Image‐scoring system for umbilical and uterine artery pulsed‐wave Doppler ultrasound measurement

Molloholli, M.; Napolitano, R.; Ohuma, Eric O; Ash, Stephen; Wanyonyi, Sikolia; Cavallaro, A; Giudicepietro, A.; Barros, Fernando C.; Carvalho, Maria; Norris, Shane A.; Min, Aung Myat; Zainab, Ghulam; Papageorghiou, Aris T.

doi:10.1002/uog.19101

Cited by 10 publications

(20 citation statements)

References 24 publications

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“…25 Our umbilical artery Doppler measurements quality control methods have previously been published, which include the interobserver variability on a large sample of measurements. 28 ajog.org…”

Section: Standard Proceduresmentioning

confidence: 99%

“…48 The second limitation was that we did not perform an inter-and intraobserver evaluation. Nevertheless, we have undertaken strict quality assessment using a scoring system that was used in this study and this has been shown to be more reproducible than subjective assessment 28 ; therefore, all possible measures to improve reproducibility have been addressed.…”

Section: Strengths and Limitationsmentioning

confidence: 99%

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International gestational age-specific centiles for umbilical artery Doppler indices: a longitudinal prospective cohort study of the INTERGROWTH-21st Project

Drukker

Staines-Urias

Barros

et al. 2020

American Journal of Obstetrics and Gynecology

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BACKGROUND: Reference values for umbilical artery Doppler indices are used clinically to assess fetal well-being. However, many studies that have produced reference charts have important methodologic limitations, and these result in significant heterogeneity of reported reference ranges. OBJECTIVES: To produce international gestational age-specific centiles for umbilical artery Doppler indices based on longitudinal data and the same rigorous methodology used in the original Fetal Growth Longitudinal Study of the INTERGROWTH-21 st Project. STUDY DESIGN: In Phase II of the INTERGROWTH-21 st Project (the INTERBIO-21st Study), we prospectively continued enrolling pregnant women according to the same protocol from 3 of the original populations in Pelotas (Brazil), Nairobi (Kenya), and Oxford (United Kingdom) that had participated in the Fetal Growth Longitudinal Study. Women with a singleton pregnancy were recruited at <14 weeks' gestation, confirmed by ultrasound measurement of crownerump length, and then underwent standardized ultrasound every 5AE1 weeks until delivery. From 22 weeks of gestation umbilical artery indices (pulsatility index, resistance index, and systolic/diastolic ratio) were measured in a blinded fashion, using identical equipment and a rigorously standardized protocol. Newborn size at birth was assessed using the international INTERGROWTH-21 st Standards, and infants had detailed assessment of growth, nutrition, morbidity, and motor development at 1 and 2 years of age. The appropriateness of pooling data from the 3 study sites was assessed using variance component analysis and standardized site differences. Umbilical artery indices were modeled as functions of the gestational age using an exponential, normal distribution with second-degree fractional polynomial smoothing; goodness of fit for the overall models was assessed. RESULTS: Of the women enrolled at the 3 sites, 1629 were eligible for this study; 431 (27%) met the entry criteria for the construction of normative centiles, similar to the proportion seen in the original fetal growth longitudinal study. They contributed a total of 1243 Doppler measures to the analysis; 74% had 3 measures or more. The healthy lowrisk status of the population was confirmed by the low rates of preterm birth (4.9%) and preeclampsia (0.7%). There were no neonatal deaths and satisfactory growth, health, and motor development of the infants at 1 and 2 years of age were documented. Only a very small proportion (2.8% e6.5%) of the variance of Doppler indices was due to between-site differences; in addition, standardized site difference estimates were marginally outside this threshold in only 1 of 27 comparisons, and this supported the decision to pool data from the 3 study sites. All 3 Doppler indices decreased with advancing gestational age. The 3rd, 5th 10th, 50th, 90th, 95th, and 97th centiles according to gestational age for each of the 3 indices are provided, as well as equations to allow calculation of any value as a centile and z scores. The mean pulsatility ...

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Section: Standard Proceduresmentioning

confidence: 99%

Section: Strengths and Limitationsmentioning

confidence: 99%

International gestational age-specific centiles for umbilical artery Doppler indices: a longitudinal prospective cohort study of the INTERGROWTH-21st Project

Drukker

Staines-Urias

Barros

et al. 2020

American Journal of Obstetrics and Gynecology

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“…A power calculation was performed to evaluate the number of women required to identify optimal reproducibility values. We estimated that a total of 100 images would be required to detect significant differences between two operators, in accordance with calculations from previous studies 18–20 . As a previous study has shown that the CS scar could be visualized in 90% of cases 13 , 55 cases (110 sagittal and transverse images to achieve adequate power) were reviewed for each part of the study.…”

Section: Methodsmentioning

confidence: 77%

Reproducibility of assessment of full‐dilatation Cesarean section scar in women undergoing second‐trimester screening for preterm birth

Banerjee

Al-Dabbach

Bredaki

et al. 2022

Ultrasound in Obstet & Gyne

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This study demonstrates that, in women with a previous full-dilatation Cesarean section (CS), CS scar niche dimensions and scar position relative to the internal os of the uterine cervix can be assessed with a high level of reproducibility using B-mode and color Doppler transvaginal ultrasound during the second trimester of pregnancy. What are the clinical implications of this work?Full-dilatation CS increases the risk of spontaneous preterm birth in a subsequent pregnancy. There are currently no guidelines on how to measure CS scar position in pregnancy. The protocol described in this study should enable objective analysis of the effect of CS scar position and niche during pregnancy, and may be used in future studies to evaluate the associated risk of subsequent preterm birth.

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“…However, objective quality scoring would be more informative, particularly in a research setting in which interpretation of the results could be highly influenced by the quality of the measurements. A scoring system for MCA Doppler quality was developed by Ruiz-Martinez et al 9 and later adapted for UA and uterine artery Doppler 4 . This objective assessment showed higher inter-rater reliability and agreement than did subjective evaluation.…”

Section: Discussionmentioning

confidence: 99%

“…In the field of ultrasound, there are quality control systems aimed at ensuring acceptable levels of reliability among operators and consistency of measurements [1][2][3][4] . This issue is particularly important for the performance of multicenter studies because of their inherent heterogeneity 5 .…”

Section: Introductionmentioning

confidence: 99%

Quality assessment of fetal middle cerebral and umbilical artery Doppler images using an objective scale within an international randomized controlled trial

Rial-Crestelo

Morales‐Roselló

Hernández‐Andrade

et al. 2020

Ultrasound in Obstet & Gyne

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Objectives To determine the quality of Doppler images of the fetal middle cerebral artery (MCA) and umbilical artery (UA) using an objective scale, and to determine the reliability of this scale, within a multicenter randomized controlled trial (Revealed versus concealed criteria for placental insufficiency in unselected obstetric population in late pregnancy (Ratio37)). Methods The Ratio37 trial is an ongoing randomized, open‐label, multicenter controlled study of women with a low‐risk pregnancy recruited at 20 weeks. Doppler measurements of the fetal MCA and UA were performed at 37 weeks. Twenty patients from each of the six participating centers were selected randomly, with two images evaluated per patient (one each for the MCA and UA). The quality of a total of 240 images was evaluated by six experts, scored on an objective scale of six items. Inter‐ and intrarater reliability was assessed using the Fleiss‐modified kappa statistic for ordinal scales. Results On average, 89.2% of MCA images and 85.0% of UA images were rated as being of perfect (score of 6) or almost perfect (score of 5) quality. Kappa values for intrarater reliability of quality assessment were 0.90 (95% CI, 0.88–0.92) and 0.90 (95% CI, 0.88–0.93) for the MCA and UA, respectively. The corresponding inter‐rater reliability values were 0.85 (95% CI, 0.81–0.89) and 0.84 (95% CI, 0.80–0.89), respectively. Conclusion The quality of MCA and UA Doppler ultrasound images can be evaluated reliably using an objective scale. Over 85% of images, which were obtained by operators from a broad range of clinical practices within a multicenter study, were rated as being of perfect or almost perfect quality. Intra‐ and inter‐rater reliability of quality assessment was very good. Copyright © 2019 ISUOG. Published by John Wiley & Sons Ltd.

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Image‐scoring system for umbilical and uterine artery pulsed‐wave Doppler ultrasound measurement

Cited by 10 publications

References 24 publications

International gestational age-specific centiles for umbilical artery Doppler indices: a longitudinal prospective cohort study of the INTERGROWTH-21st Project

International gestational age-specific centiles for umbilical artery Doppler indices: a longitudinal prospective cohort study of the INTERGROWTH-21st Project

Reproducibility of assessment of full‐dilatation Cesarean section scar in women undergoing second‐trimester screening for preterm birth

Quality assessment of fetal middle cerebral and umbilical artery Doppler images using an objective scale within an international randomized controlled trial

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