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 Epidemiology and Community Health University of Minnesota Minneapolis Minnesota USA
Second-trimester ultrasound is the standard technique for fetal anatomy evaluation in the United States despite international guidelines and literature that suggest that first-trimester timing may be superior in patients with obesity. First-trimester imaging performs well in cohorts of participants with obesity.
Objective
Our aim was to compare the completion rate of a first-trimester fetal anatomy ultrasound scan with that of a second-trimester fetal anatomy ultrasound scan among pregnant people with a body mass index ≥35 kg/m(2).
Study Design
This randomized controlled trial enrolled participants with a body mass index ≥35 kg/m(2) with a singleton gestation and who presented before 14+0/7 weeks of gestation. Participants were randomized to receive an ultrasound assessment of anatomy at either 12+0/7 to 13+6/7 weeks or at 18+0/7 to 22+6/7 weeks. The primary outcome was completion rate (percentage of scans that optimally imaged all the required fetal structures). Secondary outcomes included the necessity of a transvaginal approach, completion rates for each individual view, number of anomalies identified and missed in each group, scan duration, and patient perspectives. A 1-year pilot sample was analyzed using Bayesian methods for the primary outcome with a neutral prior and frequentist analyses for the remaining outcomes.
Results
A total of 128 participants were enrolled, and 1 withdrew consent; 62 subjects underwent a first-trimester ultrasound scan and 62 underwent a second-trimester ultrasound scan. A total of 2 participants did not attend the research visits, and 1 sought termination of pregnancy. In the first-trimester group, 66% (41/62) of ultrasound scans were completed in comparison with 53% (33/62) in the second-trimester ultrasound group (Bayesian relative risk, 1.20; 95% credible interval, 0.91-1.73). When compared with a second-trimester scan plus a follow-up ultrasound, a first-trimester ultrasound plus a second-trimester ultrasound was equally successful in completing the anatomy views (76%). First-trimester anatomy ultrasound scans required a transvaginal approach in 63% (39/62) of cases and had a longer duration than a second-trimester ultrasound scan. No anomalies were missed in either group. First-trimester ultrasound participants who responded to a survey described that they were very satisfied with the technique.
Conclusion
In pregnant subjects with a body mass index ≥35 kg/m(2), a single first-trimester anatomy ultrasound scan was more likely to obtain all the recommended anatomic views than a single second-trimester ultrasound scan. An evaluation of anatomy at 12+0/7 to 13+6/7 weeks' gestation plus an evaluation at 18+0/7 to 22+6/7 led to complete anatomic evaluation 4 weeks earlier than 2 second trimester scans. Assessment of ultrasound duration in a clinical setting is needed to ensure feasibility outside of a research setting.
first trimester anatomy ultrasound obesity randomized controlled trial, fetal anatomy scan BMI 35 first versus second trimester, ultrasound completion rate obesity pregnancy imaging, early anatomy ultrasound obese patients transvaginal approach, Bayesian analysis first trimester scan obesity completion, prenatal ultrasound high BMI imaging quality comparison, first trimester fetal anatomy evaluation maternal obesity, obesity pregnancy ultrasound scan duration feasibility, early anatomy scan detection anomalies obese pregnant patients, 12 to 14 weeks anatomy ultrasound versus 18 to 22 weeks obesity
PMID 37669739 37669739 DOI 10.1016/j.ajogmf.2023.101143 10.1016/j.ajogmf.2023.101143
Cite this article
Cara Buskmiller, Fishel Bartal, M., Bonilla, M., Denham, C., Nguyen, R., Sibai, B., Pedroza, C., & Hernandez-Andrade, E. (2023). First trimester anatomy ultrasound for patients with obesity: a randomized controlled trial. American journal of obstetrics & gynecology MFM, 5(11), 101143. https://doi.org/10.1016/j.ajogmf.2023.101143
Cara Buskmiller, Fishel Bartal M, Bonilla M, Denham C, Nguyen R, Sibai B, et al. First trimester anatomy ultrasound for patients with obesity: a randomized controlled trial. Am J Obstet Gynecol MFM. 2023;5(11):101143. doi:10.1016/j.ajogmf.2023.101143
Cara Buskmiller, et al. "First trimester anatomy ultrasound for patients with obesity: a randomized controlled trial." American journal of obstetrics & gynecology MFM, vol. 5, no. 11, 2023, pp. 101143.
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