1
|
Minocha PK, Englund EK, Friesen RM, Fujiwara T, Smith SA, Meyers ML, Browne LP, Barker AJ. Reference Values for Fetal Cardiac Dimensions, Volumes, Ventricular Function and Left Ventricular Longitudinal Strain Using Doppler Ultrasound Gated Cardiac Magnetic Resonance Imaging in Healthy Third Trimester Fetuses. J Magn Reson Imaging 2024; 60:365-374. [PMID: 37855630 PMCID: PMC11026299 DOI: 10.1002/jmri.29077] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2023] [Revised: 10/02/2023] [Accepted: 10/02/2023] [Indexed: 10/20/2023] Open
Abstract
BACKGROUND Recent advances in hardware and software permit the use of cardiac MRI of late gestation fetuses, however there is a paucity of MRI-based reference values. PURPOSE To provide initial data on fetal cardiac MRI-derived cardiac dimensions, volumes, ventricular function, and left ventricular longitudinal strain in healthy developing fetuses >30 weeks gestational age. STUDY TYPE Prospective. POPULATION Twenty-five third trimester (34 ± 1 weeks, range of 32-37 weeks gestation) women with healthy developing fetuses. FIELD STRENGTH/SEQUENCE Studies were performed at 1.5 T and 3 T. Cardiac synchronization was achieved with a Doppler ultrasound device. The protocol included T2 single shot turbo spin echo stacks for fetal weight and ultrasound probe positioning, and multiplanar multi-slice cine balanced steady state free precession gradient echo sequences. ASSESSMENT Primary analyses were performed by a single observer. Weight indexed right ventricular (RV) and left ventricular (LV) volumes and function were calculated from short axis (SAX) stacks. Cardiac dimensions were calculated from the four-chamber and SAX stacks. Single plane LV longitudinal strain was calculated from the four-chamber stack. Interobserver variability was assessed in 10 participants. Cardiac MRI values were compared against available published normative fetal echocardiogram data using z-scores. STATISTICAL TESTS Mean and SDs were calculated for baseline maternal/fetal demographics, cardiac dimensions, volumes, ventricular function, and left ventricular longitudinal strain. Bland-Altman and intraclass correlation coefficient analysis was performed to test interobserver variability. RESULTS The mean gestational age was 34 ± 1.4 weeks. The mean RV and LV end diastolic volumes were 3.1 ± 0.6 mL/kg and 2.4 ± 0.5 mL/kg respectively. The mean RV cardiac output was 198 ± 49 mL/min/kg while the mean LV cardiac output was 173 ± 43 mL/min/kg. DATA CONCLUSION This paper reports initial reference values obtained by cardiac MRI in healthy developing third trimester fetuses. MRI generally resulted in slightly larger indexed values (by z-score) compared to reports in literature using fetal echocardiography. EVIDENCE LEVEL 1 TECHNICAL EFFICACY: Stage 2.
Collapse
Affiliation(s)
- Prashant K. Minocha
- Division of Cardiology, Heart Institute, Children’s Hospital Colorado, University of Colorado School of Medicine, USA
| | - Erin K. Englund
- Department of Radiology, Section of Pediatric Radiology, Children’s Hospital Colorado, University of Colorado Anschutz Medical Campus, USA
| | - Richard M. Friesen
- Division of Cardiology, Heart Institute, Children’s Hospital Colorado, University of Colorado School of Medicine, USA
| | - Takashi Fujiwara
- Department of Radiology, Section of Pediatric Radiology, Children’s Hospital Colorado, University of Colorado Anschutz Medical Campus, USA
| | - Sarah A. Smith
- Department of Radiology, Section of Pediatric Radiology, Children’s Hospital Colorado, University of Colorado Anschutz Medical Campus, USA
| | - Mariana L. Meyers
- Department of Radiology, Section of Pediatric Radiology, Children’s Hospital Colorado, University of Colorado Anschutz Medical Campus, USA
| | - Lorna P. Browne
- Department of Radiology, Section of Pediatric Radiology, Children’s Hospital Colorado, University of Colorado Anschutz Medical Campus, USA
| | - Alex J. Barker
- Department of Radiology, Section of Pediatric Radiology, Children’s Hospital Colorado, University of Colorado Anschutz Medical Campus, USA
- Department of Bioengineering, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA
| |
Collapse
|
2
|
Vienneau EP, Ozgun KA, Byram BC. Spatiotemporal Coherence to Quantify Sources of Image Degradation in Ultrasonic Imaging. IEEE TRANSACTIONS ON ULTRASONICS, FERROELECTRICS, AND FREQUENCY CONTROL 2022; 69:1337-1352. [PMID: 35175919 PMCID: PMC9083333 DOI: 10.1109/tuffc.2022.3152717] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
Abstract
Thermal noise and acoustic clutter signals degrade ultrasonic image quality and contribute to unreliable clinical assessment. When both noise and clutter are prevalent, it is difficult to determine which one is a more significant contributor to image degradation because there is no way to separately measure their contributions in vivo. Efforts to improve image quality often rely on an understanding of the type of image degradation at play. To address this, we derived and validated a method to quantify the individual contributions of thermal noise and acoustic clutter to image degradation by leveraging spatial and temporal coherence characteristics. Using Field II simulations, we validated the assumptions of our method, explored strategies for robust implementation, and investigated its accuracy and dynamic range. We further proposed a novel robust approach for estimating spatial lag-one coherence. Using this robust approach, we determined that our method can estimate the signal-to-thermal noise ratio (SNR) and signal-to-clutter ratio (SCR) with high accuracy between SNR levels of -30 to 40 dB and SCR levels of -20 to 15 dB. We further explored imaging parameter requirements with our Field II simulations and determined that SNR and SCR can be estimated accurately with as few as two frames and sixteen channels. Finally, we demonstrate in vivo feasibility in brain imaging and liver imaging, showing that it is possible to overcome the constraints of in vivo motion using high-frame rate M-Mode imaging.
Collapse
|
3
|
Mei JY, Han CS. Ultrasound for the Pregnant Person With Diabesity. Clin Obstet Gynecol 2021; 64:144-158. [PMID: 33394705 DOI: 10.1097/grf.0000000000000600] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Diabetes and obesity increase the risk of congenital anomalies, but the putative mechanisms of this increased risk are not fully elucidated. In this chapter, we delve into sonographic characteristics associated with diabetes and obesity, including fetal structural anomalies, functional cardiac alterations, and growth abnormalities. We will also discuss the technical challenges of imaging in the patient with diabesity and propose methodologies for optimizing imaging. Lastly, we will address the prevention of workplace-associated musculoskeletal disorders injury for sonographers.
Collapse
Affiliation(s)
- Jenny Y Mei
- Department of Obstetrics and Gynecology, Division of Maternal Fetal Medicine, University of California, Los Angeles, California
| | | |
Collapse
|
4
|
Martin RB, Duryea EL, Mcintire DD, Twickler DM, Dashe JS. Fetal Anomaly Detection in Pregnancies With Pregestational Diabetes. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2020; 39:1917-1923. [PMID: 32323894 DOI: 10.1002/jum.15296] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/24/2020] [Revised: 03/23/2020] [Accepted: 03/25/2020] [Indexed: 06/11/2023]
Abstract
OBJECTIVES To evaluate fetal anomaly detection in pregnancies with pregestational diabetes, according to the gestational age at the time of specialized sonography, use of follow-up sonography, maternal body mass index, and organ system(s) involved. METHODS Women with pregestational diabetes who received prenatal care and delivered a live-born or stillborn neonate at our hospital from October 2011 through April 2017 were ascertained. We included all pregnancies with at least 1 confirmed structural anomaly (EUROCAT classification) who had detailed sonography at 18 weeks' gestation or later. We analyzed detection of anomalous fetuses at the initial detailed sonogram and, if no abnormality was identified, during any follow-up sonograms. Statistical analyses were performed with the χ2 test and Mantel-Haenszel χ2 test for trend. RESULTS Seventy-two anomalous neonates (72 of 1060 [6.8%]) were born. Overall detection was 55 of 72 (76%); 49 of 72 (68%) were detected at the initial detailed sonogram, compared to 6 of 15 (40%) of follow-up examinations (P = .04). Recognition at the initial or follow-up examination was not dependent on gestational age or body mass index category (all P > .05). Of individual organ system anomalies, 67 of 89 (75%) were identified. Detection exceeded 85% for central nervous system, genitourinary, and musculoskeletal abnormalities and 43% for craniofacial anomalies. Sixty-five percent of cardiac anomalies were detected, and 14 of 17 (82%) requiring specialized care in the immediate neonatal period were recognized. CONCLUSIONS Approximately three-fourths of anomalous fetuses were identified, with greater detection at the initial detailed examination. Fetuses with central nervous system, genitourinary, musculoskeletal abnormalities and those with cardiac anomalies requiring specialized cardiac care were more likely to come to attention.
Collapse
Affiliation(s)
- Robert B Martin
- Department of Obstetrics and Gynecology, University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | - Elaine L Duryea
- Department of Obstetrics and Gynecology, University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | - Donald D Mcintire
- Department of Obstetrics and Gynecology, University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | - Diane M Twickler
- Department of Radiology, University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | - Jodi S Dashe
- Department of Obstetrics and Gynecology, University of Texas Southwestern Medical Center, Dallas, Texas, USA
| |
Collapse
|
5
|
Maxwell C, Gaudet L, Cassir G, Nowik C, McLeod NL, Jacob CÉ, Walker M. Guideline No. 391-Pregnancy and Maternal Obesity Part 1: Pre-conception and Prenatal Care. JOURNAL OF OBSTETRICS AND GYNAECOLOGY CANADA 2020; 41:1623-1640. [PMID: 31640864 DOI: 10.1016/j.jogc.2019.03.026] [Citation(s) in RCA: 40] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
OBJECTIVE This guideline will review key aspects in the pregnancy care of women with obesity. Part I will focus on pre-conception and pregnancy care. Part II will focus on team planning for delivery and Postpartum Care. INTENDED USERS All health care providers (obstetricians, family doctors, midwives, nurses, anaesthesiologists) who provide pregnancy-related care to women with obesity. TARGET POPULATION Women with obesity who are pregnant or planning pregnancies. EVIDENCE Literature was retrieved through searches of Statistics Canada, Medline, and The Cochrane Library on the impact of obesity in pregnancy on antepartum and intrapartum care, maternal morbidity and mortality, obstetrical anaesthesia, and perinatal morbidity and mortality. Results were restricted to systematic reviews, randomized controlled trials/controlled clinical trials, and observational studies. There were no date or language restrictions. Searches were updated on a regular basis and incorporated in the guideline to September 2018. Grey (unpublished) literature was identified through searching the websites of health technology assessment and related agencies, clinical practice guideline collections, clinical trial registries, and national and international medical specialty societies. VALIDATION METHODS The content and recommendations were drafted and agreed upon by the authors. Then the Maternal-Fetal Medicine Committee peer reviewed the content and submitted comments for consideration, and the Board of the Society of Obstetricians and Gynaecologists of Canada (SOGC) approved the final draft for publication. Areas of disagreement were discussed during meetings, at which time consensus was reached. The level of evidence and quality of the recommendation made were described using the Evaluation of Evidence criteria of the Canadian Task Force on Preventive Health Care. BENEFITS, HARMS, AND COSTS Implementation of the recommendations in these guidelines may increase obstetrical provider recognition of the issues affected pregnant individuals with obesity, including clinical prevention strategies, communication between the health care team, the patient and family as well as equipment and human resource planning. It is hoped that regional, provincial and federal agencies will assist in the education and support of coordinated care for pregnant individuals with obesity. GUIDELINE UPDATE SOGC guidelines will be automatically reviewed 5 years after publication. However, authors can propose another review date if they feel that 5 years is too short/long based on their expert knowledge of the subject matter. SPONSORS This guideline was developed with resources funded by the SOGC. SUMMARY STATEMENTS RECOMMENDATIONS.
Collapse
|
6
|
Bak GS, Shaffer BL, Madriago E, Allen A, Kelly B, Caughey AB, Pereira L. Detection of fetal cardiac anomalies: cost-effectiveness of increased number of cardiac views. ULTRASOUND IN OBSTETRICS & GYNECOLOGY : THE OFFICIAL JOURNAL OF THE INTERNATIONAL SOCIETY OF ULTRASOUND IN OBSTETRICS AND GYNECOLOGY 2020; 55:758-767. [PMID: 31945242 DOI: 10.1002/uog.21977] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/25/2019] [Revised: 12/22/2019] [Accepted: 12/31/2019] [Indexed: 06/10/2023]
Abstract
OBJECTIVE To compare the recommended three-view fetal heart screening method to detect major congenital heart disease (CHD) with more elaborate screening strategies to determine the cost-effective strategy in unselected (low-risk) pregnancies. METHODS A decision-analytic model was designed to compare four screening strategies to identify fetuses with major CHD in a theoretical cohort of 4 000 000 births in the USA. The four strategies were: (1) three views: four-chamber view (4CV) and views of the left (LVOT) and right (RVOT) ventricular outflow tracts; (2) five views: 4CV, LVOT, RVOT and longitudinal views of the ductal arch and aortic arch; (3) five axial views: 4CV, LVOT, RVOT, three-vessel (3V) view and three-vessels-and-trachea view; and (4) six views: 4CV, LVOT, RVOT and 3V views and longitudinal views of the ductal arch and aortic arch. Outcomes related to neonatal mortality and neurodevelopmental disability were evaluated. The analysis was performed from a healthcare-system perspective, with a cost-effectiveness willingness-to-pay threshold set at $100 000 per quality-adjusted life year (QALY). Baseline analysis, one-way sensitivity analysis and Monte-Carlo simulation were performed. RESULTS In our baseline model, screening with five axial views was the optimal strategy, detecting 3520 more CHDs, and resulting in 259 fewer children with neurodevelopmental disability, 40 fewer neonatal deaths and only slightly higher costs, compared with screening with the currently recommended three views. Screening with six views was more effective, but also cost considerably more, compared with screening with five axial views, and had an incremental cost of $490 023/QALY, which was over the willingness-to-pay threshold. The five-view strategy was dominated by the other three strategies, i.e. it was more costly and less effective in comparison. The data were robust when tested with Monte-Carlo and one-way sensitivity analysis. CONCLUSION Although current guidelines recommend a minimum of three views for detecting CHD during the mid-trimester anatomy scan, screening with five axial views is a cost-effective strategy that may lead to improved outcome compared with three-view screening. Copyright © 2020 ISUOG. Published by John Wiley & Sons Ltd.
Collapse
Affiliation(s)
- G S Bak
- Fetal Medicine Unit, Department of Obstetrics and Gynecology, Odense University Hospital, Odense, Denmark
| | - B L Shaffer
- Department of Obstetrics and Gynecology, Division of Maternal-Fetal Medicine, Oregon Health & Science University, Portland, OR, USA
| | - E Madriago
- Department of Pediatrics, Division of Pediatric Cardiology, Oregon Health & Science University, Portland, OR, USA
| | - A Allen
- Department of Obstetrics and Gynecology, Division of Maternal-Fetal Medicine, Oregon Health & Science University, Portland, OR, USA
| | - B Kelly
- Department of Pediatrics, Division of Pediatric Cardiology, Oregon Health & Science University, Portland, OR, USA
| | - A B Caughey
- Department of Obstetrics and Gynecology, Division of Maternal-Fetal Medicine, Oregon Health & Science University, Portland, OR, USA
| | - L Pereira
- Department of Obstetrics and Gynecology, Division of Maternal-Fetal Medicine, Oregon Health & Science University, Portland, OR, USA
| |
Collapse
|
7
|
Aksu E, Albayrak Y, Beyazyüz E, Potas N, Durankuş F, Tenel B, Beyazyüz M. Distinct temperament and character traits in patients with hyperemesis gravidarum. Gynecol Endocrinol 2020; 36:525-529. [PMID: 31668106 DOI: 10.1080/09513590.2019.1683820] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/22/2023] Open
Abstract
Hyperemesis gravidarum (HG) is an extreme form of vomiting during pregnancy and is characterized with excessive vomiting and nausea and ketonuria, electrolyte imbalance, dehydration and severe nurtition deficiency. The etiology of HG is considered as multifactorial. Altough there is a great interest to HG in terms of psychiatric conditions, there have been limited numbers of studies that researched personality traits in patients with HG. In present study, we aimed to compare temperament and character traits between pregnant women with and without HG by Temperament and Character Inventory. 48 pregnant women with HG and 64 healthy pregnant women were included to study. The HG groups and control group were compared in terms of temperament and character traits and anxiety levels. The temperament scores of novelty seeking, harm avoidance and reward dependence were found to be similar between groups while the score of persistence was significantly lower in HG group compared with control group (p = .021). All character scores in HG group as cooperativeness, self-directedness, and self-transcendence were significantly lower compared with control groups (respectively; p = .002, p = .018 and p = .029). The scores of STAI-1 was higher in HG group compared with control group (p = .027) whereas the score of STAI-2 was found to be similar between groups. Present study is the first to demonstrate different temperament and character traits in patients with HG. We argue that our results support the psychiatric background of HG; however further studies are needed to confirm our results.
Collapse
Affiliation(s)
- Erson Aksu
- Department of Gynecology and Obstetrics, Vatan Hospital, İstanbul Rumeli University, İstanbul, Turkey
| | - Yakup Albayrak
- Faculty of Medicine, Department of Psychiatry, Tekirdağ Namık Kemal University, Tekirdağ, Turkey
| | - Elmas Beyazyüz
- Faculty of Medicine, Department of Psychiatry, Tekirdağ Namık Kemal University, Tekirdağ, Turkey
| | - Nihan Potas
- Faculty of Economics and Administrative Science, Department of Healthcare Managment, Ankara Hacıbayram Veli University, Ankara, Turkey
| | - Ferit Durankuş
- Department of Pediatrics, Göztepe Education and Research Hospital, İstanbul Medeniyet University, İstanbul, Turkey
| | - Burçak Tenel
- Faculty of Medicine, Department of Psychiatry, Tekirdağ Namık Kemal University, Tekirdağ, Turkey
| | - Murat Beyazyüz
- Faculty of Medicine, Department of Psychiatry, Tekirdağ Namık Kemal University, Tekirdağ, Turkey
| |
Collapse
|
8
|
Maxwell C, Gaudet L, Cassir G, Nowik C, McLeod NL, Jacob CÉ, Walker M. Directive clinique N o 391 - Grossesse et obésité maternelle Partie 1 : Préconception et soins prénataux. JOURNAL OF OBSTETRICS AND GYNAECOLOGY CANADA 2019; 41:1641-1659. [PMID: 31640865 DOI: 10.1016/j.jogc.2019.08.035] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
|
9
|
Glanc P, D'Souza R, Parrish J, Tomlinson G, Maxwell C. Should an Early Anatomy Ultrasound Scan Be Offered Routinely to Obese Pregnant Women? JOURNAL OF OBSTETRICS AND GYNAECOLOGY CANADA 2019; 40:1288-1294. [PMID: 30390944 DOI: 10.1016/j.jogc.2018.01.027] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2017] [Accepted: 01/13/2018] [Indexed: 01/30/2023]
Abstract
OBJECTIVE The primary objective of this study was to determine whether an early anatomic scan (EAS), either on its own or in combination with the routine transabdominal scan (R-TAS), would improve overall completion rates of the fetal anatomic survey in the obese pregnant woman. The study's secondary objectives were to compare patients' and sonographers' satisfaction with EAS versus R-TAS. METHODS A prospective observational study was carried out over a 2.5-year period including consecutive pregnant women with a pre-pregnancy BMI ≥30 kg/m2 who consented at a dating ultrasound appointment to undergo EAS at 15 ± 1 GA in addition to the second trimester R-TAS. Anatomic structures were categorized as normal, not well seen, or abnormal by using the institutional 26-item anatomic standardized reporting template. Examination completion and study duration were recorded. Neonatal follow-up was performed to evaluate for any missed diagnoses. Patients' and sonographers' satisfaction questionnaires were completed. RESULTS A total of 120 pregnant women completed the study. Visualization of all anatomic components was complete in 14% at EAS and in 61% at R-TAS (combined completion rate, 90%). Mean scan time was 30.4 minutes at EAS and 51 minutes at R-TAS. No missed diagnoses of structural anomalies were identified at neonatal follow-up. EAS and R-TAS differed in terms of sonographers' reports of difficult or suboptimal scans (9% vs. 58%), well-seen anatomy (85% vs. 78%), and good visibility (44% vs. 12%). Most sonographers expressed a preference for performing EAS in future pregnancies, rather than the R-TAS (96% vs. 6%). Although patients reported greater satisfaction with EAS (93% vs. 74%), for reasons that could not be determined, they expressed a preference for R-TAS in a subsequent pregnancy (23% vs. 63%). CONCLUSION Performing EAS along with R-TAS improves completion rates for anatomic evaluation in the obese gravida and is associated with greater patient and sonographer satisfaction.
Collapse
Affiliation(s)
- Phyllis Glanc
- Department of Medical Imaging, Department of Obstetrics and Gynaecology, Maternal Fetal Medicine Division, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, ON.
| | - Rohan D'Souza
- Department of Obstetrics and Gynaecology, Maternal Fetal Medicine Division, Mount Sinai Hospital, University of Toronto, Toronto, ON
| | | | - George Tomlinson
- Department of Medicine, Toronto General Hospital, University of Toronto, Toronto, ON
| | - Cynthia Maxwell
- Department of Obstetrics and Gynaecology, Maternal Fetal Medicine Division, Mount Sinai Hospital, University of Toronto, Toronto, ON
| |
Collapse
|
10
|
Toscano M, Grace D, Pressman EK, Thornburg LL. Does transvaginal ultrasound at 13-15 weeks improve anatomic survey completion rates in obese gravidas? J Matern Fetal Neonatal Med 2019; 34:803-809. [PMID: 31088198 DOI: 10.1080/14767058.2019.1618825] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
Objective: Obesity increases the difficulty of completing the fetal anatomic survey. This is of added concern in obese gravidas who are at higher risk of congenital fetal anomalies. We hypothesized that incorporation of an early transvaginal assessment could improve the completion rate of the fetal anatomic survey in obese women.Methods: We performed a prospective, longitudinal, blinded study of obese gravidas (BMI ≥ 35 kg/m2) comparing the use of a single early second trimester transvaginal ultrasound in addition to midtrimester transabdominal ultrasound versus traditional serial midtrimester ultrasound alone for completion of the anatomic survey. Transvaginal ultrasound for anatomy was performed between 13 0/7 and 15 6/7 week followed by midtrimester anatomic ultrasound, with each patient serving as her own control. Structures were marked as optimally or suboptimally viewed after each ultrasound. Sonographers and reviewers were blinded to images from the transvaginal ultrasound. Completion rates and gestational age at completion were compared between groups.Results: Fifty subjects were included. Fetal anatomic survey was completed in 62% using standard midtrimester assessment versus 78% with the addition of early transvaginal assessment (p = .04). The survey was completed at an earlier gestational age utilizing the transvaginal approach (22 0/7 ± 6 3/7) compared to traditional midtrimester transabdominal ultrasound approach (25 2/7 ± 5 3/7) p < .0005.Conclusions: Incorporation of an early transvaginal assessment of anatomy in obese women improved the rate of completion and led to earlier gestational age at completion of the fetal anatomic survey. Consideration should be given to including an early transvaginal sonogram as part of routine assessment of women with a BMI ≥ 35.
Collapse
Affiliation(s)
- Marika Toscano
- Department of Obstetrics and Gynecology, University of Rochester Medical Center, Rochester, NY, USA
| | - Daniel Grace
- Rochester Regional Health, Unity Perinatal Medicine, Rochester, NY, USA
| | - Eva K Pressman
- Department of Maternal Fetal Medicine, University of Rochester Medical Center, Rochester, NY, USA
| | - Loralei L Thornburg
- Department of Maternal Fetal Medicine, University of Rochester Medical Center, Rochester, NY, USA
| |
Collapse
|
11
|
Shin J, Huang L, Yen JT. Spatial Prediction Filtering for Medical Ultrasound in Aberration and Random Noise. IEEE TRANSACTIONS ON ULTRASONICS, FERROELECTRICS, AND FREQUENCY CONTROL 2018; 65:1845-1856. [PMID: 30072318 DOI: 10.1109/tuffc.2018.2860962] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/15/2023]
Abstract
While medical ultrasound imaging has become one of the most widely used imaging modalities in clinics, it often suffers from suboptimal image quality, especially in technically difficult patients with a large amount of fat content that induces severe phase aberration effects and decreases the signal-to-noise ratio. Several researchers have proposed various techniques, which can be broadly categorized as either a phase aberration correction (PAC) technique or a coherence-based imaging technique, to address the challenges in imaging technically difficult patients. Although both families of techniques have shown some success in improving the image quality in the presence of a mild level of phase aberration and/or random noise, they often fail to achieve meaningful improvements in the image quality and, in some cases, even create severe image artifacts. In this paper, we employ an adaptive filtering technique called frequency-space prediction filtering (FXPF), which we recently introduced in ultrasound imaging, to overcome the weaknesses of existing techniques and achieve image quality improvements more effectively under varying levels of phase aberration and random noise. Using simulated and experimental phantom data with varying levels of phase aberration and random noise, we evaluate and compare the performance of FXPF with the most representative technique for each category: nearest-neighbor cross correlation (NNCC)-based PAC and the generalized coherence factor (GCF). Our simulation, experimental phantom, and in vivo results demonstrate that FXPF is highly robust in varying levels of phase aberration and noise, and always outperforms both NNCC-based PAC and GCF in terms of the contrast-to-noise ratio (CNR) and the contrast when both random noise and phase aberration are present.
Collapse
|
12
|
Al-Obaidly S, Al-Ibrahim A, Saleh N, Al-Belushi M, Al-Mansouri Z, Khenyab N. Third trimester ultrasound accuracy and delivery outcome in obese and morbid obese pregnant women. J Matern Fetal Neonatal Med 2017; 32:1275-1279. [PMID: 29129159 DOI: 10.1080/14767058.2017.1404566] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
OBJECTIVE Several studies have highlighted the negative impact of maternal obesity on ultrasound accuracy for fetal weight estimation (EFW). However, the evidence is conflicting. We aimed in our study to find if the ultrasound accuracy for EFW would differ or decrease in obese and morbid obesity classes. We also studied the mode of delivery within the same cohort. METHODS It is a retrospective study of obese patients with recorded BMI ≥30 kg/m2, class I and II (BMI: 30-39.9 kg/m2) compared with extreme obese class III (BMI ≥40 kg/m2), who gave birth after 28-week gestation of viable singleton, who had an ultrasound within 7 d of delivery with reported normal amniotic fluid and no major fetal anomaly; the EFW was consistently measured through Hadlock regression formula in the period of 2014-2015 inclusive. Differences between the EFW and actual birth weight (ABW) were assessed by percentage error, accuracy in predictions within ±10% of error and the Pearson correlation coefficient were used to correlate EFW with the ABW. The study's secondary outcome was to study the mode of delivery and the rate of cesarean section in obese and morbid obese patients. RESULTS Total 106 cases fulfilled our criteria. Class I and II as the first group (n = 53). Class III as the second group (n = 53). Maternal and birth characteristics were similar. The Pearson correlation coefficient equal 1 in both groups. The overall mean absolute difference (MAD) in grams of the whole obese cohort was 242 ± 213. The MAD was 242 ± 202 and 242 ± 226 g for the first and second group, respectively (p = 1.0). The overall mean absolute percentage error (MAPE) in this obese cohort was 8%. The MAPE for the first and second group, respectively were 8 and 7% (p = 0.4). The overall rate of cesarean delivery was 60% (64/106) with no differences between the obese and morbid obese BMI classes. Sixty-six percentage (42/64) of these cesarean cases was for repeat cesarean section. CONCLUSION Despite what has been previously reported about the negative impact of maternal obesity on EFW accuracy, we could not demonstrate this relationship in our obese cohort (MAPE <10%). In addition, we could not illustrate a significant difference in ultrasound accuracy across various obesity classes. However, we found a significantly increased rate of delivery by repeated cesarean section in this obese cohort.
Collapse
Affiliation(s)
- Sawsan Al-Obaidly
- a Obstetrics and Gynecology Department , Hamad Medical Corporation, Feto-Maternal Medicine Unit , Doha , Qatar
| | - Abdullah Al-Ibrahim
- a Obstetrics and Gynecology Department , Hamad Medical Corporation, Feto-Maternal Medicine Unit , Doha , Qatar
| | - Najah Saleh
- a Obstetrics and Gynecology Department , Hamad Medical Corporation, Feto-Maternal Medicine Unit , Doha , Qatar
| | - Mariam Al-Belushi
- a Obstetrics and Gynecology Department , Hamad Medical Corporation, Feto-Maternal Medicine Unit , Doha , Qatar
| | - Zeena Al-Mansouri
- a Obstetrics and Gynecology Department , Hamad Medical Corporation, Feto-Maternal Medicine Unit , Doha , Qatar
| | - Najat Khenyab
- a Obstetrics and Gynecology Department , Hamad Medical Corporation, Feto-Maternal Medicine Unit , Doha , Qatar
| |
Collapse
|
13
|
Origins in the Womb: Potential Role of the Physical Therapist in Modulating the Deleterious Effects of Obesity on Maternal and Offspring Health Through Movement Promotion and Prescription During Pregnancy. Phys Ther 2017; 97:114-123. [PMID: 27417168 PMCID: PMC6396816 DOI: 10.2522/ptj.20150678] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/14/2015] [Accepted: 07/07/2016] [Indexed: 02/06/2023]
Abstract
Maternal obesity and associated metabolic disease contribute to adverse outcomes in women and their offspring, and many of these outcomes have significant acute and chronic implications for both mother and neonate. Targeted movement (ie, physical activity or exercise training) during pregnancy has been shown to be safe and effective for improving many of these outcomes in women at a healthy weight and women who are obese. However, movement prescription and advice during pregnancy are often not addressed by health care providers; this situation creates a unique opportunity for physical therapists to use their expertise in movement with patients who are pregnant. The objective of this article is to briefly review the adverse maternal and neonatal outcomes associated with maternal obesity, the benefits of intentional maternal movement during pregnancy for women who are obese, the evidence-based guidelines for prescribing intentional movement during pregnancy for women who are obese, and the potential for physical therapists to become the driving force behind a necessary increase in movement levels in women who are pregnant. Physical therapists can play a significant role in encouraging movement in women who are healthy and women who have metabolic challenges during pregnancy and thus assist in combating the vicious cycle of obesity by improving maternal and offspring health.
Collapse
|
14
|
Bak GS, Sperling L, Källén K, Salvesen KÅ. Prospective population-based cohort study of maternal obesity as a source of error in gestational age estimation at 11-14 weeks. Acta Obstet Gynecol Scand 2016; 95:1281-1287. [DOI: 10.1111/aogs.12963] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2016] [Accepted: 08/09/2016] [Indexed: 11/30/2022]
Affiliation(s)
- Geske S. Bak
- Fetal Medicine Unit; Department of Obstetrics and Gynecology; Odense University Hospital; Odense Denmark
| | - Lene Sperling
- Fetal Medicine Unit; Department of Obstetrics and Gynecology; Odense University Hospital; Odense Denmark
| | - Karin Källén
- Center of Reproduction Epidemiology; Institute of Clinical Sciences; Lund University; Lund Sweden
| | - Kjell Å. Salvesen
- National Center for Fetal Medicine; Trondheim University Hospital; Trondheim Norway
- Department of Laboratory Medicine; Children's and Women's Health; Norwegian University of Science and Technology; Trondheim Norway
| |
Collapse
|
15
|
Adekola H, Soto E, Dai J, Lam-Rachlin J, Gill N, Leon-Peters J, Puder K, Abramowicz JS. Optimal visualization of the fetal four-chamber and outflow tract views with transabdominal ultrasound in the morbidly obese: Are we there yet? JOURNAL OF CLINICAL ULTRASOUND : JCU 2015; 43:548-555. [PMID: 26419498 DOI: 10.1002/jcu.22307] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/27/2015] [Accepted: 07/27/2015] [Indexed: 06/05/2023]
Abstract
BACKGROUND To compare optimal visualization of the four-chamber and outflow-tract views of the fetal heart on sonographic examination between morbidly obese (body mass index [BMI] ≥ 40 kg/m(2) ) and nonobese (BMI < 25 kg/m(2) ) pregnant women. METHODS In this retrospective cohort study, we included records and images from 509 pregnant women who had first undergone sonographic examination between 18 and 36 weeks' fetal gestational age. RESULTS Compared with the nonobese women, morbidly obese women had lower optimal visualization of the four-chamber and outflow-tract heart views: four-chamber view, morbidly obese, 83/186 (44.6%), versus nonobese, 283/323 (87.6%), and outflow-tract view, morbidly obese, 80/186 (43%) versus nonobese, 258/290 (89%); p < 0.0001 for each comparison. Similar outcomes were observed when the results from each subcategory of morbidly obese women (ie, BMI 40-49.9, 50-59.9, and ≥60 kg/m(2) ) were compared with that from nonobese women; p < 0.0001 for each comparison. These outcomes remained the same regardless of whether this comparison was made among those who had their examination before or at 19 weeks' or more gestational age. Among the morbidly obese women, there was no difference in optimal visualization of the four-chamber or outflow-tract views regardless of whether the examination was performed at <23 weeks' or at ≥23 weeks' gestational age: four-chamber view <23 weeks, 44.8% (78/174), versus four-chamber view ≥23 weeks, 41.7% (5/12); p = 0.8, and outflow-tract view <23 weeks, 43.1% (75/174), versus outflow-tract view ≥23 weeks, 41.7% (5/12); p = 0.9. After controlling for maternal age and race, the odds of visualizing the four-chamber and outflow-tract views in the morbidly obese were reduced compared with those in their nonobese counterparts: odds ratio (OR) for four-chamber, 0.13; 95% confidence interval (CI), 0.08-0.21, and OR for outflow-tract, 0.11; 95% CI, 0.07-0.17. CONCLUSIONS Optimal visualization of the fetal four-chamber and outflow-tract views was achieved in less than 50% of morbidly obese women, compared with almost 90% in nonobese women.
Collapse
Affiliation(s)
- Henry Adekola
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Wayne State University/Detroit Medical Center, Detroit, MI, 48201
| | - Eleazar Soto
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, The University of Texas Health Science Center at Houston, Houston, TX, 77030
| | - Jing Dai
- C.S. Mott Center for Human Growth and Development, Wayne State University School of Medicine, Detroit, MI, 48201
| | - Jennifer Lam-Rachlin
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Wayne State University/Detroit Medical Center, Detroit, MI, 48201
| | - Navleen Gill
- Department of Obstetrics and Gynecology, Wayne State University/Detroit Medical Center, Detroit, MI, 48201
| | - Jocelyn Leon-Peters
- Department of Obstetrics and Gynecology, Wayne State University/Detroit Medical Center, Detroit, MI, 48201
| | - Karoline Puder
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Wayne State University/Detroit Medical Center, Detroit, MI, 48201
| | - Jacques S Abramowicz
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Wayne State University/Detroit Medical Center, Detroit, MI, 48201
| |
Collapse
|
16
|
Aksoy H, Aksoy Ü, Karadağ Öİ, Yücel B, Aydın T, Babayiğit MA. Influence of maternal body mass index on sonographic fetal weight estimation prior to scheduled delivery. J Obstet Gynaecol Res 2015; 41:1556-61. [DOI: 10.1111/jog.12755] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2014] [Revised: 04/01/2015] [Accepted: 04/08/2015] [Indexed: 11/28/2022]
Affiliation(s)
- Hüseyin Aksoy
- Department of Obstetrics and Gynecology; Kayseri Military Hospital; Kayseri Turkey
| | - Ülkü Aksoy
- Department of Obstetrics and Gynecology; Kayseri Memorial Hospital; Kayseri Turkey
| | - Özge İdem Karadağ
- Department of Obstetrics and Gynecology; Kayseri Acıbadem Hospital; Kayseri Turkey
| | - Burak Yücel
- Department of Obstetrics and Gynecology; Kayseri Acıbadem Hospital; Kayseri Turkey
| | - Turgut Aydın
- Department of Obstetrics and Gynecology; Kayseri Acıbadem Hospital; Kayseri Turkey
| | | |
Collapse
|
17
|
Kakkad V, Dahl J, Ellestad S, Trahey G. In vivo application of short-lag spatial coherence and harmonic spatial coherence imaging in fetal ultrasound. ULTRASONIC IMAGING 2015; 37:101-16. [PMID: 25116292 PMCID: PMC4326611 DOI: 10.1177/0161734614547281] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/05/2023]
Abstract
Fetal scanning is one of the most common applications of ultrasound imaging and serves as a source of vital information about maternal and fetal health. Visualization of clinically relevant structures, however, can be severely compromised in difficult-to-image patients due to poor resolution and the presence of high levels of acoustical noise or clutter. We have developed novel coherence-based beamforming methods called Short-Lag Spatial Coherence (SLSC) imaging and Harmonic Spatial Coherence imaging (HSCI), and applied them to suppress the effects of clutter in fetal imaging. This method is used to create images of the spatial coherence of the backscattered ultrasound as opposed to images of echo magnitude. We present the results of a patient study to assess the benefits of coherence-based beamforming in the context of first trimester fetal exams. Matched fundamental B-mode, SLSC, harmonic B-mode, and HSCI images were generated using raw radio frequency data collected on 11 volunteers in the first trimester of pregnancy. The images were compared for qualitative differences in image texture and target conspicuity as well as using quantitative imaging metrics such as signal-to-noise ratio (SNR), contrast-to-noise ratio (CNR), and contrast. SLSC and HSCI showed statistically significant improvements across all imaging metrics compared with B-mode and harmonic B-mode, respectively. These improvements were greatest for poor quality B-mode images where contrast of anechoic targets was improved from 15 dB in fundamental B-mode to 27 dB in SLSC and 17 dB in harmonic B-mode to 30 dB in HSCI. CNR improved from 1.4 to 2.5 in the fundamental images and 1.4 to 3.1 in the harmonic case. These results exhibit the potential of coherence-based beamforming to improve image quality and target detectability, especially in high noise environments.
Collapse
Affiliation(s)
- Vaibhav Kakkad
- Department of Biomedical Engineering, Duke University, Durham, NC, USA
| | - Jeremy Dahl
- Department of Biomedical Engineering, Duke University, Durham, NC, USA
| | - Sarah Ellestad
- Department of Obstetrics and Gynecology, Duke University Medical Center, Durham, NC, USA
| | - Gregg Trahey
- Department of Biomedical Engineering, Duke University, Durham, NC, USA
| |
Collapse
|
18
|
Aksoy H, Aksoy Ü, Karadağ Öİ, Hacimusalar Y, Açmaz G, Aykut G, Çağlı F, Yücel B, Aydın T, Babayiğit MA. Depression levels in patients with hyperemesis gravidarum: a prospective case-control study. SPRINGERPLUS 2015; 4:34. [PMID: 25646155 PMCID: PMC4308584 DOI: 10.1186/s40064-015-0820-2] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 09/15/2014] [Accepted: 01/14/2015] [Indexed: 12/30/2022]
Abstract
Hyperemesis gravidarum (HG) is a condition characterized by severe, intractable nausea and vomiting in early pregnancy. It affects about 0.3–2% of all pregnancies and is thought that HG is a multifactorial disease resulting from the combination of various unrelated conditions such as genetic, hormonal and psychiatric. Although there are studies investigating the relationship between anxiety, depression and HG; however, none have sufficiently clarified this link. The aim of this prospective case–control study was to investigate the possible relationship between depression and HG and compare the prevalence of depression disorders in pregnant women with and without HG. A prospective case–control study was performed at our tertiary referral centre between December 2013 and July 2014. The study group consisted of 78 pregnant women with HG and the control group consisted of 82 healthy pregnant women who never had experienced any nausea and vomiting. No study participants had any pre-pregnancy history of any psychiatric disorder including depression. Structured Clinical Interview for Diagnostic (SCID-I) and Statistical Manual of Mental Disorders Fourth Edition (DSM-IV) was used to evaluate symptoms of depression. Beck Depression Inventory (BDI) was administered to patients during the psychiatric interview and was evaluated by the same psychiatrist. The mean BDI scores in HG study and healthy control groups were 18.97 ± 9.85 and 6.36 ± 5.61, respectively (p < 0.001). Among the 78 women in the HG study population, 42 (53.9%) of patients had moderate or severe depression disorder. Only 6.1% of patients in the control group had moderate or severe depression. In conclusion, the findings of this study indicated that psychological distress associated with HG was a direct consequence rather than a cause of HG. Therefore, patients with HG during pregnancy should be evaluated with respect to mood disorders as much as their medical conditions.
Collapse
Affiliation(s)
- Hüseyin Aksoy
- Department of Obstetrics and Gynecology, Kayseri Military Hospital, Kayseri, Turkey
| | - Ülkü Aksoy
- Department of Obstetrics and Gynecology, Kayseri Memorial Hospital, Kayseri, Turkey
| | - Özge İdem Karadağ
- Department of Obstetrics and Gynecology, Kayseri Acıbadem Hospital, Kayseri, Turkey
| | - Yunus Hacimusalar
- Department of Psychiatry, Kayseri Education and Research Hospital of Medicine, Kayseri, Turkey
| | - Gökhan Açmaz
- Department of Obstetrics and Gynecology, Kayseri Education and Research Hospital of Medicine, Kayseri, Turkey
| | - Gülsüm Aykut
- Department of Obstetrics and Gynecology, Kayseri Education and Research Hospital of Medicine, Kayseri, Turkey
| | - Fulya Çağlı
- Department of Obstetrics and Gynecology, Kayseri Education and Research Hospital of Medicine, Kayseri, Turkey
| | - Burak Yücel
- Department of Obstetrics and Gynecology, Kayseri Acıbadem Hospital, Kayseri, Turkey
| | - Turgut Aydın
- Department of Obstetrics and Gynecology, Kayseri Acıbadem Hospital, Kayseri, Turkey
| | | |
Collapse
|
19
|
Tsai PJS, Loichinger M, Zalud I. Obesity and the challenges of ultrasound fetal abnormality diagnosis. Best Pract Res Clin Obstet Gynaecol 2014; 29:320-7. [PMID: 25457860 DOI: 10.1016/j.bpobgyn.2014.08.011] [Citation(s) in RCA: 87] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2014] [Accepted: 08/17/2014] [Indexed: 11/30/2022]
Abstract
Prenatal ultrasound has become an essential clinical tool for aneuploidy screening, detection of fetal congenital anomalies, and assessment of fetal growth and well-being. Maternal obesity, an increasing global problem, has been shown to decrease the accuracy of ultrasound examination in high-risk pregnancy. The purpose of this review is to provide an evidenced-based perspective on the challenges of performing fetal ultrasound in obese women and to provide a practical guide on how to care for these patients in the ultrasound suite.
Collapse
Affiliation(s)
- Pai-Jong Stacy Tsai
- John A Burns School of Medicine, University of Hawaii, Department of Obstetrics, Gynecology, and Women's Health, Division of Maternal Fetal Medicine, 1319 Punahou Street, Suite 824, Honolulu, HI 96826, USA.
| | - Matthew Loichinger
- John A Burns School of Medicine, University of Hawaii, Department of Obstetrics, Gynecology, and Women's Health, Division of Maternal Fetal Medicine, 1319 Punahou Street, Suite 824, Honolulu, HI 96826, USA
| | - Ivica Zalud
- John A Burns School of Medicine, University of Hawaii, Department of Obstetrics, Gynecology, and Women's Health, Division of Maternal Fetal Medicine, 1319 Punahou Street, Suite 824, Honolulu, HI 96826, USA
| |
Collapse
|
20
|
Woolner AMF, Bhattacharya S. Obesity and stillbirth. Best Pract Res Clin Obstet Gynaecol 2014; 29:415-26. [PMID: 25457855 DOI: 10.1016/j.bpobgyn.2014.07.025] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2014] [Accepted: 07/24/2014] [Indexed: 01/28/2023]
Abstract
Recent years have witnessed a rise in maternal obesity, which is independently associated with an increased risk of stillbirth. The pathophysiology is unclear, but it is likely related to abnormal placental function, and inflammatory, metabolic and hormonal imbalances in the mother. Obesity is associated with conditions such as diabetes, which can also cause stillbirth. In order to reduce the risk of obesity-associated stillbirth, women of reproductive age should be actively encouraged to optimise their pre-pregnancy weight as the safety of weight loss interventions during pregnancy is unproven. Obese and extremely obese women should be treated as high-risk obstetric patients, with increased antenatal surveillance and specialist input. The postnatal period may be a useful time to provide weight management advice to women to prevent interpregnancy weight gain and reduce the risk of stillbirth in subsequent pregnancies.
Collapse
Affiliation(s)
- Andrea M F Woolner
- Obstetrics & Gynaecology, Division of Applied Health Sciences, School of Medicine and Dentistry, University of Aberdeen, Aberdeen Maternity Hospital, Cornhill Road, Aberdeen AB25 2ZL, UK.
| | - Siladitya Bhattacharya
- Head of Division of Applied Health Sciences, School of Medicine and Dentistry, University of Aberdeen, Polwarth Building, Foresterhill, Aberdeen AB25 2ZD, UK.
| |
Collapse
|
21
|
Gupta S, Timor-Tritsch IE, Oh C, Chervenak J, Monteagudo A. Early second-trimester sonography to improve the fetal anatomic survey in obese patients. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2014; 33:1579-1583. [PMID: 25154938 DOI: 10.7863/ultra.33.9.1579] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
OBJECTIVES Fetal anatomic surveys are difficult to perform on obese patients. However, there are limited data available on methods to improve the rate of complete anatomy scans in these patients. The objective of this study was to determine whether the addition of an early second-trimester fetal anatomy scan improves the rate of complete anatomy scans in obese patients. METHODS We conducted a prospective cohort study of 100 obese patients at a city hospital who were scheduled for a fetal anatomy scan using transvaginal and transabdominal sonography at 14 to 16 weeks (early anatomy scan) and an anatomy scan at 18 to 22 weeks ("routine" anatomy scan). Inclusion criteria were a body mass index of 30 kg/m(2) or higher, singleton pregnancy, and presentation for prenatal care before 16 weeks. Data for the routine anatomy scan alone versus a combination of early and routine anatomy scans was calculated by the McNemar χ(2) test for categorical variables and the Wilcoxon signed ranks test for continuous variables. RESULTS The addition of the early anatomy scan significantly increased the rate of complete anatomy scans from 42% to 51% (P < .01). It also significantly improved visualization of the head, thorax, and abdomen and significantly increased the mean number of items seen (P < .05). CONCLUSIONS The addition of an early second-trimester fetal anatomy scan to a routine anatomy scan performed later in the second trimester significantly improves the rate of complete anatomy scans in obese patients.
Collapse
Affiliation(s)
- Simi Gupta
- From Maternal-Fetal Medicine Associates, PLLC, New York, New York USA (S.G.); and Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, New York University School of Medicine, New York, New York USA (S.G., I.E.T.-T., C.O., J.C., A.M.).
| | - Ilan E Timor-Tritsch
- From Maternal-Fetal Medicine Associates, PLLC, New York, New York USA (S.G.); and Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, New York University School of Medicine, New York, New York USA (S.G., I.E.T.-T., C.O., J.C., A.M.)
| | - Cheongeun Oh
- From Maternal-Fetal Medicine Associates, PLLC, New York, New York USA (S.G.); and Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, New York University School of Medicine, New York, New York USA (S.G., I.E.T.-T., C.O., J.C., A.M.)
| | - Judith Chervenak
- From Maternal-Fetal Medicine Associates, PLLC, New York, New York USA (S.G.); and Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, New York University School of Medicine, New York, New York USA (S.G., I.E.T.-T., C.O., J.C., A.M.)
| | - Ana Monteagudo
- From Maternal-Fetal Medicine Associates, PLLC, New York, New York USA (S.G.); and Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, New York University School of Medicine, New York, New York USA (S.G., I.E.T.-T., C.O., J.C., A.M.)
| |
Collapse
|
22
|
Cai GJ, Sun XX, Zhang L, Hong Q. Association between maternal body mass index and congenital heart defects in offspring: a systematic review. Am J Obstet Gynecol 2014; 211:91-117. [PMID: 24631708 DOI: 10.1016/j.ajog.2014.03.028] [Citation(s) in RCA: 83] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2013] [Revised: 02/27/2014] [Accepted: 03/12/2014] [Indexed: 11/26/2022]
Abstract
The aim of this study was to investigate the relationship between maternal body mass index and all congenital heart defects (CHDs) combined and 11 individual defects. PubMed, ELSEVIER ScienceDirect, and Springer Link (up to February 2013) were searched, and the reference list of retrieved articles was reviewed. Three authors independently extracted the data. The systematic review included 24 studies, 14 of which were included in a metaanalysis. Statistical software was used to perform all statistical analyses. Fixed-effects or random-effects model was used to pool the results of individual study (expressed as odds ratios [ORs] with 95% confidence intervals [CIs]). A dose-response effect was observed between overweight, moderate obesity, and severe obesity and a pregnancy with any CHD (the pooled ORs: OR, 1.08 [95% CI, 1.02-1.15]; OR, 1.15 [95% CI, 1.11-1.20]; and OR, 1.39 [95% CI, 1.31-1.47], respectively) as well as some individual defects such as hypoplastic left heart syndrome, pulmonary valve stenosis, and outflow tract defects. When we excluded mothers with diabetes mellitus, the pooled ORs for all CHDs combined were 1.12 (95% CI, 1.04-1.20) and 1.38 (95% CI, 1.20-1.59) for moderately obese and severely obese, respectively. The highest increased risk was severely obese mothers for tetralogy of Fallot (OR, 1.94; 95% CI, 1.49-2.51). Being underweight did not increase the risk of any of the aforementioned CHDs but did increase the risk of aortic valve stenosis (OR, 1.47; 95% CI, 1.01-2.15]). The results of our study showed that increasing maternal body mass index was associated with an increasing risk of CHDs; severe obesity was an even greater risk factor for the development of CHDs.
Collapse
|
23
|
Bertagna F, Rakza T, Vaksmann G, Ramdane-Sebbane N, Devisme L, Storme L, Francart C, Vaast P, Houfflin-Debarge V. Transposition of the great arteries: factors influencing prenatal diagnosis. Prenat Diagn 2014; 34:534-7. [PMID: 24532355 DOI: 10.1002/pd.4343] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2013] [Revised: 02/11/2014] [Accepted: 02/11/2014] [Indexed: 11/07/2022]
Abstract
OBJECTIVE The objective of this study is to highlight the factors that may affect prenatal diagnosis of transposition of the great arteries (TGA) in order to improve it. METHODS This is a retrospective study performed between 2004 and 2009 in the maternity units from North of France. We identified a total of 68 cases of TGA (isolated or associated with only VSD or coarctation of aorta), of which 32 (47.1%) had prenatal diagnosis (PND+) and 36 did not (PND-). Maternal characteristics and ultrasound factors were studied in relation to PND. RESULTS Maternal weight and body mass index were significantly higher in the PND- group (70.4 kg and 26.5 kg/m(2) vs 63.6 kg and 23.6 kg/m(2) , respectively). Maternal obesity (body mass index >30) was significantly more frequent in the PND- group (27.8% vs 12.5%). More than a quarter of TGA (28.1%) were diagnosed during the third trimester. CONCLUSION Obesity is the main cause of missed PND of TGA. Obese patients with suboptimal prenatal scans may benefit from reassessment of fetal cardiac anatomy and/or from referral for fetal echocardiography.
Collapse
Affiliation(s)
- F Bertagna
- Department of Obstetrics, Jeanne de Flandre Hospital, CHU Lille, Lille, France
| | | | | | | | | | | | | | | | | |
Collapse
|
24
|
Poole PS, Chung R, Lacoursiere Y, Palmieri CR, Hull A, Engelkemier D, Rochelle M, Trivedi N, Pretorius DH. Two-dimensional sonographic cine imaging improves confidence in the initial evaluation of the fetal heart. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2013; 32:963-971. [PMID: 23716517 DOI: 10.7863/ultra.32.6.963] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Abstract
OBJECTIVES Initial screening sonography of the fetal heart with static images is often inadequate, resulting in repeated imaging or failure to detect abnormalities. We hypothesized that the addition of short cine clips would reduce the need for repeated imaging. METHODS Two-dimensional (2D) static sonograms and short 2D cine clips of the 4-chamber view and left and right ventricular outflow tracts were obtained from 342 patients with gestational ages of greater than 16 weeks. A diagnostic radiologist and a perinatologist retrospectively reviewed the static and cine images independently and graded them as normal, abnormal, or suboptimal. RESULTS A statistically significant increase in the number of structures called normal was seen when 2D cine clips were added to static imaging for both observers (P < .05); the radiologist called 86.5% normal with combined static and cine images versus 61.9% with static images alone, whereas the perinatologist recorded 68.1% as normal versus 58.8%, respectively. The radiologist called 77.8% of structures normal with cine images only versus 61.9% with static images only (P < .001), whereas the perinatologist called fewer structures normal with cine images alone (38.9%) versus static images alone (58.8%). The use of cine loops alone resulted in no significant increase in the ability to clear the heart as normal. The maternal body mass index was inversely associated with the ability to clear structures when 2D cine images were added to static images (P < .05). CONCLUSIONS The addition of 2D cine clips to standard 2D static imaging of the fetal heart significantly improves the number of structures cleared as normal. Two-dimensional cine clips are easily obtained, add little time to a study, and require minimal archival space.
Collapse
Affiliation(s)
- Patricia Sims Poole
- Departments of Radiology, University of California, San Diego, California USA
| | | | | | | | | | | | | | | | | |
Collapse
|
25
|
Tao R, Popescu EA, Drake WB, Popescu M. Cardiac vectors in the healthy human fetus: developmental changes assessed by magnetocardiography and realistic approximations of the volume conductor. Physiol Meas 2013; 34:527-40. [PMID: 23604003 DOI: 10.1088/0967-3334/34/5/527] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
This study sought to characterize the developmental changes of three measures used to describe the morphology of the fetal cardiac vector: QRS peak-amplitude, QRS duration and QRS time-amplitude integral. To achieve this objective, we rely on a recently developed methodology for fetal cardiac vector estimation, using multichannel fetal magnetocardiographic (fMCG) recordings and realistic approximations of the volume conductors obtained from free-hand ultrasound imaging. fMCG recordings and 3D ultrasound images were obtained from 23 healthy, uncomplicated pregnancies for a total of 77 recordings performed at gestational ages between 22 and 37 weeks. We report the developmental changes of the cardiac vector parameters with respect to gestational age and estimated fetal weight, as well as their dependence on the estimated ventricular mass derived from cardiac dimensions measured with M-mode ultrasound. The normative values can be used along with the cardiac time intervals reported by previous fMCG studies to assist future clinical studies investigating conditions that affect fetal cardiac function.
Collapse
Affiliation(s)
- R Tao
- Hoglund Brain Imaging Center, University of Kansas Medical Center, Kansas City, KS 66160, USA
| | | | | | | |
Collapse
|
26
|
Fuchs F, Houllier M, Voulgaropoulos A, Levaillant JM, Colmant C, Bouyer J, Senat MV. Factors affecting feasibility and quality of second-trimester ultrasound scans in obese pregnant women. ULTRASOUND IN OBSTETRICS & GYNECOLOGY : THE OFFICIAL JOURNAL OF THE INTERNATIONAL SOCIETY OF ULTRASOUND IN OBSTETRICS AND GYNECOLOGY 2013; 41:40-46. [PMID: 23023941 DOI: 10.1002/uog.12311] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 09/19/2012] [Indexed: 06/01/2023]
Abstract
OBJECTIVES To evaluate the feasibility of completing in one session a second-trimester ultrasound scan in obese pregnant women, to compare the quality of images obtained with those of non-obese women and to analyze factors that can improve the completion rate. METHODS This prospective study, from 2009 to 2011, included all obese pregnant women (prepregnancy body mass index (BMI) > 30 kg/m2) who had an ultrasound examination at 20-24 weeks in our department, and a control group of pregnant women with normal BMI (20-24.9 kg/m2) who had the same examination. A single operator reviewed the standardized ultrasound images (three biometric and six to assess key anatomical features) required under French guidelines, to assess their presence, evaluate the quality of all images and score the quality of the six anatomical images. Each image was assessed according to between four and six criteria, each worth one point. We sought excellent quality, defined as the frequency of maximum points for a given image type. The factors associated with completing the scan in one session were evaluated with multivariate logistic regression. RESULTS The obese group included 223 women and the control group 60; a complete scan in one session was achieved in 70.4% and 81.7% of these, respectively (P = 0.08). The completion rate for each image type was at least 95% in the control group and 90% in the obese group, except for diaphragm and right outflow tract images. Significant factors associated with completing the scan in the multivariate model were: having 10 additional minutes for the scan (P = 0.03), moving the fetus so that the back was in posterior or lateral position (P = 0.01), more experienced sonographer (P = 0.03) and thinner maternal abdominal wall thickness (P = 0.01). Overall, the excellence rate varied from 35% to 92% in the normal BMI group and from 18% to 58% in the obese group, and was significantly lower in the latter for all images except abdominal circumference (P = 0.26) and spine (P = 0.06). Anatomical quality scores were also significantly lower in the obese group (22.3 vs. 27.2; P = 0.001). CONCLUSION Although ultrasound scans of obese pregnant women are feasible, image quality and global anatomical scores are significantly lower among obese than normal-weight women. However, certain simple improvements may increase fetal visualization.
Collapse
Affiliation(s)
- F Fuchs
- Department of Obstetrics and Gynecology, Hôpital Bicêtre, Assistance Publique Hôpitaux de Paris, Le Kremlin-Bicêtre, France.
| | | | | | | | | | | | | |
Collapse
|
27
|
Hildebrand E, Gottvall T, Blomberg M. Maternal Obesity and Detection Rate of Fetal Structural Anomalies. Fetal Diagn Ther 2013; 33:246-51. [DOI: 10.1159/000343219] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2012] [Accepted: 08/11/2012] [Indexed: 11/19/2022]
|
28
|
Donnelly JC, Malone FD. Early fetal anatomical sonography. Best Pract Res Clin Obstet Gynaecol 2012; 26:561-73. [PMID: 22776410 DOI: 10.1016/j.bpobgyn.2012.06.002] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2012] [Accepted: 06/13/2012] [Indexed: 11/25/2022]
Abstract
Over the past decade, prenatal screening and diagnosis has moved from the second into the first trimester, with aneuploidy screening becoming both feasible and effective. With vast improvements in ultrasound technology, sonologists can now image the fetus in greater detail at all gestational ages. In the hands of experienced sonographers, anatomic surveys between 11 and 14 weeks can be carried out with good visualisation rates of many structures. It is important to be familiar with the normal development of the embryo and fetus, and to be aware of the major anatomical landmarks whose absence or presence may be deemed normal or abnormal depending on the gestational age. Some structural abnormalities will nearly always be detected, some will never be and some are potentially detectable depending on a number of factors.
Collapse
Affiliation(s)
- Jennifer C Donnelly
- Royal College of Surgeons in Ireland, Rotunda Hospital, Parnell Square, Dublin, Ireland.
| | | |
Collapse
|
29
|
Weichert J, Hartge DR. Obstetrical sonography in obese women: a review. JOURNAL OF CLINICAL ULTRASOUND : JCU 2011; 39:209-216. [PMID: 21480286 DOI: 10.1002/jcu.20767] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/16/2009] [Accepted: 09/22/2010] [Indexed: 05/30/2023]
Abstract
Obstetric sonographic imaging in pregnant women is adversely affected by obesity with a negative impact on the detection rate of congenital anomalies. This review aims to analyze relevant data regarding this issue and to discuss clinical and technical problems associated with sonographic examination of obese pregnant women.
Collapse
Affiliation(s)
- Jan Weichert
- Division of Prenatal Medicine, University of Schleswig-Holstein, Campus Luebeck, Germany
| | | |
Collapse
|
30
|
McGuire W, Dyson L, Renfrew M. Maternal obesity: consequences for children, challenges for clinicians and carers. Semin Fetal Neonatal Med 2010; 15:108-12. [PMID: 19828390 DOI: 10.1016/j.siny.2009.09.005] [Citation(s) in RCA: 38] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
In many industrialised countries almost one in five pregnant women is obese. Maternal obesity has major implications for the fetus and newborn infants, and may have adverse consequences for lifelong health and well-being. We discuss the current epidemiological evidence for the association of maternal obesity with congenital structural neural tube and cardiac defects, fetal macrosomia that predisposes infants to birth injuries and to problems with physiological and metabolic transition, as well as potential for long-term effects secondary to prenatal and neonatal programming effects compounded by a reduction in sustained breastfeeding. We summarise the evidence for the effect of maternal weight management interventions on fetal and neonatal outcomes and discuss areas where further research is needed to clarify uncertainties.
Collapse
Affiliation(s)
- W McGuire
- Hull York Medical School, University of York, York, UK.
| | | | | |
Collapse
|
31
|
Maxwell C, Dunn E, Tomlinson G, Glanc P. How does maternal obesity affect the routine fetal anatomic ultrasound? J Matern Fetal Neonatal Med 2010; 23:1187-92. [DOI: 10.3109/14767050903551491] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
|
32
|
Simic M, Wåhlin IA, Marsál K, Källén K. Maternal obesity is a potential source of error in mid-trimester ultrasound estimation of gestational age. ULTRASOUND IN OBSTETRICS & GYNECOLOGY : THE OFFICIAL JOURNAL OF THE INTERNATIONAL SOCIETY OF ULTRASOUND IN OBSTETRICS AND GYNECOLOGY 2010; 35:48-53. [PMID: 20033998 DOI: 10.1002/uog.7502] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
Abstract
OBJECTIVES To investigate the possible impact of maternal obesity on ultrasonographic dating of pregnancy. METHODS The Swedish Medical Birth Registry was used to identify 842 083 singleton pregnancies for which the estimated date of delivery (EDD) according to last menstrual period (EDD-LMP) and according to ultrasound examination (EDD-US) and maternal body mass index (BMI) in early pregnancy were known. Dates were adjusted following ultrasound examination, negative adjustment representing pregnancies that were shorter according to ultrasound examination than they were according to LMP. Odds ratios (OR) were adjusted for year of birth, maternal age, parity and smoking. RESULTS The EDD was postponed at least 7 days (discrepancy between EDD-LMP and EDD-US of < or = -7 days) in 25.2% of all pregnancies. There was a statistically significant association between maternal BMI and discrepancy between EDD-LMP and EDD-US. Among pregnant women with a BMI > or = 30.0 kg/m(2), the risk of postponed EDD was significantly greater compared with women with a BMI of 20.0-24.9 kg/m(2). The EDD was more often postponed > or = 14 days (OR, 1.65; 95% CI, 1.60-1.70) or 7-13 days (OR, 1.45; 95% CI, 1.42-1.48) among women with a BMI > or = 30 kg/m(2) than among women with normal weight. Similar risk was observed among women with a BMI of 25.0-29.9 kg/m(2), but was less pronounced. CONCLUSIONS High maternal BMI increases the risk of postponing the EDD at mid-trimester ultrasound examination.
Collapse
Affiliation(s)
- M Simic
- Department of Women and Child Health, Karolinska Institute, Stockholm, Sweden.
| | | | | | | |
Collapse
|
33
|
Dashe JS, McIntire DD, Twickler DM. Maternal obesity limits the ultrasound evaluation of fetal anatomy. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2009; 28:1025-1030. [PMID: 19643785 DOI: 10.7863/jum.2009.28.8.1025] [Citation(s) in RCA: 76] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
Abstract
OBJECTIVE The purpose of this study was to evaluate the effect of maternal habitus on adequate visualization of fetal anatomy during a standard second-trimester ultrasound examination. METHODS This was a retrospective cohort study of singleton pregnancies at 18 to 24 weeks that underwent sonography over a 5-year period. Pregnancies complicated by an indication for targeted sonography were excluded. Standard ultrasound examinations were performed according to American Institute of Ultrasound in Medicine criteria. Ten anatomic components were evaluated for adequacy of visualization: atria of the cerebral ventricles, posterior fossa, midline face, 4-chamber view of the heart, spine, ventral wall, umbilical cord vessels, stomach, kidneys, and bladder. The body mass index (BMI) was based on the patient's weight at the first prenatal visit. RESULTS Of 10,112 women who underwent a standard ultrasound examination, 2% were underweight; 38% were of normal weight; 34% were overweight; and 26% were obese. Visualization of fetal anatomy decreased significantly with increasing maternal BMI for the complete survey as well as for each individual component with the exception of the fetal bladder (all P < .001). Among those with a normal or underweight BMI, an overweight BMI, and class 1, 2, and 3 obesity, all 10 anatomic components were adequately visualized at the initial examination in 72%, 68%, 57%, 41%, and 30% of cases, respectively (P < .001). CONCLUSIONS Increasing maternal BMI limits visualization of fetal anatomy during a standard ultrasound examination at 18 to 24 weeks. In obese women, the fetal anatomy survey could be completed during the initial examination in only 50% of cases. Counseling may need to be modified to reflect the limitations of sonography in obese women.
Collapse
Affiliation(s)
- Jodi S Dashe
- Department of Obstetrics and Gynecology, University of Texas Southwestern Medical Center, 5323 Harry Hines Blvd, Dallas, TX 75390-9032, USA.
| | | | | |
Collapse
|
34
|
Yu YM, Chen M, Xiong Y, Chau MMC, Li RSH, Lau TK. Comparison of conventional and PureWave Crystal transducer in obstetric sonography. J Matern Fetal Neonatal Med 2009; 22:616-21. [DOI: 10.1080/14767050902801793] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
|
35
|
Thornburg LL, Mulconry M, Post A, Carpenter A, Grace D, Pressman EK. Fetal nuchal translucency thickness evaluation in the overweight and obese gravida. ULTRASOUND IN OBSTETRICS & GYNECOLOGY : THE OFFICIAL JOURNAL OF THE INTERNATIONAL SOCIETY OF ULTRASOUND IN OBSTETRICS AND GYNECOLOGY 2009; 33:665-669. [PMID: 19479678 DOI: 10.1002/uog.6410] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/27/2023]
Abstract
OBJECTIVE To evaluate the time required and failure rate for completion of nuchal translucency thickness (NT) measurements with increased maternal body mass index (BMI). METHODS This was a retrospective review of ultrasound examinations for NT measurement in 11-14-week singleton pregnancies performed at a single site from 2004 to 2007. Women were stratified by prepregnancy BMI into normal weight (BMI, 18.5-24.9 kg/m(2)), overweight (BMI, 25.0-29.9 kg/m(2)) and obese Class I (BMI, 30.0-34.9 kg/m(2)), Class II (BMI, 35.0-39.9 kg/m(2)) and Class III (BMI >or= 40.0 kg/m(2)) groups. The failure rate, the time required for measurement, and the total study time in min were evaluated by BMI class for the first attempt and for all attempts at NT measurement. RESULTS A total of 2508 women underwent attempted NT screening with complete data available on 1678 women (1707 examinations). The failure rate for NT screening varied significantly according to BMI (P < 0.001). At the first attempt, the median time for NT measurement varied significantly according to BMI (normal weight group, 9.7 (interquartile range (IQR) 4.4, 19.0) min; overweight group, 8.8 (4.0, 19.8) min; obese Class I, 9.6 (4.8, 20.4) min; Class II, 14.1 (5.0, 28.2) min; Class III, 12.3 (4.6, 22.7) min; P < 0.01), as did the total study time (normal group, 16.4 (10.1, 26.6) min; overweight group, 15.7 (9.8, 25.0) min, Class I, 17.3 (10.3, 29.2) min; Class II, 23.0 (12.2, 36.1) min; Class III, 18.7 (11.0, 30.8) min; P = 0.002). For all attempts also, the median time for NT measurement varied significantly according to BMI (normal weight group, 9.7 (IQR 4.4, 19.0) min; overweight group, 8.8 (4.0, 19.9) min; obese Class I, 9.6 (4.8, 21.0) min; Class II, 14.1 (5.0, 28.7) min; Class III, 12.3 (4.6, 22.5) min; P < 0.01), as did the total study time (normal weight group, 16.4 (10.2, 26.7) min; overweight group, 15.7 (9.8, 25.1) min; Class I, 17.6 (10.4, 29.9) min; Class II, 23.2 (12.0, 37.5) min; Class III, 18.7 (11.9, 31.9) min; P < 0.001). CONCLUSION As maternal BMI increases, the time required to obtain NT measurements and the failure rate increase. Before the ultrasound examination, patients with a BMI over 30 should be counseled regarding the need for additional time and failure rates for first-trimester screening.
Collapse
Affiliation(s)
- L L Thornburg
- Department of Obstetrics and Gynecology, Division of Maternal Fetal Medicine, University of Rochester Strong Memorial Hospital, Rochester, NY, USA.
| | | | | | | | | | | |
Collapse
|
36
|
Paladini D. Sonography in obese and overweight pregnant women: clinical, medicolegal and technical issues. ULTRASOUND IN OBSTETRICS & GYNECOLOGY : THE OFFICIAL JOURNAL OF THE INTERNATIONAL SOCIETY OF ULTRASOUND IN OBSTETRICS AND GYNECOLOGY 2009; 33:720-729. [PMID: 19479683 DOI: 10.1002/uog.6393] [Citation(s) in RCA: 78] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/27/2023]
Abstract
Obesity has increased dramatically worldwide over the last two decades, becoming a social concern. In pregnancy, obesity is associated with increased risk of maternal death and of significant complications, such as pre-eclampsia, diabetes and postpartum hemorrhage. Several papers have also reported an increased risk of major anomalies in the offspring of obese pregnant women. At the same time, carrying out an ultrasound examination on an obese pregnant woman is a difficult task, due to the impaired acoustic window. This Review discusses the clinical, technical and medicolegal problems associated with ultrasound examination in obese and/or overweight women and provides tips for performing these examinations.
Collapse
Affiliation(s)
- D Paladini
- Department of Obstetrics and Gynecology, University Federico II of Naples, Naples, Italy.
| |
Collapse
|
37
|
Abstract
OBJECTIVE To estimate the effect of maternal habitus on detection of fetuses with major structural anomalies during second-trimester standard and targeted ultrasound examinations. METHODS This was a retrospective cohort study of pregnancies 18 to 24 weeks that underwent ultrasonography over a 5-year period. An anomalous fetus was considered detected if a major abnormality of the relevant organ system was identified, regardless of the anticipated ultrasound detection. Anomalies were verified using a prospectively maintained database. Body mass index (BMI) was based on weight at first prenatal visit. RESULTS There were 10,112 standard examinations in low-risk pregnancies and 1,098 targeted examinations in pregnancies with either high-risk indications or with an abnormality detected during standard ultrasonography. Detection of anomalous fetuses decreased with increasing BMI. For normal BMI, overweight, and class I, II, and III obesity, detection with standard ultrasonography was 66%, 49%, 48%, 42%, and 25%, respectively, and with targeted ultrasonography, 97%, 91%, 75%, 88%, and 75%, respectively, both P< or =.03. Residual anomaly risk after a normal ultrasound examination increased with increasing BMI, from 0.4% among women of normal BMI to 1.0% among obese women, P=.001. Anomaly detection was lower among women with pregestational diabetes than in those with other high-risk indications, 38% compared with 88% respectively, P<.001. CONCLUSION With increasing maternal BMI, we found decreased detection of anomalous fetuses with either standard or targeted ultrasonography, a difference of at least 20% when women of normal BMI were compared with obese women. Anomaly detection was even less in pregnancies complicated by pregestational diabetes. Counseling may need to be modified to reflect the limitations of ultrasonography in obese women.
Collapse
|
38
|
Abstract
Over the past decade, prenatal diagnosis has shifted rapidly from the second trimester into the first trimester. Although the nuchal-translucency scan may detect a small proportion of fetal structural malformations, fetal anatomy is not routinely assessed until the fetal anatomical survey is performed in the second trimester between 18 and 22 weeks. The recent development of high-frequency transvaginal ultrasound transducers has led to vastly improved ultrasound resolution and improved visualization of fetal anatomy earlier in gestation. Several pilot studies of a first-trimester anatomic survey have reported detection rates comparable with those achieved in the routine second-trimester anatomic survey. As advanced ultrasound technology becomes more available, there is an urgent need to evaluate the diagnostic ability of a first-trimester anatomic survey and to determine the role of a first-trimester anatomic survey in the current screening paradigm.
Collapse
|
39
|
Devlieger R, Guelinckx I, Vansant M. Follow-up in obese pregnant women to prevent stillbirth. Am J Obstet Gynecol 2008; 199:e17-8; author reply e18. [PMID: 18395690 DOI: 10.1016/j.ajog.2008.02.037] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2007] [Accepted: 02/21/2008] [Indexed: 10/22/2022]
|
40
|
Thornburg LL, Barnes C, Glantz JC, Pressman EK. Sonographic birth-weight prediction in obese patients using the gestation-adjusted prediction method. ULTRASOUND IN OBSTETRICS & GYNECOLOGY : THE OFFICIAL JOURNAL OF THE INTERNATIONAL SOCIETY OF ULTRASOUND IN OBSTETRICS AND GYNECOLOGY 2008; 32:66-70. [PMID: 18543370 DOI: 10.1002/uog.5319] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/26/2023]
Abstract
OBJECTIVES Ultrasound birth-weight prediction may be more accurate if assessed at 34 to 36 + 6 weeks' gestation and extrapolated using the gestation-adjusted projection (GAP) method than if done at term. Because ultrasound is less accurate in women with elevated body mass index (BMI), we assessed the accuracy of GAP birth-weight prediction in obese as compared to non-obese women. METHODS We performed a retrospective review of 1382 women with singleton pregnancies who had undergone fetal ultrasound examination at between 34 + 0 and 36 + 6 weeks, subclassified by pre-pregnancy BMI. Analysis of variance was used to compare predicted and actual birth weight. RESULTS 1025 controls and 357 obese women were included. The obese women were divided by BMI: 159 in Class I (BMI, 30-34.9 kg/m(2)); 105 in Class II (BMI, 35-40 kg/m(2)) and 93 in Class III (BMI > 40 kg/m(2)). Mean systematic (percent) birth-weight prediction error was within 4% for all groups, with a 95% error range between - 5% and + 5%. The GAP method was able to predict actual birth weight within 20% for all groups in over 90% of cases. For all groups, the GAP method correctly excluded the presence of macrosomia with >or= 90% specificity. Negative likelihood ratios for the prediction of macrosomia were between 0.4 and 0.6 for all groups, regardless of obesity. CONCLUSIONS The GAP method of birth-weight prediction using ultrasound measurement at 34 to 36 + 6 weeks predicts birth weight within 20% error in over 90% of cases, and is able to exclude macrosomia with over 90% accuracy regardless of maternal BMI.
Collapse
Affiliation(s)
- L L Thornburg
- Department of Obstetrics and Gynecology, Division of Maternal Fetal Medicine, University of Rochester Strong Memorial Hospital, Rochester, NY, USA.
| | | | | | | |
Collapse
|
41
|
Abstract
PURPOSE OF REVIEW To examine the impact of obesity and potential intervention upon human reproduction in the domain of fertility, fertility treatment, pregnancy and its complications. RECENT FINDINGS The prevalence of obesity in women of reproductive age continues to increase, with recent recognition that visceral obesity is associated with greater metabolic disturbances and reduced fecundity, even in ovulating women. Although the efficacy of infertility treatment is reduced by obesity, this effect is not profound and indeed the argument for weight reduction in young women is better serviced by the obesity-dependent increases in perinatal and maternal risks during pregnancy and potential modification of long-term health. Although lifestyle modification alone can induce significant metabolic improvement, resumption of ovulation and reduction of perinatal risks, greater weight loss, and therefore greater potential benefit, can be achieved in combination with pharmacological agents or bariatric surgery. SUMMARY Obesity in women has a broad, negative impact upon human reproduction. Specific risks through pregnancy are real and may be addressed by lifestyle modification leading to weight loss and improved insulin sensitivity. Obese women undergoing fertility treatment should be advised of the increased and absolute increased risks they are undertaking, and fertility centres should adopt appropriate strategies.
Collapse
Affiliation(s)
- Scott M Nelson
- Reproductive and Maternal Medicine, University of Glasgow, Glasgow, UK.
| | | |
Collapse
|
42
|
Abstract
Women who are overweight or obese during their childbearing years are at an increased risk for pregnancy-induced hypertension, gestational diabetes, labor induction, cesarean births, and failed vaginal birth after cesarean. During the postpartum, they experience increased rates of puerperal infection and decreased rates of breastfeeding initiation or continuation. Their infants are at higher risk for having congenital anomalies or being stillborn. Nurses can use this knowledge to adapt the care they provide and to encourage health-promoting behaviors.
Collapse
Affiliation(s)
- Karen H Morin
- College of Nursing, University of Wisconsin-Milwaukee, WI 53202, USA.
| | | |
Collapse
|
43
|
Abstract
Maternal pregravid obesity is a significant risk factor for adverse outcomes during pregnancy. In early pregnancy there is an increased risk of spontaneous abortion and congenital anomalies. In later gestation maternal metabolic manifestations of the metabolic syndrome, such as gestational hypertensive disorders and diabetes, become clinically recognized because of the increased insulin resistance in obese compared with nonobese women. In women with pregestational glucose intolerance, hypertension, central obesity, and lipid disorders, the physiologic changes in pregnancy increase the risk of problems previously not routinely encountered during pregnancy. These include chronic cardiac dysfunction, proteinuria, sleep apnea, and nonalcoholic fatty liver disease. At parturition the obese patient is at an increased risk of cesarean delivery and associated complications of anesthesia, wound disruption, infection, and deep venous thrombophlebitis. For the fetus there are short-term risks of fetal macrosomia, more specifically obesity, and long-term risks of adolescent components of the metabolic syndrome. Although preliminary results of bariatric surgery are encouraging, the procedure is expensive and not for all obese women, and we recognize that long-term follow-up data on offspring of obese women who have undergone bariatric surgery before pregnancy are lacking. In the interim, we need to encourage obese women to lose weight before conception, using lifestyle changes if possible. During pregnancy, weight gain should be limited to Institute of Medicine guidelines (currently under review) and encouragement given for physical activity.
Collapse
Affiliation(s)
- Patrick M Catalano
- Department of Reproductive Biology, Case Western Reserve University at MetroHealth Medical Center, 2500 MetroHealth Drive, Cleveland, OH 44109, USA.
| |
Collapse
|
44
|
Gorincour G, Bourlière-Najean B, Bonello B, Fraisse A, Philip N, Potier A, Kreitmann B, Petit P. Feasibility of fetal cardiac magnetic resonance imaging: preliminary experience. ULTRASOUND IN OBSTETRICS & GYNECOLOGY : THE OFFICIAL JOURNAL OF THE INTERNATIONAL SOCIETY OF ULTRASOUND IN OBSTETRICS AND GYNECOLOGY 2007; 29:105-108. [PMID: 17201007 DOI: 10.1002/uog.3924] [Citation(s) in RCA: 40] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/13/2023]
Affiliation(s)
- G Gorincour
- Department of Pediatric Radiology, La Timone Children's Hospital, Marseille, France
- Multidisciplinary Center for Prenatal Diagnosis, La Timone Children's Hospital, Marseille, France
| | - B Bourlière-Najean
- Department of Pediatric Radiology, La Timone Children's Hospital, Marseille, France
| | - B Bonello
- Department of Pediatric Cardiology, La Timone Children's Hospital, Marseille, France
| | - A Fraisse
- Department of Pediatric Cardiology, La Timone Children's Hospital, Marseille, France
| | - N Philip
- Multidisciplinary Center for Prenatal Diagnosis, La Timone Children's Hospital, Marseille, France
| | - A Potier
- Multidisciplinary Center for Prenatal Diagnosis, La Timone Children's Hospital, Marseille, France
| | - B Kreitmann
- Department of Pediatric Cardiac Surgery, La Timone Children's Hospital, Marseille, France
| | - P Petit
- Department of Pediatric Radiology, La Timone Children's Hospital, Marseille, France
| |
Collapse
|
45
|
Abstract
Obesity is a major health problem across the world. Recent editorials suggest that obese patients should be denied treatment of any kind aimed to improve ovulation rates and achieve pregnancy until they have reduced their BMI. We propose that this approach is not a resolution of the problem, but indeed may amplify the maternal and perinatal complications attributed to fertility centres. Obesity independent of polycystic ovary syndrome (PCOS) is associated with anovulation, and minimal weight loss alone is an effective therapy for induction of ovulation in both obese women and obese PCOS women. Consequently, lifestyle programmes encouraging weight loss should be considered to be an ovulation induction therapy and due consideration for a potential pregnancy in an obese woman given. We propose that women with a BMI in excess of 35 kg m(2) should lose weight prior to conception-not prior to receiving infertility treatment. Therefore, clinicians undertaking the management of infertility in obese women should adopt measures to reduce their body mass prior to exposing them to the risks of pregnancy. We advocate that this approach should be aggressively managed including pharmacological strategies; intrinsic in this programme is the use of contraception and high-dose folic acid during that period of preconceptual weight reduction.
Collapse
Affiliation(s)
- Scott M Nelson
- Reproductive and Maternal Medicine, Division of Developmental Medicine, University of Glasgow, Glasgow, UK.
| | | |
Collapse
|
46
|
Timor-Tritsch IE. As technology evolves, so should its application: shortcomings of the "18-week anatomy scan". JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2006; 25:423-8. [PMID: 16567429 DOI: 10.7863/jum.2006.25.4.423] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/08/2023]
|
47
|
Langer O. Ultrasound biometry evolves in the management of diabetes in pregnancy. ULTRASOUND IN OBSTETRICS & GYNECOLOGY : THE OFFICIAL JOURNAL OF THE INTERNATIONAL SOCIETY OF ULTRASOUND IN OBSTETRICS AND GYNECOLOGY 2005; 26:585-95. [PMID: 16254874 DOI: 10.1002/uog.2615] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/05/2023]
|
48
|
Muller PR, James A, Feldman K, Herlong JR. Utility of fetal echocardiogram in high-risk patients. Aust N Z J Obstet Gynaecol 2005; 45:117-21. [PMID: 15760311 DOI: 10.1111/j.1479-828x.2005.00347.x] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
AIM Patients at high risk of fetal congenital heart disease are commonly referred for second trimester fetal echocardiogram. The objective of this study was to evaluate the utility of routine fetal echocardiogram in high-risk patients after the evaluation of the four-chamber/left ventricular outflow tract (LVOT) views during comprehensive second trimester anatomy ultrasound. METHODS Second trimester comprehensive anatomy ultrasounds, which included a four-chamber/LVOT view, and subsequent fetal echocardiograms carried out at the Duke University Medical Center from January 1995 and July 2002 were reviewed. Those fetal echocardiograms carried out between 17 and 30 weeks gestation were included in the analysis. RESULTS A total of 725 individual subjects met the inclusion criteria. Twenty-nine fetal echocardiograms were ultimately reported as abnormal. Of these, 19 had an abnormal four-chamber/LVOT view, four had a suboptimal view and six had a normal view. Of the six patients with a normal four-chamber/LVOT, all had been referred for echocardiogram based on the presence of other significant fetal anomalies noted at the time of second trimester anatomy ultrasound (3), documented aneuploidy (2), and significant fetal arrhythmia (1). CONCLUSION Utility in carrying out fetal echocardiogram was seen in patients with an abnormal four-chamber/LVOT view, a suboptimal view in a high-risk patient, and the presence of other significant fetal abnormalities. Utility was not seen in patients with pre-existing diabetes mellitus.
Collapse
Affiliation(s)
- Peter R Muller
- Division of Maternal-Fetal Medicine, Duke University Medical Center, Durham, North Carolina, USA.
| | | | | | | |
Collapse
|
49
|
|
50
|
Current awareness in prenatal diagnosis. Prenat Diagn 2004; 24:1025-30. [PMID: 15828089 DOI: 10.1002/pd.784] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
|