Glanc Phyllis, D'Souza Rohan, Parrish Jacqueline, Tomlinson George, Maxwell Cynthia
Department of Medical Imaging, Department of Obstetrics and Gynaecology, Maternal Fetal Medicine Division, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, ON.
Department of Obstetrics and Gynaecology, Maternal Fetal Medicine Division, Mount Sinai Hospital, University of Toronto, Toronto, ON.
J Obstet Gynaecol Can. 2018 Oct;40(10):1288-1294. doi: 10.1016/j.jogc.2018.01.027.
The primary objective of this study was to determine whether an early anatomic scan (EAS), either on its own or in combination with the routine transabdominal scan (R-TAS), would improve overall completion rates of the fetal anatomic survey in the obese pregnant woman. The study's secondary objectives were to compare patients' and sonographers' satisfaction with EAS versus R-TAS.
A prospective observational study was carried out over a 2.5-year period including consecutive pregnant women with a pre-pregnancy BMI ≥30 kg/m who consented at a dating ultrasound appointment to undergo EAS at 15 ± 1 GA in addition to the second trimester R-TAS. Anatomic structures were categorized as normal, not well seen, or abnormal by using the institutional 26-item anatomic standardized reporting template. Examination completion and study duration were recorded. Neonatal follow-up was performed to evaluate for any missed diagnoses. Patients' and sonographers' satisfaction questionnaires were completed.
A total of 120 pregnant women completed the study. Visualization of all anatomic components was complete in 14% at EAS and in 61% at R-TAS (combined completion rate, 90%). Mean scan time was 30.4 minutes at EAS and 51 minutes at R-TAS. No missed diagnoses of structural anomalies were identified at neonatal follow-up. EAS and R-TAS differed in terms of sonographers' reports of difficult or suboptimal scans (9% vs. 58%), well-seen anatomy (85% vs. 78%), and good visibility (44% vs. 12%). Most sonographers expressed a preference for performing EAS in future pregnancies, rather than the R-TAS (96% vs. 6%). Although patients reported greater satisfaction with EAS (93% vs. 74%), for reasons that could not be determined, they expressed a preference for R-TAS in a subsequent pregnancy (23% vs. 63%).
Performing EAS along with R-TAS improves completion rates for anatomic evaluation in the obese gravida and is associated with greater patient and sonographer satisfaction.
本研究的主要目的是确定早期解剖扫描（EAS）单独使用或与常规经腹扫描（R-TAS）联合使用是否能提高肥胖孕妇胎儿解剖学检查的总体完成率。该研究的次要目的是比较患者和超声检查人员对EAS与R-TAS的满意度。
在2.5年的时间里进行了一项前瞻性观察性研究，纳入了连续的孕前体重指数（BMI）≥30 kg/m²的孕妇，她们在超声预产期检查时同意除了在孕中期进行R-TAS外，在孕15±1周时接受EAS检查。使用机构的26项解剖学标准化报告模板将解剖结构分类为正常、观察不清或异常。记录检查完成情况和检查持续时间。进行新生儿随访以评估是否有漏诊情况。完成了患者和超声检查人员的满意度调查问卷。
共有120名孕妇完成了研究。EAS时所有解剖结构的可视化完成率为14%，R-TAS时为61%（联合完成率为90%）。EAS的平均扫描时间为30.4分钟，R-TAS为51分钟。新生儿随访未发现结构异常的漏诊情况。EAS和R-TAS在超声检查人员报告的困难或不理想扫描（9%对58%）、清晰可见的解剖结构（85%对78%）和良好的可视性（44%对12%）方面存在差异。大多数超声检查人员表示未来怀孕时更倾向于进行EAS，而不是R-TAS（96%对6%）。尽管患者报告对EAS的满意度更高（93%对74%），但原因不明，他们在后续怀孕中更倾向于R-TAS（23%对63%）。
同时进行EAS和R-TAS可提高肥胖孕妇解剖学评估的完成率，并提高患者和超声检查人员的满意度。
