Can Ultrasound in Early Gestation Improve Visualization of Fetal Cardiac Structures in Obese Pregnant Women?

J Ultrasound Med. 2019 Aug;38(8):2057-2063. doi: 10.1002/jum.14895. Epub 2018 Dec 18.


Objectives: To determine whether ultrasound (US) imaging of obese pregnant women in early gestation improves fetal cardiac visualization.

Methods: We report a prospective longitudinal trial comparing late first- and early second-trimester US to traditional second-trimester US for fetal cardiac screening in maternal obesity. All study participants received US for fetal cardiac screening at a gestational age of 13 weeks to 15 weeks 6 days using a transvaginal or transabdominal approach (UST1). All patients also underwent a traditional transabdominal examination at 20 to 22 weeks (UST2). If UST2 failed to complete the cardiac visualization, a follow up examination (second UST2) was performed 2 to 4 weeks later. Imaging was considered complete if the visceral situs, 4 chambers, outflow tracts, and 3 vessels were visualized. The completion rates between UST1 and UST2 were the primary outcomes. A power analysis (85%) and sample size calculation (n = 145) were performed.

Results: A total of 152 pregnancies met study criteria. Completion rates of cardiac screening were 77% for UST1 and 70% for UST2 (P = .143). This comparison reached statistical significance in patients with a body mass index of greater than 40 kg/m2 (UST1 [69%] versus UST2 [38%]; P = .001). Sixty-two percent of patients with a body mass index of greater than 40 kg/m2 required second UST2. The highest fetal cardiac screening completion rate was achieved when UST1 was combined with UST2 (96.1%). In 1 fetus, congenital heart disease was detected at UST1 and later confirmed.

Conclusions: This study represents the largest prospective trial assessing early-gestation US for fetal cardiac screening in the setting of maternal obesity. In obese pregnancies, the addition of early-gestation US to the 20- to 22-week US substantially improves the visualization of fetal cardiac anatomy.

Keywords: anatomy; cardiac; obesity; obstetrics; pregnancy; ultrasound.

MeSH terms

  • Adult
  • Female
  • Fetal Heart / diagnostic imaging
  • Fetal Heart / embryology
  • Heart Defects, Congenital / diagnostic imaging*
  • Heart Defects, Congenital / embryology*
  • Humans
  • Longitudinal Studies
  • Obesity / complications*
  • Pregnancy
  • Pregnancy Complications*
  • Pregnancy Trimester, First
  • Pregnancy Trimester, Second
  • Prospective Studies
  • Ultrasonography, Prenatal / methods*