J Med Assoc Thai 2020; 103 (1):46-51

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Accuracy of Subjective Ultrasonographic Prediction of Fetal Cardiomegaly in Hemoglobin Bart’s Disease by Non- Expert Sonologists
Jirapatsakul C , Tongprasert F Mail, Rueangdetnarong H , Wudtisan J , Thapsamuthdechakorn A , Tongsong T

Objective: To determine the accuracy of subjective ultrasonographic assessment of fetal cardiomegaly in predicting fetal hemoglobin (Hb) Bart’s disease by non-expert sonologists.

Materials and Methods: Ninety video clips of fetal chest ultrasounds performed on fetuses at risk of Hb Bart’s disease at 18 to 22 weeks of gestation were retrieved from medical records. One expert and four non-expert obstetric sonologists, all blinded to patient information and initial assessment data, subjectively assessed the clips for fetal cardiomegaly. The sensitivity and specificity of subjective ultrasonographic assessment by the non-expert sonologists were compared to those based on cardiothoracic ratio (CTR), middle cerebral artery peak systolic velocity (MCA-PSV), and placental thickness measured by specialists.

Results: The sensitivity of subjective ultrasonographic assessment by the non-expert sonologists and the expert was not significantly different (82.4% versus 91.9%, p=0.061). The sensitivity of CTR (100%) measured by the expert was significantly higher than that by subjective ultrasonographic assessment by the non-expert sonologists (p<0.001). However, the sensitivities of MCA-PSV (89.2%) and placental thickness (70.3%) measured by the specialist were comparable with the sensitivity of subjective ultrasonographic assessment by the non-expert sonologists (p=0.195 and 0.059, respectively).

Conclusion: A subjective ultrasonographic assessment of fetal cardiomegaly by non-expert sonologists is acceptable in identifying Hb Bart’s disease in fetuses. Its sensitivity was comparable with MCA-PSV, but less than CTR, as measured by experts.

Keywords: Alpha thalassemia, Anemia, Cardiomegaly, Fetal heart, Fetal hemoglobin, Fetal ultrasonography

Received 14 Aug 2018 | Revised 14 Nov 2018 | Accepted 23 Nov 2018


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