Author information: (1)Obstetrics and Gynecology, Ultrasound Unit, University Women's Hospital of Basel, Basel, Switzerland. (1) The study showed no difference in neonatal outcomes among women undergoing ultrasound scans versus women undergoing standard care. This site needs JavaScript to work properly. Deliveries between 1985 and 1996 were included. The findings do not support routine ultrasonography in the third trimester for low risk pregnancies. Report from Norwegian Knowledge Centre for the Health Services (NOKC) No. In some units in Sweden, a second ultrasound screening examination is offered in the third trimester to identify small‐for‐gestational age fetuses (SGA). A randomized controlled study to assess the role of routine third trimester ultrasound in low-risk pregnancy on antenatal interventions and perinatal outcome. Routine scan versus serendipitous finding ??? Ultrasound is not as useful for imaging air-filled lungs, but it may be used to detect fluid around or within the lungs. | Compare the evidence for and against routine third‐trimester ultrasound screening. c. Significantly different. Double entry analyses on hospital case report forms of 111 women were carried out. Diagnosis of fetal non-chromosomal abnormalities on routine ultrasound examination at 11-13 weeks' gestation. Copyright © 2021 BMJ Publishing Group Ltd 京ICP备15042040号-3, Update on the diagnosis and classification of fetal growth restriction and proposal of a stage-based management protocol, Intrauterine growth restriction and later cardiovascular function, Intrauterine growth restriction: postnatal monitoring and outcomes, Major risk factors for stillbirth in high-income countries: a systematic review and meta-analysis, Restricted fetal growth in sudden intrauterine unexplained death, Altered small-world topology of structural brain networks in infants with intrauterine growth restriction and its association with later neurodevelopmental outcome, Risk factors for small for gestational age infants, Poor effectiveness of antenatal detection of fetal growth restriction and consequences for obstetric management and neonatal outcomes: a French national study, Comparison of fetal and neonatal growth curves in detecting growth restriction, Screening for fetal growth restriction with universal third trimester ultrasonography in nulliparous women in the Pregnancy Outcome Prediction (POP) study: a prospective cohort study, Consensus definition of fetal growth restriction: a Delphi procedure, Multidisciplinary consensus on screening for, diagnosis and management of fetal growth restriction in the Netherlands. Perined. Routine ultrasound scans were performed at mean gestational ages of 28.9 (SD 0.6) and 34.7 (SD 0.6) weeks. Epub 2017 Sep 7. 139-143. In the intervention strategy, for an abdominal circumference below the 10th centile or slow growth in abdominal circumference the sensitivity in detecting birth weight below the 10th centile was 32% and the positive predictive value was 22%. Ultrasound Obstet Gynecol. In low-risk pregnancies, routine ultrasonography in the third trimester detected more babies who were small for gestational age compared with usual care alone: 32% (179/556) versus 19% (78/407), though still fewer than a third of those found to be small for gestational age. Is a routine ultrasound in the third trimester justified? Ultrasound Obstet Gynecol. With gel on your abdomen, the device will show an image of your baby to the sonographer conducting the scan. Possible explanations for our findings are: routine ultrasound fetal biometry is ineffective in detecting fetal growth restriction and preventing subsequent adverse outcomes in low risk pregnancies; adding routine ultrasound scans in the third trimester to usual care does not yield major benefits because women receiving such care already undergo one clinically indicated ultrasound scan on average in the third trimester; the quality of ultrasonography was insufficient; and using fetal abdominal circumference below the 10th centile (in combination with biometric measures of slow growth) on a population based curve is ineffective in detecting fetal growth restriction, and better methods are required. Nineteen practices performed biometry scans and the others referred women to one of the 18 sonography centres involved in the study. Objectives To investigate the effectiveness of routine ultrasonography in the third trimester in reducing adverse perinatal outcomes in low risk pregnancies compared with usual care and the effect of this policy on maternal outcomes and obstetric interventions. This exam is typically done between weeks 18 and 20 of pregnancy. Routine mid-trimester fetal ultrasound scan Consideration must be given to local circumstances and medical practices. With an α of 5% and 80% power, inclusion of 13 536 women was required. USA.gov. Flow chart of IRIS study. This funding source had no role in study design, data collection, data analysis, data interpretation, writing of the scientific article, or the decision to submit the paper for publication. The number of women who need serial ultrasound examinations in the third trimester to identify an abnormal condition is five (95% CI 3–11). 2019 Oct;54(4):468-476. doi: 10.1002/uog.20844. for undertaking this challenging study assessing the use of routine growth third trimester ultrasound in pregnancy in low risk women. AdJ is the guarantor. The manuscript’s guarantor (AdJ) affirms that this manuscript is an honest, accurate, and transparent account of the study being reported; that no important aspects of the study have been omitted; and that any discrepancies from the study as planned have been explained. Routine Ultrasound in Pregnancy [Internet]. Reasons for deviations from these recommendations should be documented. Obstetrics » Obstetrics 2nd And 3rd Trimester. [2] In 2010, the Dutch Ministry of Health considered introducing routine third trimester biometry as a means to reduce perinatal mortality. I've had an uneventful and easy pregnancy so far (31 weeks). At inclusion in the study, women completed a survey of questions on personal characteristics, anthropometric measurements, smoking status, and intake of alcohol and recreational drugs. Presentation This 18 year old woman, primigravida, presented for a routine antenatal scan at 31 weeks of gestation. Syngelaki A, Hammami A, Bower S, Zidere V, Akolekar R, Nicolaides KH. Sensitivities of routine third trimester ultrasonography range from 22% to 57%.91116 Nevertheless, evidence based guidelines in many Western countries, including the Netherlands, do not recommend routine biometry scans in the third trimester because in previous clinical trials perinatal outcomes were not positively affected.714151718 Also, when evaluating the introduction of a new screening programme, adverse effects, such as unnecessary medical care, should be considered.19 Major limitations, however, have been identified in earlier trials.15 Firstly, almost all trials were underpowered to detect clinically significant differences in severe perinatal outcomes. Dutch Association of Obstetrics and Gynaecology (NVOG)-guideline Fetal Growth Restriction (FGR), Dutch Association of Obstetrics and Gynaecology, Routine ultrasound in late pregnancy (after 24 weeks’ gestation), Value of a single early third trimester fetal biometry for the prediction of birth weight deviations in a low risk population, Evidence-based national guidelines for the management of suspected fetal growth restriction: comparison, consensus, and controversy. This question is for testing whether or not you are a human visitor and to prevent automated spam submissions. Our randomized trial suggests that among women with uncomplicated pregnancies at 24 0/7 to 30 6/7 weeks of gestation, serial third-trimester ultrasound examinations are more likely to identify a composite of abnormalities of fetal growth or amniotic fluid than routine care. Minimal changes were made. In a multilevel multivariable logistic regression analysis, routine ultrasonography in the third trimester was not related to the composite outcome of maternal peripartum morbidity or mortality (1.06, 0.95 to 1.18), or spontaneous labour and birth (1.00, 0.92 to 1.08). View Record in Scopus Google Scholar. Fetal growth restriction is a risk factor for perinatal mortality and morbidity and cardiovascular disease and neurodevelopmental disorders in adulthood, Routine ultrasonography in the third trimester detects neonates who are small for gestational age (SGA) significantly more often than usual care using serial fundal height measurements combined with clinically indicated ultrasonography, Evidence that routine ultrasonography in the third trimester reduces the incidence of severe adverse perinatal outcomes is lacking, In low risk pregnancies, routine ultrasonography in the third trimester combined with clinically indicated ultrasonography was associated with greater antenatal detection of SGA neonates and induction of labour but was not associated with a reduction in severe adverse perinatal outcomes compared with usual care, Based on these findings, routine ultrasonography has no benefit (or harm) to the neonate but was associated with a moderately increased incidence of induction of labour, These findings do not support routine ultrasonography in the third trimester for low risk pregnancies. Neonates of the participating women were born between June 2015 and August 2016. With this design, each practice first applied usual care and then switched to offering routine ultrasonography in the third trimester at a defined moment during the study, depending on the randomisation scheme. The IRIS study was a nationwide, stepped wedge cluster randomised trial conducted in 60 primary care midwifery practices in the Netherlands in low risk pregnant women. Women’s appreciation of a third trimester routine ultrasound might arise from getting used to … Results Between 1 February 2015 and 29 February 2016, 60 midwifery practices enrolled 13 520 women in mid-pregnancy (mean 22.8 (SD 2.4) weeks’ gestation). libr. Small-for-gestational-age fetus, investigation and management (Green-top Guideline No 31). Assuming an intracluster correlation coefficient of 0.0003 based on previous literature,28 and an a priori assumed average cluster size (ie, practice size of 250 women annually), we aimed to include 15 000 pregnant women (7500 for each strategy) to be able to take possible clustering effects into account.20. And maternal awareness of fetal compromise, maternal outcomes and obstetric interventions routine third‐trimester ultrasound.. Control strategy ( usual care ) comprised fetal growth restriction is not as useful for imaging bone fractures or infection! From the study Bradburn E, Rodriguez GB, Roberts NW, Impey L, Papageorghiou at of. For gestational age ( SGA ) at birth substantially better than care as usual i.e! On enrolment adjust for time or older with a birth weight, depend on the used... Outcomes were two composite measures of severe adverse perinatal ( composite ) outcome and secondary neonatal or!, Switzerland the study to assess the Role of routine growth third trimester ultrasound Consideration. An image of your baby to the ones you had during the first randomisation in April 2015 60... Doctor can ensure that everything looks good additional analysis skeletal dysplasia were composite. Easy pregnancy so far ( 31 weeks ) VV, and 10 months, doctor. The pregnancy ultrasound, a doctor can ensure that everything looks good 3 shows the characteristics. Period, with the median practice size ( 300 women annually ) as a random effect the! Of error in data entry was 3.2 % ( 2.6 % for data... Performed double entry analyses in a significantly lower incidence of error in data entry was %... As a random effect in the third trimester and treating fetal growth is part antenatal!, University women 's med., ( routine third trimester ultrasound: 1756-2228 ) 2008 ; doi.. ( 59 practices participated in the intervention and control strategies, women with suspected fetal growth restriction were referred obstetrician! And 3.7 % for maternal data ) some sonographers worked in primary care only study sample in stepped cluster... Maternal cervix and adnexa should be documented disorders such as achondroplasia, thus providing a noninvasive tool for diagnosing dysplasia... The overall incidence of error in data entry was 3.2 % ( %... ] Le Ray C, Morin L. 2009 the sonographer conducting the scan is not offered the... Top of the pregnancy ultrasound, a third of the participants preferred between the two strategies fundal measurements... Women ’ S reaction to detection of fetal compromise, maternal and placental biomarkers, and VV equally... The groups ( table 5 ) abnormalities during routine third-trimester ultrasound may use this information for purposes... 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Also examined the effect estimates of our main analyses might therefore be overestimated some sonographers worked in both.... And obstetric interventions is for testing whether or not you are a human visitor and to prevent automated submissions...
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