Early ultrasound for fetal anatomy in the obese pregnant woman

Abstract

ALYSSA MILLS, BRITA BOYD, BARBARA HERTZBERG, HAYWOOD BROWN, GEETA K. SWAMY, Duke University, Obstetrics & Gynecology, Durham, North Carolina, Duke University, Radiology, Durham, North Carolina OBJECTIVE: To determine whether early transabdominal (TA) plus transvaginal (TV) ultrasound (US) can optimize standard fetal anatomic survey and can be performed in a shorter amount of time. STUDY DESIGN: In this prospective, observational pilot study, 20 obese (BMI R30 kg/m2) pregnant women underwent US for fetal anatomy at 14-16 wks (US1) and again at 18-20 wks (US2). TV & TA imaging were performed to complete US1. Images were independently reviewed by 3 physicians and individual structures were described as not visualized (0 points), suboptimally visualized (1 point), or optimally visualized (2 points). Points were added for a perfect score of 6/structure, 126/US overall. Kappa statistics were used to assess inter-reviewer agreement. Paired t-test was used to compare scores, p!.05 significant. RESULTS: Mean BMI at US1 was 40.5 kg/m2. Both US took similar time to complete (mean 35 minutes for US1, 37 for US2, p=0.6). Inter-reviewer agreement ranged .12-.78. Cardiac anatomy and kidneys were equally wellvisualized at both US; however other structures were more often optimally visualized at US2. Overall, US2 performed better than US1. CONCLUSION: Early US in obese women was useful for some structures, but should not replace US at 18-20 wks.