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

Majeed, Amara; Abuhamad, Alfred; Romary, Letty; Sinkovskaya, Elena

doi:10.1002/jum.14895

Cited by 10 publications

(16 citation statements)

References 25 publications

(38 reference statements)

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“…6,7,22 A promising alternative assessment protocol involves late first-trimester transvaginal ultrasound (15 AE 1 weeks) in combination with routine transabdominal ultrasound in the second trimester. 16,[23][24][25] Although study samples have been relatively small compared to the literature on ultrasound delays, this stepwise approach has resulted in anatomy completion rates of 78% to 90% for general anatomy and 96% for cardiac anatomy. 15,16,24 This approach has an advantage over delaying the assessment, in that it allows for earlier detection and counseling of fetal anomalies for pregnancies with obesity.…”

Section: Discussionmentioning

confidence: 99%

Delay of Fetal Anatomy Ultrasound Assessment Based on Maternal Body Mass Index Does Not Reduce the Rate of Inadequate Visualization

Khaikin

Bishop

Munawar

et al. 2020

J of Ultrasound Medicine

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Objectives-To determine whether delay of initial anatomy ultrasound based on the maternal body mass index (BMI) reduces the rate of inadequate visualization compared to standard timing at 18 0/7 to 19 6/7 weeks. Methods-A retrospective study of singleton anatomy assessments was conducted at a tertiary care center in the 2-year period before (A, 2012-2014) and after (B, 2014-2016) protocol initiation. Assessments in period B were scheduled on the basis of the BMI in the first trimester: lower than 25 kg/m 2 , 18 0/7 to 19 6/7 weeks; 25 to 29.9 kg/m 2 , 19 0/7 to 20 6/7 weeks; 30 to 34.9 kg/m 2 , 20 0/7 to 21 6/7 weeks; 35 to 39.9 kg/m 2 , 21 0/7 to 22 6/7 weeks; and 40 kg/m 2 or higher, 22 0/7 to 23 6/7 weeks. In period A, assessments were scheduled between 18 0/7 and 19 6/7 weeks. The rate of inadequate visualization and repeated assessments in periods A and B were compared. Multivariable logistic regression, per-protocol, and BMI subgroup analyses were completed. Results-In total, 3491 pregnancies in period A and 3672 in period B were included. In period B, 74% were scheduled per protocol; however, this rate decreased for higher-BMI categories (52% for BMI ≥40 kg/m 2). The inadequate visualization rate was slightly higher in period B versus A (16.9% versus 15.0%; P = .03) and exceeded 35% for a BMI of 40 kg/m 2 or higher, with or without delay. After adjusting for maternal age and fetal presentation, period B had small increased odds of inadequate visualization versus period A (adjusted odds ratio, 1.2; 95% confidence interval, 1.02-1.38). Repeated assessment rates were similar in periods B and A (14.0% versus 13.1%; P = .25). Conclusions-In pregnancies with obesity, a protocol delaying the initial assessment beyond 19 6/7 weeks based on the maternal BMI does not reduce the rate of inadequate visualization.

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Section: Discussionmentioning

confidence: 99%

Delay of Fetal Anatomy Ultrasound Assessment Based on Maternal Body Mass Index Does Not Reduce the Rate of Inadequate Visualization

Khaikin

Bishop

Munawar

et al. 2020

J of Ultrasound Medicine

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“…Our models used different completion rates for the five strategies for each of the three BMI groups (non‐obese, obese and Class‐III obese only). A recent study by Majeed et al 18 . estimated a completion rate of 70.4% for fetal cardiac screening with five axial views in obese women at 20–22 weeks' gestation, which dropped to 38.0% when the analysis was limited to women with Class‐III obesity or higher.…”

Section: Methodsmentioning

confidence: 99%

“…Our models used different completion rates for the five strategies for each of the three BMI groups (non-obese, obese and Class-III obese only). A recent study by Majeed et al 18 estimated a completion rate of 70.4% for fetal cardiac screening with five axial views in obese women at 20-22 weeks' gestation, which dropped to 38.0% when the analysis was limited to women with Class-III obesity or higher. Since the proportions of women in each obesity class in this study did not match those of the general population in the USA (which is 46% for Class I, 30% for Class II and 24% for Class III), we developed a weighted average completion rate of 76.5% for obese women (BMI ≥ 30) using the obesity proportions of the general population.…”

Section: Probabilitiesmentioning

confidence: 99%

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Impact of maternal obesity on fetal cardiac screening: which follow‐up strategy is cost‐effective?

Bak

Shaffer

Madriago

et al. 2020

Ultrasound in Obstet & Gyne

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Objective To perform a cost‐effectiveness analysis of different follow‐up strategies for non‐obese and obese women who had incomplete fetal cardiac screening for major congenital heart disease (CHD). Methods Three decision‐analytic models, one each for non‐obese, obese and Class‐III‐obese women, were developed to compare five follow‐up strategies for initial suboptimal fetal cardiac screening. The five strategies were: (1) no follow‐up ultrasound (US) examination but direct referral to fetal echocardiography (FE); (2) one follow‐up US, then FE if fetal cardiac views were still suboptimal; (3) up to two follow‐up US, then FE if fetal cardiac views were still suboptimal; (4) one follow‐up US and no FE; and (5) up to two follow‐up US and no FE. The models were designed to identify fetuses with major CHD in a theoretical cohort of 4 000 000 births in the USA. Outcomes related to neonatal mortality and neurodevelopmental disability were evaluated. A cost‐effectiveness willingness‐to‐pay threshold was set at US$100 000 per quality‐adjusted life year (QALY). Base‐case and sensitivity analysis and Monte‐Carlo simulation were performed. Results In our base‐case models for all body mass index (BMI) groups, no follow‐up US, but direct referral to FE led to the best outcomes, detecting 7%, 25% and 82% more fetuses with CHD in non‐obese, obese and Class‐III‐obese women, respectively, compared with the baseline strategy of one follow‐up US and no FE. However, no follow‐up US, but direct referral to FE was above the US$100 000/QALY threshold and therefore not cost‐effective. The cost‐effective strategy for all BMI groups was one follow‐up US and no FE. Both up to two follow‐up US with no FE and up to two follow‐up US with FE were dominated (being more costly and less effective), while one follow‐up US with FE was over the cost‐effectiveness threshold. One follow‐up US and no FE was the optimal strategy in 97%, 93% and 86% of trials in Monte‐Carlo simulation for non‐obese, obese and Class‐III‐obese models, respectively. Conclusion For both non‐obese and obese women with incomplete fetal cardiac screening, the optimal CHD follow‐up screening strategy is no further US and immediate referral to FE; however, this strategy is not cost‐effective. Considering costs, one follow‐up US and no FE is the preferred strategy. For both obese and non‐obese women, Monte‐Carlo simulations showed clearly that one follow‐up US and no FE was the optimal strategy. Both non‐obese and obese women with initial incomplete cardiac screening examination should therefore be offered one follow‐up US. Copyright © 2019 ISUOG. Published by John Wiley & Sons Ltd.

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“…Positive screening test results for aneuploidy, including cell‐free DNA screening and serum‐only or combined first‐trimester screening 52 Other conditions possibly affecting the pregnancy/fetus, including: Maternal body mass index of 30 kg/m 2 or higher 53–55 Placental implantation covering the internal cervical os under a cesarean scar site or cesarean scar pregnancy diagnosed in index gestation 56,57 …”

Section: Indicationsmentioning

confidence: 99%

AIUM Practice Parameter for the Performance of Detailed Diagnostic Obstetric Ultrasound Examinations Between 12 Weeks 0 Days and 13 Weeks 6 Days

2020

J of Ultrasound Medicine

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This practice parameter is intended to provide the medical ultrasound community with recommendations for the performance and recording of high-quality ultrasound examinations. The parameter reflects what the AIUM considers the appropriate criteria for this type of ultrasound examination but is not intended to establish a legal standard of care. Examinations performed in this specialty area are expected to follow the parameter with recognition that deviations may occur depending on the clinical situation.This specialized diagnostic examination is an extension of the standard sonographic fetal assessment described in the AIUM-ACR-ACOG-SMFM-SRU Practice Parameter for the Performance of Standard Diagnostic Obstetric Ultrasound Examinations and the American College of Obstetricians and Gynecologist practice bulletin Ultrasound in Pregnancy. 1,2 The detailed obstetric ultrasound examination in the late first trimester is an indication-driven examination for women at increased risk for fetal or placental abnormalities that are potentially detectable between 12 weeks 0 days and 13 weeks 6 days' gestation. Performance and interpretation of this examination require advanced training, knowledge, and imaging

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

Cited by 10 publications

References 25 publications

Delay of Fetal Anatomy Ultrasound Assessment Based on Maternal Body Mass Index Does Not Reduce the Rate of Inadequate Visualization

Delay of Fetal Anatomy Ultrasound Assessment Based on Maternal Body Mass Index Does Not Reduce the Rate of Inadequate Visualization

Impact of maternal obesity on fetal cardiac screening: which follow‐up strategy is cost‐effective?

AIUM Practice Parameter for the Performance of Detailed Diagnostic Obstetric Ultrasound Examinations Between 12 Weeks 0 Days and 13 Weeks 6 Days

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