Factors affecting feasibility and quality of second‐trimester ultrasound scans in obese pregnant women

Fuchs, Florent; Houllier, Marie; Voulgaropoulos, Audrey; Levaillant, Jean‐Marc; Colmant, C.; Bouyer, Jean; Sénat, Marie-Victoire

doi:10.1002/uog.12311

Cited by 51 publications

(60 citation statements)

References 15 publications

(27 reference statements)

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“…This wider distribution of SFT measures in overweight and obese pregnant women was also observed by Fusch. 41 Our data demonstrated that SFT decreased significantly from the first measurement (SFT1) to the second (SFT2) in overweight and obese women (Table 1). Early research with small numbers of normal weight women using skin calipers and body composition demonstrated an increase in fat deposits from 6-10 to 28-35 weeks' gestation.…”

Section: Discussionmentioning

confidence: 50%

Maternal abdominal subcutaneous fat thickness as a predictor for adverse pregnancy outcome: a longitudinal cohort study

Kennedy

Peek

et al. 2015

BJOG

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Objective To assess maternal abdominal subcutaneous fat thickness (SFT) measured by ultrasound as an independent predictor of adverse pregnancy outcomes.Design A prospective longitudinal cohort study performed on pregnancies delivered between 2012 and 2014.Setting Sydney, Australia.Population About 1510 pregnant women attending routine obstetric ultrasounds.Methods Maternal SFT was measured on routine ultrasounds at 11-14 weeks' gestation (SFT1) and 18-22 weeks' gestation (SFT2). SFT measurements were assessed for estimating risks for obesityrelated pregnancy outcomes using logistic regression modelling adjusted for maternal age, parity, smoking status and body mass index (BMI).Main outcome measures Hypertensive disease, gestational diabetes, caesarean section, low birthweight, preterm delivery, neonatal respiratory distress, Apgar scores, and admission to a neonatal intensive care unit.Results SFT1 and SFT2 were measured on 1461 and 1363 women, respectively. Mean thickness (range) were 21.2 mm (6.9-73.9) for SFT1 and 20.3 mm (7.5-68.0) for SFT2. Complete outcome data were available for 1385 pregnancies. In all, 54% of the women were overweight/obese. The SFT measures decreased from early to mid-pregnancy in overweight/obese women. There was moderate correlation between BMI and SFT1 (R 2 = 0.56) and BMI and SFT2 (R 2 = 0.55). In a multivariate model, SFT1 and SFT2 were better predictors for adverse pregnancy outcomes than BMI.Conclusion Maternal SFT is a significant independent predictor of adverse pregnancy outcomes. Incorporation of SFT into future models for adverse pregnancy outcome may prove valuable.

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Section: Discussionmentioning

confidence: 50%

Maternal abdominal subcutaneous fat thickness as a predictor for adverse pregnancy outcome: a longitudinal cohort study

Kennedy

Peek

et al. 2015

BJOG

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“…Where it is a case of poor image quality due to the distorting effects of overlying tissue, it is less likely that a repeat transabdominal examination will improve the situation and a TV scan may be requested. Fuchs et al 3 suggested that moving the position of the foetus and using a more experienced sonographer may sometimes improve the result. However, if approaching the imaging from another plane or compressing the skin with the ultrasound transducer has no effect, then a repeat TA scan is not really indicated.…”

Section: Discussionmentioning

confidence: 99%

“…The problem of achieving a high-quality obstetric scan in women with a high BMI has always been an issue that is not getting any easier with the increasing rise in obesity within this population. [2][3][4] Uhden et al 5 found that the rate of obtaining inadequate images for assessing foetal heart defects, in patients where the foetus did have a defect, increased from 6.4% for a normal weight population to 17.4% in the obese population (BMI 30), and that these obese patients were significantly more likely to have a foetus with a heart defect (relative risk 2.04). Following the introduction of the NICE Guidelines in 2010, 2 our own department has introduced a midwife-led BMI clinic (BMI 30-34.9) and a consultant-led clinic (BMI >35).…”

Section: Introductionmentioning

confidence: 99%

“…When the scan is suboptimal, with poor quality images, the reaction of the patient is often to blame the sonographer or the equipment. 3 This reaction may be compounded when the patient receives a copy of the scan report that indicates that the scan was suboptimal because of the patient body habitus or high BMI. There are well-understood reasons why some types of subcutaneous fat will distort an ultrasound beam, thereby degrading the image quality.…”

Section: Introductionmentioning

confidence: 99%

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Helping expectant mothers understand inadequate ultrasound images

Oates

Taylor

2016

Ultrasound

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Background: Obstetric ultrasound scans may fail to provide all the information that is needed because of poor visualisation. Two main causes of poor visualisation are addressed. These are poor foetal position and poor quality imaging due to beam distortion by overlying fatty tissue. Method: To improve communication with patients attending obstetric scans, a poster and leaflet were designed to explain these causes of inadequate scans. A questionnaire was used to assess the value of the poster. Results: 57/66 (86%) questionnaires were completed. 52 (91%) found the information on the poster was helpful and well explained. For 8 (14%) the information changed their thoughts about the scan. Conclusion: Clear communication aids the expectant mothers understanding of why scans may be suboptimal. The way this is recorded in the scan results is discussed.

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“…– 31 As such, the AC measurement is faster and easier to obtain than the EFW in a term pregnancy, where the engaged head can make the HC and BPD measurements technically difficult and less reliable. It is also one of the measurements which appears to be more achievable in the obese population, with equivalence of image quality compared with patients of average BMI 41 . This may be an important factor in the gestational diabetic population, who are more likely to be obese and therefore more difficult to scan.…”

Section: Discussionmentioning

confidence: 99%

Ultrasound (in)accuracy: it's in the formulae not in the technique – assessment of accuracy of abdominal circumference measurement in term pregnancies

Nesbitt‐Hawes

Tetstall

Gee

et al. 2014

Australas J Ultrason Med

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Introduction: Fetal abdominal circumference (AC) is utilised in calculations for the estimation of fetal weight (EFW) and has been proposed as a method of monitoring diabetic pregnancies. We evaluated true ultrasound accuracy by comparing fetal AC biometry with neonatal anthropometry and compared this with standard ultrasound estimations of fetal weight. Methods: A prospective observational study was performed at a tertiary referral centre. Women who were having their confinement of a term, singleton gestation either by induction of labour or elective caesarean section from 2009–2011 were approached to participate. An ultrasound was performed within 24 hours of delivery measuring the biometric parameters of AC, head circumference (HC), biparietal diameter and femur length. Following delivery the AC, HC and birthweight were measured on the neonate. Results: Fifty‐two patients were enrolled in the study with data collected from 50. Mean AC measurement was 35.1 ± 2.1 cm and birth weight was 3596 ± 517 g. A Bland‐Altman plot was used to compare the two AC measurements with the 95% limits of agreement ranging from −2.33–4.69 cm around a mean difference of 1.2 cm. Mean percentage error was 5.0% and 6.2% for the AC and HC measurements respectively, in comparison with percentage errors of 7.0–13.8% for estimation of fetal weight (EFW) from 27 formulae. Conclusions: Sonographic AC measurement is accurate in term pregnancies, with a percentage error less than HC or EFW. Perceptions of ultrasound inaccuracy may relate to the application of formulae rather than the ultrasound technique itself. Fetal surveillance using serial AC measurement has been proposed, in particular monitoring of diabetic pregnancies and in such a group AC may be easier and faster to obtain and more meaningful than EFW.

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Factors affecting feasibility and quality of second‐trimester ultrasound scans in obese pregnant women

Abstract: Objectives

Cited by 51 publications

References 15 publications

Maternal abdominal subcutaneous fat thickness as a predictor for adverse pregnancy outcome: a longitudinal cohort study

Maternal abdominal subcutaneous fat thickness as a predictor for adverse pregnancy outcome: a longitudinal cohort study

Helping expectant mothers understand inadequate ultrasound images

Ultrasound (in)accuracy: it's in the formulae not in the technique – assessment of accuracy of abdominal circumference measurement in term pregnancies

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