Routine prenatal ultrasonography as a screening tool

INTRODUCTION

Prenatal ultrasonography is a common procedure. In the United States, the Centers for Disease Control and Prevention reported that a prenatal ultrasound examination was performed in 67 percent of live births in 2002 [1]. The percent was higher in white women than in black women. Whether all obstetrical patients should undergo ultrasound screening and whether such screening improves pregnancy outcome is controversial. Currently, the American College of Obstetricians and Gynecologists (ACOG), the American Institute for Ultrasound in Medicine (AIUM), and the American College of Radiology (ACR) support the use of ultrasound when there is a specific medical indication and advises against casual use of ultrasonography during pregnancy [2-5]. ACOG also stated that the benefits and limitations of ultrasonography should be discussed with all patients, and performance of the procedure is reasonable in patients who request it.

Many other countries have developed local guidelines for the practice of prenatal ultrasonography and most offer at least one mid-trimester ultrasound examination as part of standard prenatal care, although worldwide obstetric practice varies.

An evidence-based discussion of the application of ultrasound to an unselected obstetric population as a screening tool will be presented here. The use of prenatal ultrasonography for specific obstetrical indications is reviewed separately. (See "Ultrasound examination in obstetrics and gynecology".)

OBJECTIVES OF PRENATAL SCREENING ULTRASOUND

The primary objective of routine fetal ultrasound examination is to obtain information that will enable delivery of optimal antenatal care and thus the best possible outcomes for mother and fetus [6]. The following information is obtained: (See "Ultrasound examination in obstetrics and gynecology".)

  • Fetal viability
  • Gestational age and expected date of delivery
  • Number of fetuses. Chorionicity should be determined in multiple gestations.
  • Fetal biometry
  • Fetal survey to detect congenital anomalies, including signs suggestive of aneuploidy
  • Assessment of amniotic fluid volume
  • Placental location (2nd trimester)

                          

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Literature review current through: Apr 2013. | This topic last updated: Oct 22, 2012.
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References
Top
  1. Martin, J, et al., Births: Final data for 2002. National Vital Statistics Reports 2003.
  2. ACOG Committee on Ethics. ACOG Committee Opinion. Number 297, August 2004. Nonmedical use of obstetric ultrasonography. Obstet Gynecol 2004; 104:423.
  3. AIUM Practice Guidelines for the Performance of Obstetric Ultrasound Examinations. October 1, 2007.
  4. ACR Practice Guideline for the Performance of Obstetrical Ultrasound. October 1, 2007.
  5. Abuhamad AZ, ACOG Committee on Practice Bulletins-Obstetrics. ACOG Practice Bulletin, clinical management guidelines for obstetrician-gynecologists number 98, October 2008 (replaces Practice Bulletin number 58, December 2004). Ultrasonography in pregnancy. Obstet Gynecol 2008; 112:951.
  6. Salomon LJ, Alfirevic Z, Berghella V, et al. Practice guidelines for performance of the routine mid-trimester fetal ultrasound scan. Ultrasound Obstet Gynecol 2011; 37:116.
  7. Mongelli M, Wilcox M, Gardosi J. Estimating the date of confinement: ultrasonographic biometry versus certain menstrual dates. Am J Obstet Gynecol 1996; 174:278.
  8. Crowther CA, Kornman L, O'Callaghan S, et al. Is an ultrasound assessment of gestational age at the first antenatal visit of value? A randomised clinical trial. Br J Obstet Gynaecol 1999; 106:1273.
  9. Whitworth M, Bricker L, Neilson JP, Dowswell T. Ultrasound for fetal assessment in early pregnancy. Cochrane Database Syst Rev 2010; :CD007058.
  10. Eik-Nes SH, Salvesen KA, Okland O, Vatten LJ. Routine ultrasound fetal examination in pregnancy: the 'Alesund' randomized controlled trial. Ultrasound Obstet Gynecol 2000; 15:473.
  11. Bennett KA, Crane JM, O'shea P, et al. First trimester ultrasound screening is effective in reducing postterm labor induction rates: a randomized controlled trial. Am J Obstet Gynecol 2004; 190:1077.
  12. Waldenström U, Axelsson O, Nilsson S. Ultrasonic dating of pregnancies: effect on incidence of SGA diagnoses. A randomised controlled trial. Early Hum Dev 1992; 30:75.
  13. LeFevre ML, Bain RP, Ewigman BG, et al. A randomized trial of prenatal ultrasonographic screening: impact on maternal management and outcome. RADIUS (Routine Antenatal Diagnostic Imaging with Ultrasound) Study Group. Am J Obstet Gynecol 1993; 169:483.
  14. Hughey MJ, Olive DL. Routine ultrasound scanning for the detection and management of twin pregnancies. J Reprod Med 1985; 30:427.
  15. Saari-Kemppainen A, Karjalainen O, Ylöstalo P, Heinonen OP. Ultrasound screening and perinatal mortality: controlled trial of systematic one-stage screening in pregnancy. The Helsinki Ultrasound Trial. Lancet 1990; 336:387.
  16. Ewigman BG, Crane JP, Frigoletto FD, et al. Effect of prenatal ultrasound screening on perinatal outcome. RADIUS Study Group. N Engl J Med 1993; 329:821.
  17. Neilson JP. Ultrasound for fetal assessment in early pregnancy. Cochrane Database Syst Rev 2000; :CD000182.
  18. Levi S. Ultrasound in prenatal diagnosis: polemics around routine ultrasound screening for second trimester fetal malformations. Prenat Diagn 2002; 22:285.
  19. Saari-Kemppainen A, Karjalainen O, Ylöstalo P, Heinonen OP. Fetal anomalies in a controlled one-stage ultrasound screening trial. A report from the Helsinki Ultrasound Trial. J Perinat Med 1994; 22:279.
  20. Crane JP, LeFevre ML, Winborn RC, et al. A randomized trial of prenatal ultrasonographic screening: impact on the detection, management, and outcome of anomalous fetuses. The RADIUS Study Group. Am J Obstet Gynecol 1994; 171:392.
  21. Grandjean H, Larroque D, Levi S. The performance of routine ultrasonographic screening of pregnancies in the Eurofetus Study. Am J Obstet Gynecol 1999; 181:446.
  22. Friedberg MK, Silverman NH, Moon-Grady AJ, et al. Prenatal detection of congenital heart disease. J Pediatr 2009; 155:26.
  23. Tworetzky W, McElhinney DB, Reddy VM, et al. Improved surgical outcome after fetal diagnosis of hypoplastic left heart syndrome. Circulation 2001; 103:1269.
  24. Bonnet D, Coltri A, Butera G, et al. Detection of transposition of the great arteries in fetuses reduces neonatal morbidity and mortality. Circulation 1999; 99:916.
  25. Clayton DB, Brock JW 3rd. Prenatal ultrasonography: implications for pediatric urology. J Pediatr Urol 2011; 7:118.
  26. Timor-Tritsch IE, Fuchs KM, Monteagudo A, D'alton ME. Performing a fetal anatomy scan at the time of first-trimester screening. Obstet Gynecol 2009; 113:402.
  27. Syngelaki A, Chelemen T, Dagklis T, et al. Challenges in the diagnosis of fetal non-chromosomal abnormalities at 11-13 weeks. Prenat Diagn 2011; 31:90.
  28. Ebrashy A, El Kateb A, Momtaz M, et al. 13-14-week fetal anatomy scan: a 5-year prospective study. Ultrasound Obstet Gynecol 2010; 35:292.
  29. Lombardi CM, Bellotti M, Fesslova V, Cappellini A. Fetal echocardiography at the time of the nuchal translucency scan. Ultrasound Obstet Gynecol 2007; 29:249.
  30. Duff GB. A randomized controlled trial in a hospital population of ultrasound measurement screening for the small for dates baby. Aust N Z J Obstet Gynaecol 1993; 33:374.
  31. Bricker L, Neilson JP, Dowswell T. Routine ultrasound in late pregnancy (after 24 weeks' gestation). Cochrane Database Syst Rev 2008; :CD001451.
  32. McKenna D, Tharmaratnam S, Mahsud S, et al. A randomized trial using ultrasound to identify the high-risk fetus in a low-risk population. Obstet Gynecol 2003; 101:626.
  33. Arbeille, P, Leguyader, P, Fignon, A. Fetal Hemodynamics and Flow Velocity Indices. In: Doppler Ultrasound in Obstetrics and Gynecology, Copel, JA (Ed), Raven Press, New York 1995.
  34. Bricker L, Neilson JP. Routine doppler ultrasound in pregnancy. Cochrane Database Syst Rev 2000; :CD001450.
  35. Vintzileos AM, Ananth CV, Smulian JC, et al. Routine second-trimester ultrasonography in the United States: a cost-benefit analysis. Am J Obstet Gynecol 2000; 182:655.
  36. Saari-Kemppainen A. Use of antenatal care services in a controlled ultrasound screening trial. Acta Obstet Gynecol Scand 1995; 74:12.
  37. Leivo T, Tuominen R, Saari-Kemppainen A, et al. Cost-effectiveness of one-stage ultrasound screening in pregnancy: a report from the Helsinki ultrasound trial. Ultrasound Obstet Gynecol 1996; 7:309.
  38. Geerts LT, Brand EJ, Theron GB. Routine obstetric ultrasound examinations in South Africa: cost and effect on perinatal outcome--a prospective randomised controlled trial. Br J Obstet Gynaecol 1996; 103:501.
  39. Roberts T, Henderson J, Mugford M, et al. Antenatal ultrasound screening for fetal abnormalities: a systematic review of studies of cost and cost effectiveness. BJOG 2002; 109:44.
  40. Chervenak FA, McCullough LB. Ethical dimensions of ultrasound screening for fetal anomalies. Ann N Y Acad Sci 1998; 847:185.
  41. Hoare C, Li Wan Po A, Williams H. Systematic review of treatments for atopic eczema. Health Technol Assess 2000; 4:1.
  42. Georgsson Ohman S, Saltvedt S, Grunewald C, Waldenström U. Does fetal screening affect women's worries about the health of their baby? A randomized controlled trial of ultrasound screening for Down's syndrome versus routine ultrasound screening. Acta Obstet Gynecol Scand 2004; 83:634.
  43. American College of Obstetricians and Gynecologists. ACOG Practice Bulletin No. 101: Ultrasonography in pregnancy. Obstet Gynecol 2009; 113:451.