Ultrasound for fetal assessment in early pregnancy
- PMID: 20393955
- PMCID: PMC4084925
- DOI: 10.1002/14651858.CD007058.pub2
Ultrasound for fetal assessment in early pregnancy
Update in
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Ultrasound for fetal assessment in early pregnancy.Cochrane Database Syst Rev. 2015 Jul 14;2015(7):CD007058. doi: 10.1002/14651858.CD007058.pub3. Cochrane Database Syst Rev. 2015. PMID: 26171896 Free PMC article.
Abstract
Background: Diagnostic ultrasound is a sophisticated electronic technology, which utilises pulses of high frequency sound to produce an image. Diagnostic ultrasound examination may be employed in a variety of specific circumstances during pregnancy such as after clinical complications, or where there are concerns about fetal growth. Because adverse outcomes may also occur in pregnancies without clear risk factors, assumptions have been made that routine ultrasound in all pregnancies will prove beneficial by enabling earlier detection and improved management of pregnancy complications. Routine screening may be planned for early pregnancy, late gestation, or both. The focus of this review is routine early pregnancy ultrasound.
Objectives: To assess whether routine early pregnancy ultrasound for fetal assessment (i.e. its use as a screening technique) influences the diagnosis of fetal malformations, multiple pregnancies, the rate of clinical interventions, and the incidence of adverse fetal outcome when compared with the selective use of early pregnancy ultrasound (for specific indications).
Search strategy: We searched the Cochrane Pregnancy and Childbirth Group's Trials Register (September 2009).
Selection criteria: Published, unpublished, and ongoing randomised controlled trials that compared outcomes in women who experienced routine versus selective early pregnancy ultrasound (i.e. less than 24 weeks' gestation). We have included quasi-randomised trials.
Data collection and analysis: Two review authors independently extracted data for each included study. We used the Review Manager software to enter and analyse data.
Main results: Routine/revealed ultrasound versus selective ultrasound/concealed: 11 trials including 37505 women. Ultrasound for fetal assessment in early pregnancy reduces the failure to detect multiple pregnancy by 24 weeks' gestation (risk ratio (RR) 0.07, 95% confidence interval (CI) 0.03 to 0.17). Routine scan is associated with a reduction in inductions of labour for 'post term' pregnancy (RR 0.59, 95% CI 0.42 to 0.83). Routine scans do not seem to be associated with reductions in adverse outcomes for babies or in health service use by mothers and babies. Long-term follow up of children exposed to scan in utero does not indicate that scans have a detrimental effect on children's physical or cognitive development.
Authors' conclusions: Early ultrasound improves the early detection of multiple pregnancies and improved gestational dating may result in fewer inductions for post maturity. Caution needs to be exercised in interpreting the results of aspects of this review in view of the fact that there is considerable variability in both the timing and the number of scans women received.
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References
References to studies included in this review
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- Crowther CA. Trial to assess whether ultrasound examination at the booking antenatal visit reduces the number of repeat screenings and results in earlier diagnosis of non-viable pregnancy/congenital abnormality. 1992 Personal communication.
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- Crowther CA, Kornman L, O’Callaghan S, George K, Furness M, Willson K. Is an ultrasound assessment of gestational age at the first antenatal visit of value? A randomised clinical trial. British Journal of Obstetrics and Gynaecology. 1999;106(12):1273–9. - PubMed
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- Eik-Nes SH. Effects of routine two-stage ultrasound screening in pregnancy: the Alesund randomised controlled trial revisited. 1984 Personal communication.
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- Eik-Nes SH, Okland O. Diagnostic ultrasound imaging in pregnancy. US Department of Health and Human Services; Washington: 1984. Ultrasound screening of pregnant women - a prospective randomized study; pp. 207–13. NIH Publication No.84-667.
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- Eik-Nes SH, Okland O, Aure JC, Ulstein M. Ultrasound screening in pregnancy: a randomised controlled trial. Lancet. 1984;1:1347. - PubMed
References to studies excluded from this review
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- Belanger K, Hobbins JC, Muller JP, Howard S. Neurological testing in ultrasound exposed infants. American Journal of Obstetrics and Gynecology. 1996;174(1 Pt 2):413.
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- Bennett K, Crane J, O’Shea P, Lacelle J, Hutchens D, Copel J. Combined first and second trimester ultrasound screening is effective in reducing postterm labor induction rates: a randomized controlled trial [abstract] American Journal of Obstetrics and Gynecology. 2002;187(6 Pt 2):S68. - PubMed
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- Bennett KA, Crane JMG, O’Shea P, Lacelle J, Hutchens D, Copel JA. First trimester ultrasound screening is effective in reducing postterm labor induction rates: a randomized controlled trial. American Journal of Obstetrics and Gynecology. 2004;190:1077–81. - PubMed
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- Duff G. A randomised controlled trial in a hospital population of ultrasound measurement screening for the small for dates baby; Proceedings of 2nd International Scientific Meeting of the Royal College of Obstetricians and Gynaecologists; Hong Kong. 1993.Sep 7-10, p. 90. - PubMed
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- Duff GB. A randomized controlled trial in a hospital population of ultrasound measurement screening for the small for dates baby. Australian and New Zealand Journal of Obstetrics and Gynaecology. 1993;33:374–8. - PubMed
References to studies awaiting assessment
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- Deverill M, Snaith V, Howel D, Hewison J, Sturgiss S, Robson S. The Newcastle randomised controlled trial of early screening for fetal abnormality - women’s preferences for early information on fetal status and cost-effectiveness analysis [abstract] Journal of Obstetrics and Gynaecology. 2004;24(Suppl 1):S20.
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- Snaith V, Howel D, Deverill M, Hewison J, Sturgiss S, Robson S. The Newcastle randomised controlled trial of early ultrasound screening for fetal abnormality (FA) - termination of pregnancy for FA and psychological consequences [abstract] Journal of Obstetrics and Gynaecology. 2004;24(Suppl 1):S19.
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- Snaith VJ, Howel D, Chadwick T, Deverill M, Hewison J, Sturgiss SN, et al. First trimester ultrasound screening - the psychological consequences of termination of pregnancy for foetal abnormality. Journal of Reproductive and Infant Psychology. 2004;22(3):239.
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- Sturgiss S, Howel D, Snaith V, Deverill M, Hewison J, Robson S. The Newcastle randomized controlled trial of early ultrasound screening for fetal abnormality: impact on gestation at diagnosis [abstract] Journal of Obstetrics and Gynaecology. 2005;25(Suppl 1):S20.
Additional references
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- Barrett J, Brinson J. Evaluation of obstetric ultrasonography at the first prenatal visit. American Journal of Obstetrics and Gynecology. 1991;165:1002–5. - PubMed
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- Bricker L, Garcia J, Henderson J, Mugford M, Neilson J, Roberts T, et al. Ultrasound screening in pregnancy: a systematic review of the clinical effectiveness, cost-effectiveness and women’s views. Health Technology Assessment. 2000;4:1–193. - PubMed
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- Crane JM, Hutchens D, Crane JMG. Transvaginal sonographic measurement of cervical length to predict preterm birth in asymptomatic women at increased risk: a systematic review. Ultrasound in Obstetrics & Gynecology. 2008;31(5):579–87. - PubMed
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