The effect of maternal body mass index on fetal ultrasound image quality

More than 60% of women are overweight or obese in the United States, with obesity most common clinical risk factor obstetrical practice.1World Health OrganizationObesity and overweight.https://www.who.int/en/news-room/fact-sheets/detail/obesity-and-overweightDate: 2018Date accessed: December 15, 2019Google Scholar,2Maxwell C. Glanc P. Imaging obesity: a perspective during pregnancy.AJR Am J Roentgenol. 2011; 196: 311-319Crossref PubMed Scopus (25) Google Scholar Although increasing maternal body mass index (BMI) is thought to be associated lower ultrasound image quality,2Maxwell Scholar, 3Paladini D. Sonography pregnant women: clinical, medicolegal technical issues.Ultrasound Obstet Gynecol. 2009; 33: 720-729Crossref (105) 4Dashe J.S. McIntire D.D. Twickler D.M. Maternal limits evaluation fetal anatomy.J Ultrasound Med. 28: 1025-1030Crossref (79) no large-scale studies have quantified effect real-world settings. We investigated BMI on quality standard views at time routine midtrimester ultrasound. Retrospective analysis images, using large dataset, prospectively acquired John Radcliffe Hospital Oxford, Kingdom, anomaly screening (18–23 weeks’ gestation) 5 different machines by 20 qualified sonographers. After institutional review board approval, all images were fully anonymized. Detailed, objective scoring5Yaqub M. Kelly B. Stobart H. Napolitano R. Noble J.A. Papageorghiou A.T. Quality-improvement program for ultrasound-based anatomy audit.Ultrasound 2019; 54: 239-245Crossref (9) each (without knowledge BMI) was undertaken team 12 independent assessed 6 views: transventricular transcerebellar head views, abdominal circumference, femur length, sagittal spine, coronal view lips. For image, score generated.5Yaqub Nonparametric testing used assess association between category (<25, 25–30, 30–35, ≥35 kg/m2) (pooled analysis, significance level set P<.05). also impact individual criteria view. 26,954 from 3251 women, 1788 (55%), 843 (26%), 383 (12%), 237 (7%) 4 groups, respectively. There decrease (Figure) (Kruskal Wallis test, Some more affected others (Figure): instance, visibility cavum septi pellucidi umbilical vein circumference decreased higher category. Magnification not significantly BMI, probably because magnification, geometric criterion, does directly relate appearance under control sonologist. taken examinations, scored these objectively, BMI. Using “real-world” dataset number sonographers multiple machines, we able show consistent substantial effect: category, less likely satisfy criteria, some (Figure). These raise important concerns: as an example, poor important, visualization marker normal brain development closely formation corpus callosum. In addition, finding that head, abdomen, relevance biometry, measurements performed images. Whether robust according remains evaluated examining reproducibility high The largest consecutive differences scores categories 30 <35 least 35 kg/m2, suggesting degrades kg/m2. This adds limitation imaging, information which should shared attending scans.