Official Proceedings - AIUM

American Institute of Ultrasound in Medicine Proceedings J Ultrasound Med 32(suppl):S1–S134, 2013Obstetric Ultrasound: General and Fetal GrowthModerators: Wesley Lee, MD, Mani Montazemi, RDMS1539437 Fetal Loss Rate and Associated Risk Factors AfterAmniocentesis, Chorionic Villus Sampling, and FetalBlood SamplingChristian Enzensberger, 1 * Christina Pulvermacher, 1Jan Degenhardt, 1 Andreaa Kawecki, 1 Ute Germer, 2 UlrichGembruch, 3 Martin Krapp, 4 Jan Weichert, 5 RolandAxt-Fliedner 1 1 Division of Prenatal Medicine, University ofGiessen & Marburg, Giessen, Germany; 2 Center for PrenatalMedicine, Caritas Krankenhaus St Josef, Regensburg, Germany;3 Division of Prenatal Medicine, University of Bonn,Bonn, Germany; 4 Center for Endocrinology and Reproductiveand Prenatal Medicine, Amedes Hamburg, Hamburg, Germany;5 Division of Prenatal Medicine, University of Schleswig-Holstein, Campus Luebeck, Luebeck, GermanyObjectives—To assess the total and procedure-related fetal lossrates and associated risk factors following amniocentesis (AC), chorionicvillus sampling (CVS), and fetal blood sampling (FBS).Methods—We performed a retrospective analysis of patientswith invasive diagnostics from 1993 to 2011 in 2 tertiary referral centers.We aimed to classify pregnancy loss after an invasive procedure and includedthe time after the invasive procedure and the result of targeted ultrasound/karyotypeanalysis in the analysis. Fetal losses occurring within2 weeks after an invasive procedure were classified as procedure related.Results—After excluding 1553 pregnancies with abnormalkaryotypes, fetal malformations, and multiple insertions, 6256 cases wereretrieved for final analysis. The total fetal loss rate was 1.5%. The procedure-relatedfetal loss rates were 0.4% for AC, 1.1% for CVS, and 0.4 %for FBS. Maternal vaginal bleeding in the first trimester was significantlyassociated with an increased procedure-related fetal loss rate (P = .008).The number of invasive procedures declined during the study period withincreasing numbers of CVS in the first trimester.Conclusions—In our population, the procedure-related fetalloss rates were 0.4% after AC and 1.1% and 0.4% after CVS and FBS, respectively.Different gestational ages at the time of invasive proceduresmight account in part for those differences. Vaginal bleeding during thefirst trimester is associated with increased procedure-related fetal loss.Overall, declining numbers of invasive procedures are the result of changingattitudes toward invasive procedures and more sophisticated noninvasiveprenatal screening programs over the last 20 years.1537806 Quality Control in Obstetric Ultrasound: Evaluating theReproducibility of an Image Scoring Tool for the Second-Trimester Anatomic SurveyKatherine Goetzinger,* Methodius Tuuli, Alison Cahill,George Macones, Anthony Odibo Obstetrics and Gynecology,Washington University, St Louis, Missouri USAObjectives—To evaluate the reproducibility of an image scoringtool for quality control of second-trimester fetal anatomic surveys ina US academic center.Methods—This was a retrospective study of 40 randomly selectednonanomalous singleton gestations between 18 and 22 weeks whopresented for an anatomic survey. Images from each ultrasound exam wereevaluated by 2 independent reviewers and assigned a score based on aquality control tool, previously derived in a European ultrasound unit. Thistool assigns an overall score (46 points possible), which is the sum of individualscores for each of the following anatomic views: head (6), abdomen(6), femur (4), 4-chamber heart (6), outflow tracts (5), kidneys (4),spine (5), stomach/diaphragm (6), and face (4). Individual scores are basedon the number of specific criteria fulfilled for each view. Spearman correlationcoefficients and percent agreement (“excellent”: score difference,0–1 points; “acceptable”: 2 points; “poor”: ≥3 points) were used to estimateinter-reviewer reproducibility. Bland-Altman plots were used to assessbias and compare the 95% limits of agreement between reviewers.Results—There was a significant correlation between the 2 reviewers’overall scores (ρ = 0.73; P < .001). One hundred percent excellentagreement was observed in the individual categories of femur, outflowtracts, stomach/diaphragm, and spine. Poor agreement was rare (kidney,2.5%; and face, 2.5%) Bland-Altman statistics demonstrated no evidenceof systematic bias in the overall score (mean difference = 1.5; P = .761).The 95% limits of agreement were clinically acceptable for the overallscore (–2.4 to 5.4) and all individual categories except fetal face views(Table 1).Conclusions—This image quality scoring tool demonstratedoverall acceptable reproducibility without evidence of systematic bias.Careful evaluation of specific criteria comprising each individual scoringcategory is, however, warranted prior to implementation into practice.Table 1Category Bias 95% Limits of AgreementHead 0.2 –1.0 to 1.5Abdomen 0.2 –1.4 to 1.8Femur –0.1 –1.2 to 1.14-Chamber heart 0.5 –1.0 to 2.1Outflow tract –0.1 –1.4 to 2.2Kidneys 0.4 –1.4 to 2.2Stomach and diaphragm –0.2 –1.7 to 1.2Spine 0.1 –0.6 to 0.4Face 0.7 –1.3 to 2.71540992 Time Required for the Fetal Anatomic Survey in Obese andMorbidly Obese WomenRobert Ehsanipoor,* Gofran Tarabulsi, Shannon Trebes,Erika Werner, Janice Henderson, Jude Crino Johns HopkinsUniversity School of Medicine, Baltimore, Maryland USAObjectives—To determine if there is a difference in time requiredto perform the fetal anatomy survey in obese and morbidly obesewomen compared to women with a body mass index (BMI) of