Adekola Henry, Soto Eleazar, Dai Jing, Lam-Rachlin Jennifer, Gill Navleen, Leon-Peters Jocelyn, Puder Karoline, Abramowicz Jacques S
Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Wayne State University/Detroit Medical Center, Detroit, MI, 48201.
Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, The University of Texas Health Science Center at Houston, Houston, TX, 77030.
J Clin Ultrasound. 2015 Nov-Dec;43(9):548-55. doi: 10.1002/jcu.22307. Epub 2015 Sep 30.
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.
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.
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.
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.
比较病态肥胖（体重指数[BMI]≥40kg/m²）和非肥胖（BMI<25kg/m²）孕妇在超声检查时胎儿心脏四腔心切面和流出道切面的最佳可视化情况。
在这项回顾性队列研究中，我们纳入了509名在孕18至36周首次接受超声检查的孕妇的记录和图像。
与非肥胖女性相比，病态肥胖女性的四腔心切面和流出道切面的最佳可视化情况较差：四腔心切面，病态肥胖组为83/186（44.6%），非肥胖组为283/323（87.6%）；流出道切面，病态肥胖组为80/186（43%），非肥胖组为258/290（89%）；每次比较p<0.0001。将病态肥胖女性各亚组（即BMI 40 - 49.9、50 - 59.9和≥60kg/m²）的结果与非肥胖女性的结果进行比较时，观察到类似结果；每次比较p<0.0001。无论这种比较是在孕19周之前还是之后进行，这些结果都保持不变。在病态肥胖女性中，无论检查是在孕23周之前还是之后进行，四腔心切面或流出道切面的最佳可视化情况均无差异：四腔心切面在孕23周之前为44.8%（78/174），在孕23周及之后为41.7%（5/12）；p = 0.8，流出道切面在孕23周之前为43.1%（75/174），在孕23周及之后为41.7%（5/12）；p = 0.9。在控制了产妇年龄和种族后，病态肥胖女性中观察到四腔心切面和流出道切面的几率低于非肥胖女性：四腔心切面的比值比（OR）为0.13；95%置信区间（CI）为0.08 - 0.21，流出道切面的OR为0.11；95%CI为0.07 - 0.17。
病态肥胖女性中胎儿四腔心切面和流出道切面的最佳可视化情况不到50%，而非肥胖女性中这一比例接近90%。
