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Meta-Analysis
. 2015 Jun 29;2015(6):CD001451.
doi: 10.1002/14651858.CD001451.pub4.

Routine ultrasound in late pregnancy (after 24 weeks' gestation)

Leanne Bricker  1 , Nancy Medley, Jeremy J Pratt
Affiliations
Meta-Analysis

Routine ultrasound in late pregnancy (after 24 weeks' gestation)

Leanne Bricker et al. Cochrane Database Syst Rev. .

Abstract

Background: Diagnostic ultrasound is used selectively in late pregnancy where there are specific clinical indications. However, the value of routine late pregnancy ultrasound screening in unselected populations is controversial. The rationale for such screening would be the detection of clinical conditions which place the fetus or mother at high risk, which would not necessarily have been detected by other means such as clinical examination, and for which subsequent management would improve perinatal outcome.

Objectives: To assess the effects on obstetric practice and pregnancy outcome of routine late pregnancy ultrasound, defined as greater than 24 weeks' gestation, in women with either unselected or low-risk pregnancies.

Search methods: We searched the Cochrane Pregnancy and Childbirth Group's Trials Register (31 May 2015) and reference lists of retrieved studies.

Selection criteria: All acceptably controlled trials of routine ultrasound in late pregnancy (defined as after 24 weeks).

Data collection and analysis: Three review authors independently assessed trials for inclusion and risk of bias, extracted data and checked them for accuracy.

Main results: Thirteen trials recruiting 34,980 women were included in the systematic review. Risk of bias was low for allocation concealment and selective reporting, unclear for random sequence generation and incomplete outcome data and high for blinding of both outcome assessment and participants and personnel. There was no difference in antenatal, obstetric and neonatal outcome or morbidity in screened versus control groups. Routine late pregnancy ultrasound was not associated with improvements in overall perinatal mortality. There is little information on long-term substantive outcomes such as neurodevelopment. There is a lack of data on maternal psychological effects.Overall, the evidence for the primary outcomes of perinatal mortality, preterm birth less than 37 weeks, induction of labour and caesarean section were assessed to be of moderate or high quality with GRADE software. There was no association between ultrasound in late pregnancy and perinatal mortality (risk ratio (RR) 1.01, 95% confidence interval (CI) 0.67 to 1.54; participants = 30,675; studies = eight; I² = 29%), preterm birth less than 37 weeks (RR 0.96, 95% CI 0.85 to 1.08; participants = 17,151; studies = two; I² = 0%), induction of labour (RR 0.93, 95% CI 0.81 to 1.07; participants = 22,663; studies = six; I² = 78%), or caesarean section (RR 1.03, 95% CI 0.92 to 1.15; participants = 27,461; studies = six; I² = 54%). Three additional primary outcomes chosen for the 'Summary of findings' table were preterm birth less than 34 weeks, maternal psychological effects and neurodevelopment at age two. Because none of the included studies reported these outcomes, they were not assessed for quality with GRADE software.

Authors' conclusions: Based on existing evidence, routine late pregnancy ultrasound in low-risk or unselected populations does not confer benefit on mother or baby. There was no difference in the primary outcomes of perinatal mortality, preterm birth less than 37 weeks, caesarean section rates, and induction of labour rates if ultrasound in late pregnancy was performed routinely versus not performed routinely. Meanwhile, data were lacking for the other primary outcomes: preterm birth less than 34 weeks, maternal psychological effects, and neurodevelopment at age two, reflecting a paucity of research covering these outcomes. These outcomes may warrant future research.

PubMed Disclaimer

Conflict of interest statement

None known.

Figures

1
1
'Risk of bias' graph: review authors' judgements about each risk of bias item presented as percentages across all included studies.
2
2
'Risk of bias' summary: review authors' judgements about each risk of bias item for each included study.
1.1
1.1. Analysis
Comparison 1 Routine ultrasound > 24 weeks versus no/concealed/selective ultrasound > 24 weeks, Outcome 1 Induction of labour.
1.2
1.2. Analysis
Comparison 1 Routine ultrasound > 24 weeks versus no/concealed/selective ultrasound > 24 weeks, Outcome 2 Caesarean section.
1.3
1.3. Analysis
Comparison 1 Routine ultrasound > 24 weeks versus no/concealed/selective ultrasound > 24 weeks, Outcome 3 Perinatal mortality.
1.4
1.4. Analysis
Comparison 1 Routine ultrasound > 24 weeks versus no/concealed/selective ultrasound > 24 weeks, Outcome 4 Preterm delivery < 37 weeks' gestation.
1.5
1.5. Analysis
Comparison 1 Routine ultrasound > 24 weeks versus no/concealed/selective ultrasound > 24 weeks, Outcome 5 Antenatal admission.
1.6
1.6. Analysis
Comparison 1 Routine ultrasound > 24 weeks versus no/concealed/selective ultrasound > 24 weeks, Outcome 6 Number of days in hospital (mean, standard deviation (SD)) (non‐prespecified).
1.7
1.7. Analysis
Comparison 1 Routine ultrasound > 24 weeks versus no/concealed/selective ultrasound > 24 weeks, Outcome 7 CTG (cardiotocograph).
1.8
1.8. Analysis
Comparison 1 Routine ultrasound > 24 weeks versus no/concealed/selective ultrasound > 24 weeks, Outcome 8 Further ultrasound scan/s.
1.9
1.9. Analysis
Comparison 1 Routine ultrasound > 24 weeks versus no/concealed/selective ultrasound > 24 weeks, Outcome 9 Instrumental delivery.
1.10
1.10. Analysis
Comparison 1 Routine ultrasound > 24 weeks versus no/concealed/selective ultrasound > 24 weeks, Outcome 10 Elective caesarean section.
1.11
1.11. Analysis
Comparison 1 Routine ultrasound > 24 weeks versus no/concealed/selective ultrasound > 24 weeks, Outcome 11 Emergency caesarean section.
1.12
1.12. Analysis
Comparison 1 Routine ultrasound > 24 weeks versus no/concealed/selective ultrasound > 24 weeks, Outcome 12 Gestation at birth (mean, SD).
1.13
1.13. Analysis
Comparison 1 Routine ultrasound > 24 weeks versus no/concealed/selective ultrasound > 24 weeks, Outcome 13 Birthweight (mean, SD).
1.14
1.14. Analysis
Comparison 1 Routine ultrasound > 24 weeks versus no/concealed/selective ultrasound > 24 weeks, Outcome 14 Birthweight < 10th centile.
1.15
1.15. Analysis
Comparison 1 Routine ultrasound > 24 weeks versus no/concealed/selective ultrasound > 24 weeks, Outcome 15 Low birthweight < 2.5 kg.
1.16
1.16. Analysis
Comparison 1 Routine ultrasound > 24 weeks versus no/concealed/selective ultrasound > 24 weeks, Outcome 16 Neonatal resuscitation.
1.17
1.17. Analysis
Comparison 1 Routine ultrasound > 24 weeks versus no/concealed/selective ultrasound > 24 weeks, Outcome 17 Neonatal ventilation.
1.18
1.18. Analysis
Comparison 1 Routine ultrasound > 24 weeks versus no/concealed/selective ultrasound > 24 weeks, Outcome 18 Admission to special care baby unit.
1.19
1.19. Analysis
Comparison 1 Routine ultrasound > 24 weeks versus no/concealed/selective ultrasound > 24 weeks, Outcome 19 Apgar score < 7 at 5 minutes.
1.20
1.20. Analysis
Comparison 1 Routine ultrasound > 24 weeks versus no/concealed/selective ultrasound > 24 weeks, Outcome 20 Stillbirths (non‐prespecified).
1.21
1.21. Analysis
Comparison 1 Routine ultrasound > 24 weeks versus no/concealed/selective ultrasound > 24 weeks, Outcome 21 Neonatal deaths.
1.22
1.22. Analysis
Comparison 1 Routine ultrasound > 24 weeks versus no/concealed/selective ultrasound > 24 weeks, Outcome 22 Perinatal mortality (excluding congenital abnormalities) (non‐prespecified).
1.23
1.23. Analysis
Comparison 1 Routine ultrasound > 24 weeks versus no/concealed/selective ultrasound > 24 weeks, Outcome 23 Stillbirths (excluding congenital abnormalities) (non‐prespecified).
1.24
1.24. Analysis
Comparison 1 Routine ultrasound > 24 weeks versus no/concealed/selective ultrasound > 24 weeks, Outcome 24 Neonatal deaths (excluding congenital abnormalities).
1.25
1.25. Analysis
Comparison 1 Routine ultrasound > 24 weeks versus no/concealed/selective ultrasound > 24 weeks, Outcome 25 Post‐term delivery > 42 weeks' gestation (non‐prespecified).
1.26
1.26. Analysis
Comparison 1 Routine ultrasound > 24 weeks versus no/concealed/selective ultrasound > 24 weeks, Outcome 26 Birthweight < 5th centile (non‐prespecified).
1.27
1.27. Analysis
Comparison 1 Routine ultrasound > 24 weeks versus no/concealed/selective ultrasound > 24 weeks, Outcome 27 Moderate neonatal morbidity (non‐prespecified).
1.28
1.28. Analysis
Comparison 1 Routine ultrasound > 24 weeks versus no/concealed/selective ultrasound > 24 weeks, Outcome 28 Severe neonatal morbidity (non‐prespecified).
1.29
1.29. Analysis
Comparison 1 Routine ultrasound > 24 weeks versus no/concealed/selective ultrasound > 24 weeks, Outcome 29 Perinatal mortality (twins) (non‐prespecified).
2.1
2.1. Analysis
Comparison 2 Serial ultrasound and Doppler ultrasound versus selective ultrasound, Outcome 1 Induction of labour.
2.2
2.2. Analysis
Comparison 2 Serial ultrasound and Doppler ultrasound versus selective ultrasound, Outcome 2 Caesarean section.
2.3
2.3. Analysis
Comparison 2 Serial ultrasound and Doppler ultrasound versus selective ultrasound, Outcome 3 Perinatal mortality.
2.4
2.4. Analysis
Comparison 2 Serial ultrasound and Doppler ultrasound versus selective ultrasound, Outcome 4 CTG (cardiograph).
2.5
2.5. Analysis
Comparison 2 Serial ultrasound and Doppler ultrasound versus selective ultrasound, Outcome 5 Elective caesarean section.
2.6
2.6. Analysis
Comparison 2 Serial ultrasound and Doppler ultrasound versus selective ultrasound, Outcome 6 Emergency caesarean section.
2.7
2.7. Analysis
Comparison 2 Serial ultrasound and Doppler ultrasound versus selective ultrasound, Outcome 7 Gestation at birth (mean, SD).
2.8
2.8. Analysis
Comparison 2 Serial ultrasound and Doppler ultrasound versus selective ultrasound, Outcome 8 Birthweight (mean, SD).
2.9
2.9. Analysis
Comparison 2 Serial ultrasound and Doppler ultrasound versus selective ultrasound, Outcome 9 Birthweight < 10th centile.
2.10
2.10. Analysis
Comparison 2 Serial ultrasound and Doppler ultrasound versus selective ultrasound, Outcome 10 Birthweight < 3rd centile.
2.11
2.11. Analysis
Comparison 2 Serial ultrasound and Doppler ultrasound versus selective ultrasound, Outcome 11 Low birthweight (< 2.5 kg).
2.12
2.12. Analysis
Comparison 2 Serial ultrasound and Doppler ultrasound versus selective ultrasound, Outcome 12 Very low birthweight (< 1.5 kg).
2.13
2.13. Analysis
Comparison 2 Serial ultrasound and Doppler ultrasound versus selective ultrasound, Outcome 13 Need for resuscitation.
2.14
2.14. Analysis
Comparison 2 Serial ultrasound and Doppler ultrasound versus selective ultrasound, Outcome 14 Need for ventilation.
2.15
2.15. Analysis
Comparison 2 Serial ultrasound and Doppler ultrasound versus selective ultrasound, Outcome 15 Admission to special care baby unit.
2.16
2.16. Analysis
Comparison 2 Serial ultrasound and Doppler ultrasound versus selective ultrasound, Outcome 16 Apgar score < 7 at 5 minutes.
2.17
2.17. Analysis
Comparison 2 Serial ultrasound and Doppler ultrasound versus selective ultrasound, Outcome 17 Neonatal intraventricular haemorrhage.
2.18
2.18. Analysis
Comparison 2 Serial ultrasound and Doppler ultrasound versus selective ultrasound, Outcome 18 Stillbirths.
2.19
2.19. Analysis
Comparison 2 Serial ultrasound and Doppler ultrasound versus selective ultrasound, Outcome 19 Neonatal deaths (non‐prespecified).
2.20
2.20. Analysis
Comparison 2 Serial ultrasound and Doppler ultrasound versus selective ultrasound, Outcome 20 Neonatal deaths (excluding congenital abnormalities) (non‐prespecified).
See this image and copyright information in PMC

Update of

Comment in

References

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