Results
For each practitioner, we analyzed 15 cases from the second trimester
and 15 from the third trimester for the three periods, i.e ., 90
cases per practitioner, which represented 300 cases before 2016, 300 in
2017, and 300 in 2020, making a total of 900 cases.
Inclusion of LVOT
images
In our study, of the 900 files analyzed, there were no images relating
to the LVOT in 51 (5.7%) of the cases. These files were therefore given
a score of 0. These included 14 (4.7%) before 2016, 17 (5.7%) in 2017,
and 20 (6.7%) in 2020; 34/360 (9.4%) were taken from files extracted
from the database of the Saint Joseph hospital and 17/180 (9.4%) from
the Var center. For the Saint Joseph’s Hospital, LVOT images were absent
in 8/120 (6.7%) before 2016, 11/120 (9.2%) in 2017, and 15/120
(12.5%) in 2020. For the Var center, LVOT images were absent in 6/60
(10%) before 2016, 6/60 (10%) in 2017, and 5/60 (8.3%) in 2020. In
total, 25/450 (5.6%) images were documented to be absent in the second
trimester and 26/450 (5.8%) in the third trimester. Thus, images of
LVOT were present in 95.3%, 94.3%, and 93.3% of cases before 2016, in
2017, and after 2020, respectively, for the three centers combined.
In order to make our analysis of practices more meaningful, we
deliberately chose to exclude all files without an LVOT image. We
therefore restricted our study to files with an image of the LVOT in
order to shed more light on the use, or otherwise, of the proposed
quality criteria.
Total average scores for the three
centres over the three
periods
The average total scores for the quality criteria across all centers
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 2).
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 3) .
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) (Figure
4 ).
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).
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 center
5.83/7 (95% CI: 5.69-5.98) (Figure 5 ).
We note a significant difference between the scores from Saint Joseph’s
Hospital and the GHSR, but also between Saint Joseph’s Hospital and the
Var center (p < 0.01 for each). There was no
significant difference between average scores from the GHSR and the Var
center (p =1).
Average scores according to centre
for each of the three periods
The average scores for the three centers over the three periods studied
are summarized in Figure 6 .
At the GHSR
Before 2016, the average score was 5.67 (95% CI: 5.49-5.85), in 2017
5.96/7 (95% CI: 5.78-6.14) and in 2020 6.08/7 (95% CI: 5.90-6.26).
At Saint Joseph’s Hospital
Before 2016, the average score was 5.25/7 (95% CI: 5.06-5.44), in 2017
5.76/7 (95% CI: 5.57-5.95) and in 2020 5.21/7 (95% CI: 5.02-5.40).
At the Var centre
Before 2016, the average score was 5.57/7 (95% CI: 5.30-5.84), in 2017
6.11/7 (95% CI: 5.84-6.38) and in 2020 5.82/7 (95% CI: 5.55-6.09).
Average scores according to operator
for the three periods
combined
Average scores for the 10 practitioners in the three centers over the
three periods combined are summarized in Figure 7 .
At the GHSR
The total average for Practitioner A was 5.63/7 (95% CI: 5.43-5.84),
and for Practitioner B was 6.03/7 (95% CI: 5.85-6.22). The total
average for Practitioner C was 5.79 (95% CI: 5.58-5.99), and for
Practitioner D was 6.16 (95% CI: 5.95-6.36).
At Saint Joseph’s Hospital
The total average for Practitioner A was 5.45/7 (95% CI: 5.23-5.68),
and for Practitioner B was 5.24/7 (95% CI: 4.98-5.51). The total
average for Practitioner C was 5.37/7 (95% CI: 5.10-5.64), and for
Practitioner D was 5.54/7 (95% CI: 5.31-5.77).
At the Var centre
The total average for Practitioner A was 5.59/7 (95% CI: 5.35-5.84) and
for Practitioner B was 6.03/7 (95% CI: 5.87-6.20).
Average scores according to
practitioner for each of the three periods
Average scores for the 10 practitioners over the three periods studied
are summarized in Figure 8 .
Individual study of the seven
quality criteria
(%)
The percentage of quality criteria considered in all three periods
combined and according to the position of the back of the foetus is
summarized in Table 1 .
Consideration of the seven quality criteria over the three periods
studied and according to the position of the back of the foetus is
summarized in Figure 9 and Figure 10,respectively.
Variability
The intra-class correlation coefficient (ICC) for intra- and
inter-operator agreement between the junior doctor (MR) and expert
doctor (EQ), with and without 0 scores, is presented in
Table 2 . All ICCs were between 0.601 and 1.