Pasko Daniel N, Wood S Lindsay, Jenkins Sheri M, Owen John, Harper Lorie M
Department of Obstetrics and Gynecology, University of Alabama at Birmingham, Birmingham, Alabama USA
Division of Maternal-Fetal Medicine, University of Alabama at Birmingham, Birmingham, Alabama USA.
J Ultrasound Med. 2016 Nov;35(11):2449-2457. doi: 10.7863/ultra.15.11057. Epub 2016 Oct 3.
To estimate the effect of maternal body mass index (BMI) on the completion of fetal anatomic surveys before 20 weeks' estimated gestational age (GA).
We conducted a retrospective cohort study of singletons undergoing standard or detailed anatomic sonographic examinations from 2006 to 2014. Patients were categorized by ranges of BMI. The primary outcomes were completion of standard and detailed anatomic surveys before 20 weeks' estimated GA. The effect of the BMI category was assessed by the χ test for trends and analysis of variance.
Of 15,313 patients, 5917 (38%) were obese, and 1581 (10%) had a BMI of 40 kg/m or higher. Standard (P < .01) and detailed (P < .01) surveys were less likely to be completed as the BMI category increased. Suboptimal visualization of the fetal chest (P < .01), abdomen (P < .01), and extremities (P < .01) significantly contributed to the decreased standard survey completion rates. Suboptimal visualization of the fetal head (P < .01) and chest (P < .01) significantly contributed to the decreased detailed survey completion rates. There was no statistically significant difference in the sensitivity of a completed standard or detailed anatomic survey for the detection of fetal anomalies.
An increasing BMI category was associated with decreased completion of standard and detailed anatomic surveys by 20 weeks' estimated GA. Strategies to improve early visualization of the fetal head, chest, and abdomen in obese women should be investigated to promote anomaly detection and appropriate counseling.
评估孕妇体重指数（BMI）对估计孕周（GA）20周前完成胎儿解剖学超声检查的影响。
我们对2006年至2014年接受标准或详细解剖学超声检查的单胎妊娠进行了一项回顾性队列研究。根据BMI范围对患者进行分类。主要结局是在估计GA 20周前完成标准和详细解剖学超声检查。通过趋势χ检验和方差分析评估BMI分类的影响。
在15313例患者中，5917例（38%）肥胖，1581例（10%）BMI为40kg/m²或更高。随着BMI分类增加，标准（P<.01）和详细（P<.01）检查完成的可能性降低。胎儿胸部（P<.01）、腹部（P<.01）和四肢（P<.01）的显示不佳显著导致标准检查完成率降低。胎儿头部（P<.01）和胸部（P<.01）的显示不佳显著导致详细检查完成率降低。完成的标准或详细解剖学超声检查对胎儿异常检测的敏感性无统计学显著差异。
BMI分类增加与估计GA 20周前标准和详细解剖学超声检查完成率降低相关。应研究改善肥胖女性胎儿头部、胸部和腹部早期显示的策略，以促进异常检测和适当咨询。
