Maternal severe obesity and sonographic visualization of fetal anatomy.

Objective: We sought to investigate adequacy of fetal anatomic visualization in pregnant patients with BMI ≥ 50 kg/m Methods: This was a retrospective chart review of singleton pregnancies presenting for fetal anatomic survey from 18 0/7 to 21 6/7 weeks gestation between January 2019 and December 2020 at a single tertiary care center. The primary outcome was rate of anatomic survey completion stratified by body mass index (BMI) category, as defined by the World Health Organization. Severe obesity was defined as BMI ≥50 kg/m Results: Of 2372 anatomic surveys, 9.0% of patients were normal weight, 31.5% of patients were overweight, 54.7% of patients were obese (26.0% class I, 15.9% class II, 12.2% class III), and 4.8% of patients were with severe obesity. Rates of anatomic survey completion were highest in normal weight patients, and lowest in those with severe obesity (67.6%  vs. 4.4%, Conclusions: Patients with severe obesity have extremely low rates of anatomic survey completion at the first attempt. The inability to adequately evaluate fetal anatomy in this patient population is especially concerning due to the higher baseline risk of fetal anomalies with increasing obesity. The healthcare disparity demonstrated in this data justifies further research on advancements in practice standards and technology in obstetric imaging.