Fetal echocardiography: factors that influence imaging of the fetal heart during the second trimester of pregnancy

DeVore, G R; Medearis, Arnold L.; Bear, Moraye B.; Horenstein, Janet; Platt, Lawrence D.

doi:10.7863/jum.1993.12.11.659

Cited by 97 publications

(79 citation statements)

References 7 publications

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“…Our purpose in choosing this approach was to limit our study only to the postprocessing part of the examination. As volume acquisition can be affected by many factors such as operator skills, gestational age at examination, maternal body habitus, fetal position, fetal movement, fetal breathing, and amniotic fluid volume [54,55,58,69], it would be difficult to control for these factors when analyzing the data. Volume acquisition has been previously studied by Viñ als et al [55], who examined volume datasets of 100 consecutive fetuses between 18 and 37 weeks.…”

Section: Discussionmentioning

confidence: 99%

Four-dimensional fetal echocardiography with spatiotemporal image correlation (STIC): A systematic study of standard cardiac views assessed by different observers

Gonçalves

Espinoza

Romero

et al. 2005

The Journal of Maternal-Fetal & Neonatal Medicine

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Methods.A technique was developed to obtain dynamic multiplanar images of the left ventricular outflow tract (LVOT) and right ventricular outflow tract (RVOT) from volume datasets acquired with STIC. Volume datasets were acquired from fetuses with normal cardiac anatomy. Twenty volume datasets of satisfactory quality were pre-selected by one investigator. The data was randomly assigned for a blinded review by two independent observers with previous experience in fetal echocardiography. Only one volume dataset was used for each fetus. After a training session, the observers obtained standardized cardiac views of the LVOT and RVOT, which were scored on a scale of 1 to 5, based on diagnostic value and image quality (1 = unacceptable, 2 = marginal, 3 = acceptable, 4 = good, and 5 = excellent). Median scores and interquartile range, as well as inter-and intraobserver agreement were calculated for each view. Results. The mean menstrual age at the time of volume acquisition was 25.5 + 4.5 weeks. Median scores (interquartile range) for LVOT images, obtained by the first and second observers, were 3.5 (2.25-5.00) and 4 (3.00-5.00), respectively. The median scores (interquartile range) for RVOT images obtained by the first and second observers were 3 (3.00-5.00) and 3 (2.00-4.00), respectively. The interobserver intraclass correlation coefficient for the LVOT was 0.693 (95% CI 0.380-0.822), and 0.696 (95% CI 0.382-0.866) for the RVOT. For the intraobserver agreement analysis, observer 1 gave higher scores to the LVOT the second time the volumes were analyzed [LVOT: 3.50 (2.25-5.00) vs. 5.00 (4.00-5.00, p = 0.008)]. Conclusion. STIC can be reproducibly used to evaluate fetal cardiac outflow tracts by independent examiners. Slightly better image quality rating scores during the intraobserver variability trial suggests the presence of a learning curve for the manipulation and analysis of volume data obtained by STIC.

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Section: Discussionmentioning

confidence: 99%

Four-dimensional fetal echocardiography with spatiotemporal image correlation (STIC): A systematic study of standard cardiac views assessed by different observers

Gonçalves

Espinoza

Romero

et al. 2005

The Journal of Maternal-Fetal & Neonatal Medicine

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“…13 However, sonographic visualization of fetal structures is adversely affected by the size of the body fat layer and thus the degree of maternal obesity. 14,15 The impact of obesity on the quality of prenatal ultrasound examination was described by Wolfe et al, 16 in 1990, who found a greater risk for suboptimal visualization only when body mass index (BMI, kg/m 2 ) was above the 90th percentile. Although this finding (a decreased ability to visualize fetal structures with maternal obesity) was described over 14 y ago, quantification of this effect based on the severity of obesity using National Institute of Health (NIH) guidelines 17 is not well defined.…”

Section: Introductionmentioning

confidence: 99%

The impact of maternal obesity on midtrimester sonographic visualization of fetal cardiac and craniospinal structures

et al. 2004

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OBJECTIVE:To examine the impact of maternal obesity on the rate of suboptimal ultrasound visualization (SUV) of fetal anatomy and determine the optimal timing of prenatal ultrasound examination for the obese gravida. METHODS: A computerized ultrasound database was used to identify ultrasound examinations for singleton gestations performed between 14 0/7 and 23 6/7 weeks at a tertiary care, university-based hospital. Patients were divided into four groups and categorized based on body mass index (BMI): nonobese (BMI o30 kg/m 2 ), class I obesity (30rBMIo35 kg/m 2 ), class II obesity (35rBMIo40 kg/m 2 ), and extreme obesity (BMI Z40 kg/m 2 ). The rates of SUV for fetal cardiac and craniospinal structures were calculated for each group and compared. RESULTS: A total of 11 019 pregnancies were studied, of which 38.6% of the patients were obese. Overall, the rate of SUV of the fetal structures was higher for obese compared to nonobese women for both cardiac (37. With increasing gestational age at examination, the rate of SUV decreased for both obese and nonobese women. However, for obese women there was minimal improvement in visualization after 18-20 weeks. Even after adjustment for gestational age and the type of ultrasound machine, obese women (class I, class II, and extreme obesity) were still associated with increased odds for SUV of the fetal cardiac and craniospinal structures compared to nonobese women. CONCLUSION: Maternal obesity increases the rate of SUV for the fetal cardiac structures by 49.8% and for the craniospinal structures by 31%. The optimal gestational age for visualization of fetal cardiac and craniospinal anatomy in obese patients may be after 18-20 weeks.

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“…Schwärzler et al 26 and DeVore et al 41 found a direct relationship between visualization and GA, which in our case was not significant. However, fetal movements, the maternal habitus, and uterine fibroids were not associated with poorer sensitivity.…”

Section: Exploration Timementioning

confidence: 32%

“…Our algorithm was feasible in 81.5% of cases, which was similar to other algorithms for evaluation of the fetal heart (Table 7). 3,24,41 Comparisons, however, are difficult, given that those algorithms are not based on exactly the same views as our algorithm and often do not take the exploration time into account.…”

Section: Use Of Complementary Techniques: Color Doppler Imagingmentioning

confidence: 99%

Cardiovascular System Sonographic Evaluation Algorithm

León-Luis

Bravo

Gámez

et al. 2015

J of Ultrasound Medicine

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Objectives To evaluate the reproducibility and feasibility of the new cardiovascular system sonographic evaluation algorithm for studying the extended fetal cardiovascular system, including the portal, thymic, and supra‐aortic areas, in the second trimester of pregnancy (19–22 weeks). Methods We performed a cross‐sectional study of pregnant women with healthy fetuses (singleton and twin pregnancies) attending our center from March to August 2011. The extended fetal cardiovascular system was evaluated by following the new algorithm, a sequential acquisition of axial views comprising the following (caudal to cranial): I, portal sinus; II, ductus venosus; III, hepatic veins; IV, 4‐chamber view; V, left ventricular outflow tract; VI, right ventricular outflow tract; VII, 3‐vessel and trachea view; VIII, thy‐box; and IX, subclavian arteries. Interobserver agreement on the feasibility and exploration time was estimated in a subgroup of patients. The feasibility and exploration time were determined for the main cohort. Maternal, fetal, and sonographic factors affecting both features were evaluated. Results Interobserver agreement was excellent for all views except view VIII; the difference in the mean exploration time between observers was 1.5 minutes (95% confidence interval, 0.7–2.1 minutes; P < .05). In 184 fetuses (mean gestational age ± SD, 20 ± 0.6 weeks), the feasibility of all views was close to 99% except view VIII (88.7%). The complete feasibility of the algorithm was 81.5%. The mean exploration time was 5.6 ± 4.2 minutes. Only the occiput anterior fetal position was associated with a lower frequency of visualization and a longer exploration time (P < .05). Conclusions The cardiovascular system sonographic evaluation algorithm is a reproducible and feasible approach for exploration of the extended fetal cardiovascular system in a second‐trimester scan. It can be used to explore these areas in normal and abnormal conditions and provides an integrated image of extended fetal cardiovascular anatomy.

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Fetal echocardiography: factors that influence imaging of the fetal heart during the second trimester of pregnancy

Cited by 97 publications

References 7 publications

Four-dimensional fetal echocardiography with spatiotemporal image correlation (STIC): A systematic study of standard cardiac views assessed by different observers

Four-dimensional fetal echocardiography with spatiotemporal image correlation (STIC): A systematic study of standard cardiac views assessed by different observers

The impact of maternal obesity on midtrimester sonographic visualization of fetal cardiac and craniospinal structures

Cardiovascular System Sonographic Evaluation Algorithm

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