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Master Thesis

La voie d’éjection gauche en échocardiographie fœtale de dépistage : audit des pratiques et critères de qualité

Abstract : Background: Congenital heart defects (CHD) are common and are the leading cause of infant mortality. However, the detection rate of these malformations is barely acceptable. Since 2016, when the CNEOF (French National Conference on Obstetrical and Foetal Ultrasound) updated its recommendations, the inclusion of an examination of the left ventricular outflow tract (LVOT) based on echocardiography screening has been mandatory in France in the second and third trimester of pregnancy in an attempt to improve, among other things, screening for conotruncal heart defects. The objective of this study was firstly to carry out an audit of practices, and subsequently study possible changes in these practices following the implementation of quality criteria regarding images of the LVOT as part of foetal echocardiography screening. Study Design: We conducted a multicentric, retrospective and prospective, descriptive, longitudinal study divided into three distinct periods: before 2016, in 2017, and in 2020. Seven quality criteria were investigated and rated from 0 to 1 for LVOT screening. Files were randomly selected from three centres and average total scores and scores according to quarter, period, centre, practitioner, and cardiac position were calculated. We also carried out analyses of intra- and inter-operator variability in the use of these quality criteria. Results: LVOT images were present in ultrasound reports before 2016, in 2017, and in 2020 in 95.3%, 94.3%, and 93.3% of cases for the three centres, respectively. Before 2016, the average quality score was 5.49/7 (95% CI: 5.36-5.62), in 2017 5.91/7 (95% CI: 5.80-6.03), and in 2020 5.70/7 (95% CI: 5.58-5.82) for the three centres. There was a statistically significant difference between the average scores from the periods before 2016 and in 2017 (p<0.001) and between the period before 2016 and in 2020 (p=0.039). There was no significant difference following the introduction of the quality criteria; 2017 vs. 2020, p = 0.054. There was also a statistically significant difference between the scores when the back of the foetus was in a certain position. Quality Criteria 5 and 6, the mitro-aortic and ventriculo-aortic continuities, were the least represented, in 60.9% and 63.2% of cases, respectively. Kappa coefficients of the inter- and intra-operator variables were all within 0.601 and 1. Conclusion: Left ventricular outflow tract images were present in most of ultrasound reports. The introduction of the proposed quality criteria is not associated with a significant change in practice. The development of modern tools, such as artificial intelligence and deep learning, could improve this.
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Master Thesis
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https://dumas.ccsd.cnrs.fr/dumas-03430283
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Submitted on : Tuesday, November 16, 2021 - 10:43:17 AM
Last modification on : Wednesday, November 24, 2021 - 3:41:01 AM

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  • HAL Id : dumas-03430283, version 1

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Maud Regouin. La voie d’éjection gauche en échocardiographie fœtale de dépistage : audit des pratiques et critères de qualité. Sciences du Vivant [q-bio]. 2021. ⟨dumas-03430283⟩

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