Combs C Andrew, Ashimi Balogun Olaide, Vanderhoeven Jeroen, Amara Sushma
Pediatrix Center for Research, Education, Quality & Safety, Sunrise, FL 33323, USA.
Obstetrix Maternal-Fetal Medicine Specialists, Houston, TX 77054, USA.
J Clin Med. 2025 May 12;14(10):3356. doi: 10.3390/jcm14103356.
It is challenging to obtain all the required views for a fetal anatomy ultrasound examination, so exams are often incomplete. Our objective was to develop and demonstrate quantitative methods to assess the overall rate of incomplete exams for an ultrasound practice and for individual examiners. We performed a retrospective quality review of all detailed fetal anatomy exams at seven maternal-fetal medicine practices in 2024 with singleton pregnancies and cardiac activity present. The exams were considered incomplete if any of the 36 required anatomy views were reported as inadequate. The analysis focused on exams at a gestational age (GA) of 18.0 to 23.9 weeks. The rates of incomplete exams were tabulated across practices and for individual sonographers and physicians. Multivariable logistic regression was used to adjust for known covariates. In total, 15,723 detailed fetal anatomy exams were performed at 18.0-23.9 weeks of gestation. Incomplete exams were significantly more common with maternal obesity, prior cesarean, maternal age < 35 years and GA < 19 weeks. There were significant between-practice differences in the rate of incomplete exams, varying from 1% to 53%. Incomplete exams had a median of four inadequate views (interquartile range 2-7). Practices also varied significantly in the rate of missing measurements for nuchal fold (0 to 9%) and nose bone length (11-100%). There were significant between-individual differences in the rate of incomplete exams. The tabulation of specific views showed some individuals with very high rates of inadequate views of certain elements. For some practices, there is a need for practice-wide quality improvement to increase the rate of measurement of the nuchal fold and nose bone. For selected individuals, the tabulation of which anatomy elements were inadequate can identify areas for targeted education or mentorship. We suggest strategies and software enhancements that may reduce the rate of incomplete exams. Sample data and statistical analysis scripts are provided for those who wish to adopt these methods to review their own data.
要获得胎儿解剖超声检查所需的所有视图具有挑战性，因此检查往往不完整。我们的目标是开发并展示定量方法，以评估超声检查机构及个体检查者的检查不完整总体发生率。我们对2024年七家母胎医学机构中所有单胎妊娠且有心跳活动的详细胎儿解剖检查进行了回顾性质量评估。如果36个所需解剖视图中的任何一个被报告为不充分，则该检查被视为不完整。分析集中在孕龄（GA）为18.0至23.9周的检查。统计了各机构以及个体超声检查技师和医生的检查不完整率。使用多变量逻辑回归对已知协变量进行校正。总共在妊娠18.0 - 23.9周进行了15,723次详细的胎儿解剖检查。检查不完整在母亲肥胖、既往剖宫产、母亲年龄<35岁以及孕龄<19周时更为常见。各机构之间检查不完整率存在显著差异，从1%到53%不等。检查不完整的情况中位数为四个不充分视图（四分位间距为2 - 7）。各机构在颈项褶测量缺失率（0至9%）和鼻骨长度测量缺失率（11 - 100%）方面也存在显著差异。个体之间检查不完整率存在显著差异。特定视图的统计显示，某些个体对某些部位的视图不充分率非常高。对于一些机构，需要进行全机构的质量改进，以提高颈项褶和鼻骨的测量率。对于选定的个体，列出哪些解剖部位不充分可以确定有针对性的教育或指导领域。我们提出了可能降低检查不完整率的策略和软件改进措施。为希望采用这些方法来审查自己数据的人提供了示例数据和统计分析脚本。
