Dashe Jodi S, McIntire Donald D, Twickler Diane M
Department of Obstetrics and Gynecology, University of Texas Southwestern Medical Center, 5323 Harry Hines Blvd, Dallas, TX 75390-9032, USA.
J Ultrasound Med. 2009 Aug;28(8):1025-30. doi: 10.7863/jum.2009.28.8.1025.
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.
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.
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).
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.
本研究旨在评估孕妇体型对标准孕中期超声检查时胎儿解剖结构清晰显示的影响。
这是一项回顾性队列研究，研究对象为在5年期间接受超声检查的18至24周单胎妊娠孕妇。排除因有针对性超声检查指征而合并其他情况的妊娠。根据美国医学超声学会标准进行标准超声检查。评估10个解剖部位的显示清晰度：脑室心房、后颅窝、面部中线、心脏四腔心切面、脊柱、腹壁、脐带血管、胃、肾脏和膀胱。体重指数（BMI）基于患者首次产前检查时的体重。
在接受标准超声检查的10112名女性中，2%体重过轻；38%体重正常；34%超重；26%肥胖。随着孕妇BMI增加，整个检查以及除胎儿膀胱外的每个单独部位的胎儿解剖结构显示清晰度均显著降低（所有P <.001）。在BMI正常或体重过轻、超重以及1级、2级和3级肥胖的孕妇中，在初次检查时，10个解剖部位均清晰显示的病例分别占72%、68%、57%、41%和30%（P <.001）。
孕妇BMI增加会限制18至24周标准超声检查时胎儿解剖结构的显示。在肥胖女性中，仅50%的病例能在初次检查时完成胎儿解剖结构检查。可能需要调整咨询内容，以反映超声检查在肥胖女性中的局限性。
