Ultrasound examination difficulties in overweight pregnant patients. Review of literature and retrospective study

R. Socolov, M. Akad, R. Covali, I. Shadye-Scripcariu, D. Socolov, D. Crauciuc, E. Crauciuc, F. Akad, D. Popovici, R. Gireadă

Rezumat: Introduction. In the last decades, the medical system has encountered more frequently obese or overweight patients. Obesity is associated with higher risks for one’s life and with technical difficulties when it comes to management and treatment. It is estimated that 15-20% of the population is affected by this condition, and the percentage for the pregnant women has doubled in the last decade. As ultrasound examination is an important part of prenatal care, we studied how the Body Mass Index (BMI) affected the ultrasound examination in a specialized medical clinic. Materials and method. This is a longitudinal retrospective study on the second- and third-trimester ultrasound scans performed in the last five years on patients with BMI over 25 kg/m2. The repartition was done regarding the recommended categories: overweight (25-30 kg/m2), first-degree obesity (30-35 kg/m2), second-degree obesity (35-40 kg/ m2) and third-degree obesity (>35 kg/m2). The statistical analysis regarded the number of ultrasound examinations performed for each patient and the technical difficulties experienced due to overweight or obese patients. Factors such as timing for each scanning and recommendations for better ultrasound examination were mentioned. Results. There were 1101 ultrasound scans selected, that were performed for second- and third-trimester morphological ultrasounds in 942 patients. These patients were distributed as overweight (69%), with first-degree obesity (22%), second-degree obesity (6%) and third-degree obesity (3%). In general, the number of repeated scans in the study was higher than in normal patients, although no statistical correlation to BMI could be established. In 58% of cases, the specialist marked the technical difficulties in the fetal ultrasound assessment, mainly related to the abdominal maternal adiposity. Most frequently, the recommendation was for the scan to be repeated after 2-4 weeks, as opposed to the usual 6-8 weeks interval in regular patients. No correlation to the BMI was found for fetal anomalies, Doppler parameters or estimation of fetal growth. Conclusions. Obesity has become an important risk factor during pregnancy and implies difficulties in performing antenatal fetal ultrasound. The new specialists for antenatal fetal morphology ultrasound evaluation should be trained to deal with the pitfalls and tricks related to the accuracy of fetal ultrasound examination in obese or overweight patients. The limitations of this imagistic investigation should be explained to each patient.
Cuvinte cheie: obesity, pregnancy, antenatal care, fetal ultrasound.