Department of Obstetrics, Gynecology and Reproductive Sciences (UTHealth) McGovern Medical School at The University of Texas Health Science Center at Houston Houston Texas USA
Department of Obstetrics, Gynecology, and Women’s Health, St. Louis University, St. Louis, MO, USAROR
Department of Obstetrics, Gynecology and Reproductive Sciences (UTHealth), McGovern Medical School at The University of Texas Health Science Center at Houston, Houston, Texas, USA.
Division of Public Health, Department of Family and Preventive Medicine, University of Utah School of Medicine, and Huntsman Cancer Institute, Salt Lake City, UT, United States of America.ROR
As maternal body mass index (BMI) increases, fetal anatomy ultrasound becomes more challenging, less sensitive, and less likely to be complete. We sought to report our experience of incomplete evaluation of anatomy in patients with BMI of 50 kg/m(2) or greater.
Methods
This is a retrospective cohort of singleton gestations in mothers with BMI of 50 kg/m(2) or greater, undergoing anatomy evaluations between 2017 and 2021 at 9 maternal-fetal-medicine sites in Houston, TX. Patient variables and scan results were collected throughout pregnancy to provide a longitudinal assessment of the primary outcome, completion rate (percent of all scans which optimally captured 24 American Institute of Ultrasound in Medicine-recommended images). Secondary outcomes included the rate of optimal capture of each individual structure.
Results
In total, 293 patients with BMI ≥50 kg/m(2) were identified. Only 28% of initial scans were complete, but over the entire pregnancy, a complete anatomic evaluation was achieved in 76% of women, largely due to weekly ultrasounds done for antenatal testing later in pregnancy. Neither BMI, placental location, nor amniotic fluid volume affected completion rate. The most difficult views are the outflow tracts, 4-chamber view, and spine.
Conclusions
One quarter of women with BMI of 50 kg/m(2) or greater will not have a complete fetal anatomic evaluation by the end of pregnancy, since even basic fetal anatomic views are technically challenging to complete. Solutions deserve further attention, and may include first trimester imaging, transvaginal imaging, and optimization of ultrasound machine settings.
PMID 37647313 37647313 DOI 10.1002/jum.16323 10.1002/jum.16323
Cite this article
Cara Buskmiller, Huntley, E., Blackburn, B., Sanchez, D., & Hernandez-Andrade, E. (2023). Completion of Fetal Anatomy Evaluations in Women With Body Mass Index ≥ 50 kg/m(2). Journal of ultrasound in medicine : official journal of the American Institute of Ultrasound in Medicine, 42(12), 2839-2844. https://doi.org/10.1002/jum.16323
Cara Buskmiller, Huntley E, Blackburn B, Sanchez D, Hernandez-Andrade E. Completion of Fetal Anatomy Evaluations in Women With Body Mass Index ≥ 50 kg/m(2). J Ultrasound Med. 2023;42(12):2839-2844. doi:10.1002/jum.16323
Cara Buskmiller, et al. "Completion of Fetal Anatomy Evaluations in Women With Body Mass Index ≥ 50 kg/m(2)." Journal of ultrasound in medicine : official journal of the American Institute of Ultrasound in Medicine, vol. 42, no. 12, 2023, pp. 2839-2844.
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