Figure 1: Schematic representation of the LVOT according to the position of the fetal back following to the classification

Figure 2: Total average scores for the three centres over the three periods

The average total scores for the quality criteria across all centres were 5.49/7 (95% CI: 5.36-5.62), 5.91/7 (95% CI: 5.80-6.03), and 5.70 (95% CI: 5.58-5.82) for study periods before 2016, in 2017, and after 2020, respectively.
There was a significant difference between the scores obtained before 2016 and in 2017 (p < 0.001) and also between the scores 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

Figure 3: Average scores according to trimester

Score averages were 5.75/7 (95% CI: 5.65-5.85) and 5.65/7 (95% CI: 5.55-5.75) in the second and third trimester respectively.

Figure 4: Average scores according to cardiac position

In Position 1 (with the back at between 12 o’clock and 3 o’clock), the average score was 5.59/7 (95% CI: 5.45-5.73). In Position 2 (back between 3 o’clock and 6 o’clock), the average score was 5.99/7 (95% CI:5.87-6.10). In Position 3 (back between 6 o’clock and 9 o’clock), the average score was 5.82/7 (95% CI: 5.65-5.98). In Position 4 (back between 9 o’clock and 12 o’clock), the average score was 5.33/7 (95% CI: 5.19-5.48).
Comparing the score averages obtained according to the position of the back of the foetus, we found a statistically significant difference between Positions 1 and 2 (p <0,01), between Positions 2 and 4 (p <0,01), and between Positions 3 and 4 (p < 0,01).

Figure 5: Average scores according to centre for the three periods combined

The average score at the GHSR was 5.90/7 (95% CI: 5.8-6), at the Saint Joseph’s Hospital 5.41/7 (95% CI: 5.29-5.53), and at the Var centre 5.83/7 (95% CI: 5.69-5.98)

Figure 6: Average scores according to centre for each of the three periods

Figure 7: Average scores according to operator for the three periods combined

Figure 8: Average scores according to practitioner for each of the three periods

Table 1: The percentage of quality criteria considered in all three periods combined and according to the position of the back of the foetus