embryology
Humans
Longitudinal Studies
Pregnancy
Pregnancy Trimester, First
Pregnancy Trimester, Second
Prospective Studies
Heart Defects, Congenital diagnostic imaging
Heart Defects, Congenital embryology
Obesity complications
Pregnancy Complications
Ultrasonography, Prenatal methods
Subjects
Details
- Language :
- English
- ISSN :
- 1550-9613
- Volume :
- 38
- Issue :
- 8
- Database :
- MEDLINE
- Journal :
- Journal of ultrasound in medicine : official journal of the American Institute of Ultrasound in Medicine
- Publication Type :
- Academic Journal
- Accession number :
- 30561065
- Full Text :
- https://doi.org/10.1002/jum.14895