Limitations of the fetal anatomic survey via ultrasound in the obese obstetrical population

Judith H. Chung, Raquel Pelayo, Tamera J. Hatfield, Vinita J. Speir, Jun Wu, Aaron Caughey

Research output: Contribution to journalArticle

20 Citations (Scopus)

Abstract

Objective: To evaluate limitations of the fetal anatomic survey in obese women. Methods: Retrospective cohort study of obese gravidas with singleton gestations who had at least one, sonographic fetal evaluation at ≥14 weeks between January 2009 and March 2011. The impact of pre-pregnancy body mass index (BMI), placental location, prior cesarean scar and sonographer experience on ability to achieve an adequate ultrasound was evaluated using multilevel modeling. Ability to visualize specific fetal parts by BMI class and gestational age was also evaluated. Results: There were 245 obese women (42% with class III obesity). Senior faculty (>20 years experience) were more likely to achieve adequate visualization (adjusted odds ratio [aOR] 3.27; 95% confidence interval [CI] 1.159.25) compared with junior faculty. Among women with BMI > 40.0, odds of inadequate views of the face and spine were 10.0 (95% CI 1.3176.0) and 5.17 (95% CI 0.6540.8), when compared with women with a BMI=3034.9. Odds for inadequate views of sex (OR 3.83; 95% CI 0.8617.1) and extremities (OR 4.37; 95% CI 0.9919.4) were similarly increased with a BMI ≥ 40. The optimal gestational age for a complete anatomic survey was 2224 weeks (93% completion rate), with an OR of 41.3 (95% CI 7.89215.8), compared with a survey at 1416 weeks. Conclusions: Attending sonographer experience is associated with improved visualization of fetal anatomy among obese gravidas. Face, spine, sex and extremity views are particularly difficult in the highest BMI category.

Original languageEnglish (US)
Pages (from-to)1945-1949
Number of pages5
JournalJournal of Maternal-Fetal and Neonatal Medicine
Volume25
Issue number10
DOIs
StatePublished - Oct 2012

Fingerprint

Body Mass Index
Confidence Intervals
Population
Gestational Age
Spine
Extremities
Pregnancy
Cicatrix
Surveys and Questionnaires
Anatomy
Cohort Studies
Retrospective Studies
Obesity
Odds Ratio

Keywords

  • Body mass index
  • Obesity
  • Pregnancy
  • Prenatal sonography
  • Sonographer experience

ASJC Scopus subject areas

  • Pediatrics, Perinatology, and Child Health
  • Obstetrics and Gynecology

Cite this

Limitations of the fetal anatomic survey via ultrasound in the obese obstetrical population. / Chung, Judith H.; Pelayo, Raquel; Hatfield, Tamera J.; Speir, Vinita J.; Wu, Jun; Caughey, Aaron.

In: Journal of Maternal-Fetal and Neonatal Medicine, Vol. 25, No. 10, 10.2012, p. 1945-1949.

Research output: Contribution to journalArticle

Chung, Judith H. ; Pelayo, Raquel ; Hatfield, Tamera J. ; Speir, Vinita J. ; Wu, Jun ; Caughey, Aaron. / Limitations of the fetal anatomic survey via ultrasound in the obese obstetrical population. In: Journal of Maternal-Fetal and Neonatal Medicine. 2012 ; Vol. 25, No. 10. pp. 1945-1949.
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abstract = "Objective: To evaluate limitations of the fetal anatomic survey in obese women. Methods: Retrospective cohort study of obese gravidas with singleton gestations who had at least one, sonographic fetal evaluation at ≥14 weeks between January 2009 and March 2011. The impact of pre-pregnancy body mass index (BMI), placental location, prior cesarean scar and sonographer experience on ability to achieve an adequate ultrasound was evaluated using multilevel modeling. Ability to visualize specific fetal parts by BMI class and gestational age was also evaluated. Results: There were 245 obese women (42{\%} with class III obesity). Senior faculty (>20 years experience) were more likely to achieve adequate visualization (adjusted odds ratio [aOR] 3.27; 95{\%} confidence interval [CI] 1.159.25) compared with junior faculty. Among women with BMI > 40.0, odds of inadequate views of the face and spine were 10.0 (95{\%} CI 1.3176.0) and 5.17 (95{\%} CI 0.6540.8), when compared with women with a BMI=3034.9. Odds for inadequate views of sex (OR 3.83; 95{\%} CI 0.8617.1) and extremities (OR 4.37; 95{\%} CI 0.9919.4) were similarly increased with a BMI ≥ 40. The optimal gestational age for a complete anatomic survey was 2224 weeks (93{\%} completion rate), with an OR of 41.3 (95{\%} CI 7.89215.8), compared with a survey at 1416 weeks. Conclusions: Attending sonographer experience is associated with improved visualization of fetal anatomy among obese gravidas. Face, spine, sex and extremity views are particularly difficult in the highest BMI category.",
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