Search

Objectives: A recent randomized controlled trial of first-trimester anatomy ultrasound in obese women found some advantages to using this technique in this population, but some aspects of feasibility were not clear, such as whether first-trimester ultrasound can be brought outside of a research setting. The learning curve for first-trimester anatomy has been described in the general population, but a learning curve has not been described for this technique in obese patients. This study sought to describe a learning curve for first-trimester anatomy ultrasounds in obese patients with an operator familiar with the basics of first-trimester imaging. Design: This was a secondary analysis of the EASE-O pilot randomized controlled trial (NCT04639973), which recruited 128 women with a BMI ≥35 kg/m2 and randomized them into two groups based on the timing of the first evaluation of fetal anatomy, to compare the completion rate of first- and second-trimester anatomy ultrasound. Participants: Pregnant women with a BMI ≥35 kg/m2 participated in the study. Setting: Between January 2021 and February 2022, the study was conducted at maternal-fetal medicine clinics in Houston, TX, USA. Methods: This secondary analysis evaluated data on the completion rate of first-trimester scans from the parent trial. Scans were grouped into bin sizes of 3, and prop_model for R version 4.2.0 for Windows was used to generate a learning curve across the first 60 scans. Results: The parent study included 60 scans performed by one imager who had previously only done first-trimester scans in lean patients for limited anatomy. The probability of a complete scan increased over 60 scans from 0.38 to 0.69; 29 scans were required to reach the final probability, after which only marginal improvement followed. Limitations: The major limitation is the inclusion of only one operator for this curve. Conclusions: For an ultrasound operator with basic familiarity in first-trimester imaging, approximately 30 scans are needed to acquire a completion rate of 70% for detailed first-trimester anatomy in women with BMI ≥35 kg/m2. This can be used in education and training programs focused on imaging in the first trimester. [ABSTRACT FROM AUTHOR]

Objectives: As maternal body mass index (BMI) increases, fetal anatomy ultrasound becomes more challenging, less sensitive, and less likely to be complete. We sought to report our experience of incomplete evaluation of anatomy in patients with BMI of 50 kg/m2 or greater. Methods: This is a retrospective cohort of singleton gestations in mothers with BMI of 50 kg/m2 or greater, undergoing anatomy evaluations between 2017 and 2021 at 9 maternal‐fetal‐medicine sites in Houston, TX. Patient variables and scan results were collected throughout pregnancy to provide a longitudinal assessment of the primary outcome, completion rate (percent of all scans which optimally captured 24 American Institute of Ultrasound in Medicine‐recommended images). Secondary outcomes included the rate of optimal capture of each individual structure. Results: In total, 293 patients with BMI ≥50 kg/m2 were identified. Only 28% of initial scans were complete, but over the entire pregnancy, a complete anatomic evaluation was achieved in 76% of women, largely due to weekly ultrasounds done for antenatal testing later in pregnancy. Neither BMI, placental location, nor amniotic fluid volume affected completion rate. The most difficult views are the outflow tracts, 4‐chamber view, and spine. Conclusions: One quarter of women with BMI of 50 kg/m2 or greater will not have a complete fetal anatomic evaluation by the end of pregnancy, since even basic fetal anatomic views are technically challenging to complete. Solutions deserve further attention, and may include first trimester imaging, transvaginal imaging, and optimization of ultrasound machine settings. [ABSTRACT FROM AUTHOR]

To evaluate associations between maternal characteristics and a short cervix in patients without history of preterm delivery, and to determine if these characteristics can predict the presence of a short cervix. This is a retrospective cohort study that included 18,592 women with singleton pregnancies without history of previous preterm deliveries who underwent universal transvaginal cervical length (TVCL) screening between 18 + 0 and 23 + 6 weeks/days of gestation. A short cervix was defined as a cervical length (CL) ≤25 mm, ≤20 mm, and ≤15 mm. Associations between maternal age, weight, height, body mass index (BMI), previous term deliveries, and history of previous miscarriages, with a short cervix were evaluated using logistic regression models. The prevalence of a short cervix in our population was: CL ≤25 mm, 2.2% (n = 403); CL ≤20 mm, 1.2% (n = 224); and CL ≤15 mm, 0.9% (n = 161). Women with BMI >30 and/or previous abortions constituted 45.5% of the total population (8463/18,582). Significant associations with short cervix were observed for women with BMI ≥30, and for women with at least one previous abortion (p <.001). Parous women had a significantly lower association with a short cervix than nulliparous women (p <.001). Maternal age or height were not associated with a short cervix. Prediction of short cervix based on presence of any of the following: BMI ≥ 30 or previous abortions showed sensitivities of 55.8% (≤25 mm), 61.6% (≤20 mm), and 63.4% (≤15 mm) with similar specificity (50.1–54.6%) and likelihood ratio positive (1.2–1.5); and prediction based on BMI ≥ 30 and previous abortions showed sensitivities of 11.1% (≤25 mm), 14.7% (≤20 mm), and 16.7% (≤15 mm) with specificity 93%. Among low risk women for spontaneous preterm delivery, those with a BMI ≥30 and/or previous miscarriages had a significantly increased risk for a short cervix at 18 + 0 and 23 + 6 weeks/days of gestation. Despite these significant associations, screening by maternal risk factors in a low risk population of pregnant women should not be an alternative to mid-trimester universal CL measurement. In pregnant women evaluated at 18/0 and 23/6 weeks + days of gestation without history of preterm delivery, a 16.7% detection rate for short cervix ≤15 mm can be achieved by risk factors BMI ≥30, and at least one previous miscarriage. Nevertheless, screening for short cervix by risk factors among low risk women might not be an effective alternative to universal cervical length screening. [ABSTRACT FROM AUTHOR]

Introduction: To evaluate differences in Doppler velocimetry parameters when the uterine arteries (UtA) are evaluated transabdominally (TA) at different sampling locations and transvaginally (TV). Materials and methods: Five hundred and fifty-seven pregnant women were evaluated between 11 and 39 weeks of gestation. The mean UtA pulsatility index (PI) and prevalence of bilateral notching were obtained at four different locations: (1) TA just above the crossing with the iliac artery; (2) TA just below the crossing with the iliac artery; (3) TA well above approximately 3 cm away from the crossing with the iliac artery; and (4) TV at the point closest to the internal cervical os. Measurements obtained just above the external iliac artery were considered the standard for comparison. Differences among different locations per gestational week were calculated. Results: The mean UtA-PI and prevalence of bilateral notching were similar when the uterine arteries were sampled TA just above or just below the crossing with the external iliac artery. The mean UtA-PI values and prevalence of bilateral notching were significantly higher (p < .0001) when obtained TV and significantly lower when obtained 3 cm above the crossing with the external iliac artery (p = .004), as compared to the standard plane just above the crossing. Conclusion: The mean UtA-PI and prevalence of bilateral notching vary significantly when the uterine arteries are sampled far above the crossing with the external iliac artery or when obtained transvaginally. [ABSTRACT FROM AUTHOR]

Acute cervical insufficiency is frequently associated with subclinical intra-amniotic inflammation and intra-amniotic infection. Amniotic fluid analysis has been recommended prior to the placement of a cervical cerclage given that preexisting infection is associated with adverse pregnancy outcome. We report a case for which commonly available laboratory tests—amniotic fluid Gram stain, white blood cell count, and glucose concentration—did not detect either intra-amniotic inflammation, diagnosed by elevated amniotic fluid interleukin-6, or intra-amniotic infection, diagnosed by cultivation. Following cerclage placement, the patient developed clinical chorioamnionitis and bacteremia and experienced a spontaneous mid-trimester pregnancy loss. This case illustrates the need for a rapid and sensitive point-of-care test capable of detecting infection or inflammation, given recent evidence in support of treatment of intra-amniotic infection and intra-amniotic inflammation with antimicrobial agents. [ABSTRACT FROM AUTHOR]

Objective: The study aimed to estimate weekly differences in the prevalence of a short cervix during the period of 18+0 to 23+6 weeks of gestation in pregnant women with and without a history of previous preterm delivery (PTD). Design: An observational study was conducted. Methods:Setting and participants: 20,002 pregnant women, 18,591 without a history of previous PTD (low risk) and 1,411 with at least one previous PTD (high risk), were evaluated at 18+0 to 23+6 weeks + days of gestation. Weekly differences in the prevalence of a short cervix (≤25 mm, ≤20 mm, and ≤15 mm) between women with and without previous PTD were estimated. Results: High-risk women had a significantly higher prevalence of a short cervix, defined as either ≤25 mm (4.4% vs. 2.2%; p < 0.0001) or ≤20 mm (2.4% vs. 1.2%; p < 0.0001) but not for ≤15 mm (1.2% vs. 0.9%; p < 0.2) as compared to low-risk pregnant women. The odds ratio for a short cervix ≤25 mm in high-risk as compared to low-risk women was 2.0 (95% CI 1.54–2.61; p < 0.0001). Among low-risk women, those evaluated at 22 or 23 weeks of gestation had a significantly higher prevalence of a short cervix ≤25 mm (3.8% vs. 1.9%; p < 0.0001), ≤20 mm (2.4% vs. 0.98%; p < 0.0001), and ≤15 mm (1.6% vs. 0.7%; p < 0.0001) than low-risk women scanned between 18 and 21 weeks of gestation. Similar results were observed for high-risk women. Limitations: No gestational age at delivery was evaluated. Conclusion: There is higher prevalence of short cervix when pregnant women are evaluated at 22+0 to 23+6 than at 18+0 to 21+6 weeks of gestation. [ABSTRACT FROM AUTHOR]