Oral Plenary Session II - Fellows Plenary and Late-Breaking
Oral Plenary Sessions
Melissa L. Wise, MD (she/her/hers)
Maternal-fetal medicine fellow
Prisma Health, University of South Carolina School of Medicine Greenville
Greenville, SC, United States
Katelyn Pratt, MD (she/her/hers)
Prisma Health, University of South Carolina School of Medicine Greenville
Greenville, SC, United States
Laura Carlson, MD
Prisma Health, University of South Carolina School of Medicine Greenville
Greenville, SC, United States
Amy Crockett, MD, MSPH (she/her/hers)
Professor
Prisma Health, University of South Carolina School of Medicine Greenville
Greenville, SC, United States
Disclosure(s): I have no relevant financial relationships to report.
Daniel Pasko, MD
Prisma Health, University of South Carolina School of Medicine Greenville
Greenville, SC, United States
The detection of fetal anomalies decreases as maternal body mass index (BMI) increases. Panniculus retraction provides access to the suprapubic acoustic window and could improve sonographer ergonomics. We tested the hypothesis that use of a panniculus retractor during the detailed fetal anatomic survey improves visualization of fetal anatomy for participants with obesity and a panniculus.
Study Design:
This was a randomized controlled trial conducted at a single academic center (NCT05764408). Pregnant participants with a BMI ≥ 40 kg/m2 and a panniculus were randomized 1:1 to undergo a detailed anatomy ultrasound with or without use of a panniculus retractor. The primary outcome was adequate visualization of 16 prespecified anatomic views. Secondary outcomes included adequate visualization of all detailed anatomic views, detection of fetal anomalies, and survey satisfaction for participants and sonographers. A sample size of n=150 provided 80% power to detect a two-fold improvement in the primary outcome, assuming a historical baseline visualization rate of 23% and 2-sided alpha of 0.05. Analysis was by intention-to-treat.
Results:
2123 participants were screened from March 2023 to July 2023, of which 216 met inclusion criteria and 150 were randomized (n=74 to retractor, n=76 to no retractor). Baseline characteristics were similar between groups apart from panniculus grade. Adequate visualization of the 16 prespecified anatomic views did not differ between groups (25.7% retractor vs. 31.6% no retractor, RR 0.81; 95% CI 0.49-1.35). This finding persisted after adjusting for panniculus grade. There were also no differences in adequate visualization of all detailed anatomic views (13.5% retractor vs. 15.8% no retractor, RR 0.86; 95% CI 0.39-1.86). No major fetal anomalies were detected in either group. Sonographer and participant survey scores were similar between groups (Table).
Conclusion:
Use of a panniculus retractor during the detailed fetal anatomic survey for participants with a BMI ≥ 40 kg/m2 and a panniculus did not improve visualization of 16 prespecified fetal anatomic views.