Obstetrical ultrasound challenges in obese patients

D. Diculescu, D. Pop, R. Ciortea, A. Maluțan, S. Ciuchină, D. Mihu

Rezumat: The incidence of obesity has doubled or even tripled, so that developed countries present a rate of 28% overweight and 11% obese pregnant women; developing countries present a similar evolution. Recent studies suggest the unfortunate association between obesity/overweight and powerfull complications during pregnancy and labour (pre-eclampsia, diabetes, trombembolism, postpartum hemorrhage, fetal macrosomia and neonatal death). At the same time we know that obesity, being overweight, and high interpregnancy weight gain in pregnancy are all associated with high risk for congenital anomalies (neural tube defects, CNS of cardiac malformations). All this lead to increased materno-fetal mortality and morbidity, with severe social and economic consequences which push us toward a ferm and adequate management of this pathology. Ultrasound evaluation of obese patients is extremely difficult for any sonographer and in some cases is impossible to dismiss a congenital anomaly in these fetuses. Technical factors that impair ultrasound evaluation in obese patients are: the depth of insonation required and the absorbtion of ultrasound energy (dropout) by the abdominal tissue. Some studies claim that using highend ultrasound equipment will contribute only partially to improving the quality of ultrasound visualization; it is also important to have professional medical sonologists. All these aspects, combined with increased incidence of cardiac and extra-cardiac anomalies, conduct towards the hypothesis that obese pregnant women should be referred directly to tertiary refferal centers for fetal morphology. Being overweight or obese is not the only factors that impair a proper evaluation of pregnancy. There are an array of additional factors such as increased rate of multiple pregnacies due to assisted reproductive techniques and increased rates of cesarean births. In conclusion, ultrasound evaluation of pregnancy in overweight/obese patients (especially fetal morphology assesment) represents a challenge for all medical proffesionals involved, therefore clinical and technical limitations should be well known and accepted both by doctors and future parents.
Cuvinte cheie: obstetrical ultrasound, obesity, pregnancy, fetal morphology, congenital anomalies.