Department of Obstetrics and Gynecology, University of Rochester Medical Center, Rochester, NY, USA.
Rochester Regional Health, Unity Perinatal Medicine, Rochester, NY, USA.
J Matern Fetal Neonatal Med. 2021 Mar;34(5):803-809. doi: 10.1080/14767058.2019.1618825. Epub 2019 May 23.
Obesity increases the difficulty of completing the fetal anatomic survey. This is of added concern in obese gravidas who are at higher risk of congenital fetal anomalies. We hypothesized that incorporation of an early transvaginal assessment could improve the completion rate of the fetal anatomic survey in obese women. We performed a prospective, longitudinal, blinded study of obese gravidas (BMI ≥ 35 kg/m) comparing the use of a single early second trimester transvaginal ultrasound in addition to midtrimester transabdominal ultrasound versus traditional serial midtrimester ultrasound alone for completion of the anatomic survey. Transvaginal ultrasound for anatomy was performed between 13 0/7 and 15 6/7 week followed by midtrimester anatomic ultrasound, with each patient serving as her own control. Structures were marked as optimally or suboptimally viewed after each ultrasound. Sonographers and reviewers were blinded to images from the transvaginal ultrasound. Completion rates and gestational age at completion were compared between groups. Fifty subjects were included. Fetal anatomic survey was completed in 62% using standard midtrimester assessment versus 78% with the addition of early transvaginal assessment ( = .04). The survey was completed at an earlier gestational age utilizing the transvaginal approach (22 0/7 ± 6 3/7) compared to traditional midtrimester transabdominal ultrasound approach (25 2/7 ± 5 3/7) < .0005. Incorporation of an early transvaginal assessment of anatomy in obese women improved the rate of completion and led to earlier gestational age at completion of the fetal anatomic survey. Consideration should be given to including an early transvaginal sonogram as part of routine assessment of women with a BMI ≥ 35.
肥胖增加了完成胎儿解剖检查的难度。对于肥胖孕妇来说，这种情况更为严重，因为她们的先天性胎儿畸形风险更高。我们假设在肥胖孕妇中早期经阴道评估可以提高胎儿解剖检查的完成率。我们对肥胖孕妇（BMI≥35kg/m）进行了一项前瞻性、纵向、盲法研究，比较了在中孕期经腹超声检查的基础上增加单次早孕期经阴道超声检查与单纯使用传统的中孕期经腹超声检查来完成解剖检查的效果。早孕期经阴道超声检查在 13 0/7-15 6/7 周进行，随后进行中孕期解剖超声检查，每位患者均为自身对照。在每次超声检查后，将结构标记为最佳或次佳视图。超声医师和审阅者对经阴道超声图像均不知情。比较两组的完成率和完成时的孕龄。共纳入 50 例患者。标准中孕期评估组胎儿解剖检查的完成率为 62%，而增加早孕期经阴道评估后的完成率为 78%（ =.04）。经阴道方法完成检查的孕龄更早（22 0/7±6 3/7），与传统的中孕期经腹超声方法（25 2/7±5 3/7）相比，差异有统计学意义（<.0005）。在肥胖女性中早期经阴道评估解剖学可提高完成率，并使胎儿解剖检查的完成时间更早。考虑将早孕期经阴道超声检查作为 BMI≥35 的女性常规评估的一部分。
