Department of Obstetrics, Gynecology & Reproductive Sciences, University of Maryland School of Medicine, Baltimore, Maryland, USA.
J Ultrasound Med. 2019 May;38(5):1269-1277. doi: 10.1002/jum.14807. Epub 2018 Sep 24.
This study aimed to evaluate the impact of obesity on early evaluation of fetal cardiac landmarks using a standardized examination method at the time of nuchal translucency scan.
This was a cross-sectional study of an ongoing prospective cohort at high risk for congenital heart defects. We used a standardized examination protocol using 2-dimensional sonography with power Doppler in the evaluation of fetal cardiac landmarks consisting of 4-chamber view, outflow tract relationship, and transverse arches view. The study population was stratified based on maternal body mass index into nonobese (<30 kg/m ) and obese (≥30 kg/m ). Groups were compared in terms of satisfactory evaluation of fetal cardiac landmarks, transvaginal sonography use, and scan times required for the evaluations. Subanalysis was performed by further categorizing obesity into nonmorbid obesity (30.0-39.9 kg/m ) and morbid obesity (≥40 kg/m ).
A total of 190 patients were evaluated. Of these, 48.4% (n = 92) were obese. The most common indication for fetal cardiac assessment was maternal pregestational diabetes mellitus (42.6%). Transvaginal sonography was utilized in one nonobese woman (1.4%) and 11 obese women (12%) (P = .002). The satisfactory evaluation of 4-chamber view, outflow tract relationship, transverse arches view, and all views were not significantly different between groups (P > .05). The scan time was about 5 minutes longer in the obese group compared with nonobese group (P = .020).
Obesity does not hamper early evaluation of fetal cardiac landmarks around the time of nuchal translucency scan. However, obese patients are more likely to require transvaginal examinations.
本研究旨在评估在颈项透明层扫描时使用标准化检查方法肥胖对胎儿心脏标志的早期评估的影响。
这是一项对先天性心脏病高风险的前瞻性队列进行的横断面研究。我们使用标准化的检查方案，使用二维超声和彩色多普勒血流成像评估胎儿心脏标志，包括四腔心切面、流出道关系和横弓切面。根据母体体重指数将研究人群分为非肥胖（<30kg/m²）和肥胖（≥30kg/m²）。比较两组对胎儿心脏标志的满意评估、经阴道超声检查的使用情况以及评估所需的扫描时间。进一步将肥胖分为非病态肥胖（30.0-39.9kg/m²）和病态肥胖（≥40kg/m²）进行亚组分析。
共评估了 190 例患者。其中，48.4%（n=92）为肥胖。胎儿心脏评估最常见的指征是母体孕前糖尿病（42.6%）。1 例非肥胖妇女（1.4%）和 11 例肥胖妇女（12%）接受了经阴道超声检查（P=0.002）。四腔心切面、流出道关系、横弓切面以及所有切面的满意评估在两组之间无显著差异（P＞0.05）。肥胖组的扫描时间比非肥胖组长约 5 分钟（P=0.020）。
肥胖并不妨碍颈项透明层扫描时胎儿心脏标志的早期评估。然而，肥胖患者更有可能需要经阴道检查。
