Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Meta-Analysis
. 2015 Jul 14;2015(7):CD007058.
doi: 10.1002/14651858.CD007058.pub3.

Ultrasound for fetal assessment in early pregnancy

Melissa Whitworth  1 , Leanne Bricker, Clare Mullan
Affiliations
Meta-Analysis

Ultrasound for fetal assessment in early pregnancy

Melissa Whitworth et al. Cochrane Database Syst Rev. .

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 methods: We searched the Cochrane Pregnancy and Childbirth Group's Trials Register (30 March 2015) and reference lists of retrieved studies.

Selection criteria: Published, unpublished, and ongoing randomised controlled trials that compared outcomes in women who experienced routine versus selective early pregnancy ultrasound (i.e. less than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 assessed trials for inclusion and risk of bias, extracted data and checked them for accuracy. We used the Review Manager software to enter and analyse data.

Main results: Routine/revealed ultrasound versus selective ultrasound/concealed: 11 trials including 37,505 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; participants = 295; studies = 7), moderate quality of evidence). Routine scans improve the detection of major fetal abnormality before 24 weeks' gestation (RR 3.46, 95% CI 1.67 to 7.14; participants = 387; studies = 2,moderate quality of evidence). 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; participants = 25,516; studies = 8), but the evidence related to this outcome is of low quality, because most of the pooled effect was provided by studies with design limitation with presence of heterogeneity (I² = 68%). Ultrasound for fetal assessment in early pregnancy does not impact on perinatal death (defined as stillbirth after trial entry, or death of a liveborn infant up to 28 days of age) (RR 0.89, 95% CI 0.70 to 1.12; participants = 35,735; studies = 10, low quality evidence). 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.The review includes several large, well-designed trials but lack of blinding was a problem common to all studies and this may have an effect on some outcomes. The quality of evidence was assessed for all review primary outcomes and was judged as moderate or low. Downgrading of evidence was based on including studies with design limitations, imprecision of results and presence of heterogeneity.

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.

PubMed Disclaimer

Conflict of interest statement

None known.

Figures

1
1
'Risk of bias' summary: review authors' judgements about each risk of bias item for each included study.
2
2
'Risk of bias' graph: review authors' judgements about each risk of bias item presented as percentages across all included studies.
3
3
Funnel plot of comparison: 1 Routine/revealed versus selective/concealed ultrasound in early pregnancy, outcome: 1.4 Perinatal death (all babies).
1.1
1.1. Analysis
Comparison 1 Routine/revealed versus selective/concealed ultrasound in early pregnancy, Outcome 1 Detection of fetal abnormality before 24 weeks' gestation.
1.2
1.2. Analysis
Comparison 1 Routine/revealed versus selective/concealed ultrasound in early pregnancy, Outcome 2 Detection of multiple pregnancy by 24 to 26 weeks' gestation (number NOT detected).
1.3
1.3. Analysis
Comparison 1 Routine/revealed versus selective/concealed ultrasound in early pregnancy, Outcome 3 Induction of labour for 'post‐term' pregnancy.
1.4
1.4. Analysis
Comparison 1 Routine/revealed versus selective/concealed ultrasound in early pregnancy, Outcome 4 Perinatal death (all babies).
1.5
1.5. Analysis
Comparison 1 Routine/revealed versus selective/concealed ultrasound in early pregnancy, Outcome 5 Perinatal death (excluding lethal malformations).
1.6
1.6. Analysis
Comparison 1 Routine/revealed versus selective/concealed ultrasound in early pregnancy, Outcome 6 Detection of multiple pregnancy before labour (number NOT detected).
1.7
1.7. Analysis
Comparison 1 Routine/revealed versus selective/concealed ultrasound in early pregnancy, Outcome 7 Detection of major anomaly before birth.
1.8
1.8. Analysis
Comparison 1 Routine/revealed versus selective/concealed ultrasound in early pregnancy, Outcome 8 Low birthweight (less than 2500 g).
1.9
1.9. Analysis
Comparison 1 Routine/revealed versus selective/concealed ultrasound in early pregnancy, Outcome 9 Very low birthweight (< 1500 g).
1.10
1.10. Analysis
Comparison 1 Routine/revealed versus selective/concealed ultrasound in early pregnancy, Outcome 10 Small‐for‐gestational age.
1.11
1.11. Analysis
Comparison 1 Routine/revealed versus selective/concealed ultrasound in early pregnancy, Outcome 11 Mean birthweight (g).
1.12
1.12. Analysis
Comparison 1 Routine/revealed versus selective/concealed ultrasound in early pregnancy, Outcome 12 Apgar score 7 or less at 5 minutes.
1.13
1.13. Analysis
Comparison 1 Routine/revealed versus selective/concealed ultrasound in early pregnancy, Outcome 13 Admission to neonatal intensive care unit (various definitions).
1.14
1.14. Analysis
Comparison 1 Routine/revealed versus selective/concealed ultrasound in early pregnancy, Outcome 14 Impaired development (screened using the Denver developmental screening test) at childhood follow‐up.
1.15
1.15. Analysis
Comparison 1 Routine/revealed versus selective/concealed ultrasound in early pregnancy, Outcome 15 Poor oral reading at school.
1.16
1.16. Analysis
Comparison 1 Routine/revealed versus selective/concealed ultrasound in early pregnancy, Outcome 16 Poor reading comprehension at school.
1.17
1.17. Analysis
Comparison 1 Routine/revealed versus selective/concealed ultrasound in early pregnancy, Outcome 17 Poor spelling at school.
1.18
1.18. Analysis
Comparison 1 Routine/revealed versus selective/concealed ultrasound in early pregnancy, Outcome 18 Poor arithmetic at school.
1.19
1.19. Analysis
Comparison 1 Routine/revealed versus selective/concealed ultrasound in early pregnancy, Outcome 19 Poor overall school performance.
1.20
1.20. Analysis
Comparison 1 Routine/revealed versus selective/concealed ultrasound in early pregnancy, Outcome 20 Dyslexia.
1.21
1.21. Analysis
Comparison 1 Routine/revealed versus selective/concealed ultrasound in early pregnancy, Outcome 21 Reduced hearing in childhood.
1.22
1.22. Analysis
Comparison 1 Routine/revealed versus selective/concealed ultrasound in early pregnancy, Outcome 22 Reduced vision in childhood.
1.23
1.23. Analysis
Comparison 1 Routine/revealed versus selective/concealed ultrasound in early pregnancy, Outcome 23 Use of spectacles.
1.24
1.24. Analysis
Comparison 1 Routine/revealed versus selective/concealed ultrasound in early pregnancy, Outcome 24 Non right‐handedness.
1.25
1.25. Analysis
Comparison 1 Routine/revealed versus selective/concealed ultrasound in early pregnancy, Outcome 25 Ambidexterity.
1.26
1.26. Analysis
Comparison 1 Routine/revealed versus selective/concealed ultrasound in early pregnancy, Outcome 26 Appropriately timed serum screening tests (number having repeat screening).
1.27
1.27. Analysis
Comparison 1 Routine/revealed versus selective/concealed ultrasound in early pregnancy, Outcome 27 Appropriately timed anomaly scan (18 to 22 weeks)(number NOT appropriately timed).
1.28
1.28. Analysis
Comparison 1 Routine/revealed versus selective/concealed ultrasound in early pregnancy, Outcome 28 Termination of pregnancy for fetal abnormality.
1.29
1.29. Analysis
Comparison 1 Routine/revealed versus selective/concealed ultrasound in early pregnancy, Outcome 29 Number of antenatal visits.
1.30
1.30. Analysis
Comparison 1 Routine/revealed versus selective/concealed ultrasound in early pregnancy, Outcome 30 Antenatal hospital admission.
1.31
1.31. Analysis
Comparison 1 Routine/revealed versus selective/concealed ultrasound in early pregnancy, Outcome 31 Induction of labour for any reason.
1.32
1.32. Analysis
Comparison 1 Routine/revealed versus selective/concealed ultrasound in early pregnancy, Outcome 32 Caesarean section.
1.33
1.33. Analysis
Comparison 1 Routine/revealed versus selective/concealed ultrasound in early pregnancy, Outcome 33 Mother not satisfied with care (worried about pregnancy).
1.34
1.34. Analysis
Comparison 1 Routine/revealed versus selective/concealed ultrasound in early pregnancy, Outcome 34 Subgroup analysis by timing of scan: detection of multiple pregnancy by 24‐26 weeks' gestation (number not detected).
1.35
1.35. Analysis
Comparison 1 Routine/revealed versus selective/concealed ultrasound in early pregnancy, Outcome 35 Subgroup analysis: induction of labour for 'post‐term' pregnancy (early and later scans).
1.36
1.36. Analysis
Comparison 1 Routine/revealed versus selective/concealed ultrasound in early pregnancy, Outcome 36 Subgroup analysis: perinatal death (earlier and late scans).
1.37
1.37. Analysis
Comparison 1 Routine/revealed versus selective/concealed ultrasound in early pregnancy, Outcome 37 Subgroup analysis: detection of multiple pregnancy before 24 weeks (number not detected; concealed results.
1.38
1.38. Analysis
Comparison 1 Routine/revealed versus selective/concealed ultrasound in early pregnancy, Outcome 38 Subgroup analysis: perinatal death. Concealed results.
See this image and copyright information in PMC

Update of

References

References to studies included in this review

Adelaide 1999 {published data only}
    1. 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. Personal communication 1992.
    1. 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
Alesund 1984 {published data only}
    1. Eik‐Nes SH. Effects of routine two‐stage ultrasound screening in pregnancy: the Alesund randomised controlled trial revisited. Personal communication 1984.
    1. Eik‐Nes SH, Okland O. Ultrasound screening of pregnant women ‐ a prospective randomized study. Diagnostic Ultrasound Imaging in Pregnancy. NIH Publication No.84‐667. Washington: US Department of Health and Human Services, 1984:207‐13.
    1. Eik‐Nes SH, Okland O, Aure JC, Ulstein M. Ultrasound screening in pregnancy: a randomised controlled trial. Lancet 1984;1:1347. - PubMed
    1. Eik‐Nes SH, Salvesen KA, Okland O, Vatten LJ. Routine ultrasound fetal examination in pregnancy: the 'Alesund' randomized controlled trial. Ultrasound in Obstetrics & Gynecology 2000;15(6):473‐8. - PubMed
    1. Salvesen KA. Routine Ultrasonography in Utero and Development in Childhood ‐ a Randomized Controlled Follow‐up Study [MSc thesis]. University of Trondheim, 1993.
Helsinki 1990 {published data only}
    1. Leivo T, Tuominen R, Saari‐Kemppainen A, Ylostalo P, Karjalainen O, Heinonen OP. Cost‐effectiveness of one‐stage ultrasound screening in pregnancy: a report from the Helsinki ultrasound trial. Ultrasound in Obstetrics & Gynecology 1996;7(5):309‐14. - PubMed
    1. Saari‐Kemppainen A. Use of antenatal care services in a controlled ultrasound screening trial. Acta Obstetricia et Gynecologica Scandinavica 1995;74:12‐4. - PubMed
    1. Saari‐Kemppainen A, Karjalainen O, Ylostalo P. A randomised study of ultrasound screening during pregnancy. 12th FIGO World Congress of Gynecology and Obstetrics; 1988 October 23‐28; Brazil. 1988:247‐8.
    1. Saari‐Kemppainen A, Karjalainen O, Ylostalo P. Ultrasound screening and perinatal mortality: a controlled clinical trial. Proceedings of 12th European Congress of Perinatal Medicine; 1990 Sept 11‐14; Lyon, France. 1990:36.
    1. Saari‐Kemppainen A, Karjalainen O, Ylostalo P, Heinonen OP. Fetal anomalies in a controlled one‐stage ultrasound screening trial. A report from the Helsinki Ultrasound Trial. Journal of Perinatal Medicine 1994;22:279‐89. - PubMed
Johannesburg 2007 {published data only}
    1. Dyk B, Motto JA, Buchmann EJ. Routine second‐trimester ultrasound for low risk pregnancies in a South African community. International Journal of Gynecology & Obstetrics 2007;98(3):257‐8. - PubMed
    1. Dyk B, Motto JA, Buchmann EJ. The value of routine mid‐trimester ultrasound in low‐risk pregnancies at primary care level. Health SA Gesondheid 2008;13(4):41‐9.
London 1982 {published data only}
    1. Bennett MJ, Little G, Dewhurst J, Chamberlain GVP. Predictive value of ultrasound measurement in early pregnancy: a randomized controlled trial. British Journal of Obstetrics and Gynaecology 1982;89:338‐41. - PubMed
Missouri 1990 {published data only}
    1. Ewigman B, LeFevre M, Hesser J. A randomized trial of routine prenatal ultrasound. Obstetrics & Gynecology 1990;76:189‐94. - PubMed
Norway 1993 {published data only}
    1. Salvesen KA. Routine ultrasonography in utero and development in childhood ‐ a randomized controlled follow‐up study. Acta Obstetricia et Gynecologica Scandinavica 1995;74:166‐7.
    1. Salvesen KA, Bakketeig LS, Eik‐Nes SH, Undheim JO, Okland O. Routine ultrasonography in utero and school performance at age 8‐9 years. Lancet 1992;339:85‐9. - PubMed
    1. Salvesen KA, Jacobsen G, Vatten LJ, Eik‐Nes SH, Bakketeig LS. Routine ultrasonography in utero and subsequent growth during childhood. Ultrasound in Obstetrics & Gynecology 1993;3:6‐10. - PubMed
    1. Salvesen KA, Vatten LJ, Eik‐Nes SH, Hugdahl K, Bakketeig LS. Routine ultrasonography in utero and subsequent handedness and neurological development. BMJ 1993;307:159‐64. - PMC - PubMed
    1. Salvesen KA, Vatten LJ, Jacobsen G, Eik‐Nes SH, Okland O, Molne K, et al. Routine ultrasonography in utero and subsequent vision and hearing at primary school age. Ultrasound in Obstetrics & Gynecology 1992;2:243‐7. - PubMed
Oxford 2006 {published data only}
    1. Harrington DJ, MacKenzie IZ, Thompson K, Fleminger M, Greenwood C. Does a first trimester dating scan using crown rump length measurement reduce the rate of induction of labour for prolonged pregnancy? An uncompleted randomised controlled trial of 463 women. BJOG: an international journal of obstetrics and gynaecology 2006;113(2):171‐6. - PubMed
    1. Harrington DJ, Mackenzie IZ, Chamberlain P, Greenwood C. Does a first trimester crown‐rump length (CRL) measurement reduce the rate of elective timed delivery for post dates? A randomised control trial [abstract]. Journal of Obstetrics and Gynaecology 2004;24(Suppl 1):S22.
    1. MacKenzie I. The effect of first trimester crown rump length (CRL) measurement rates of labour for postdates. Research Findings Register www.refer.nhs.uk (accessed 7 March 2006).
RADIUS 1993 {published data only}
    1. Crane JP, LeFevre ML, Winborn RC, Evans JK, Ewigman G, Bain RP, et al. A randomized trial of prenatal ultrasonographic screening: impact on the detection, management, and outcome of anomalous fetuses. American Journal of Obstetrics and Gynecology 1994;171:392‐9. - PubMed
    1. Ewigman BG, Crane JP, Frigoletto FD, LeFevre ML, Bain RP, McNellis D, et al. Effect of prenatal ultrasound screening on perinatal outcome. New England Journal of Medicine 1993;329:821‐7. - PubMed
    1. Frigoletto FD Jr, Ewigman BG, Crane JP, LeFevre ML, Bain RP, McNellis D. Routine ultrasound screening for all pregnant women: does it make a difference?. Acta Obstetrica Et Gynaecologica Japonica 1997;49:452.
    1. Harlow BL, Frigoletto FD, Cramer DW, Evans JK, Bain RP, Ewigman B, et al. Epidemiologic predictors of Cesarean section in nulliparous patients at low risk. American Journal of Obstetrics and Gynecology 1995;172:156‐62. - PubMed
    1. LeFevre ML, Bain RP, Ewigman BG, Frigoletto FD, Crane JP, McNellis D, et al. A randomized trial of prenatal ultrasonographic screening: impact on maternal management and outcome. American Journal of Obstetrics and Gynecology 1993;169:483‐9. - PubMed
Sweden 1988 {published data only}
    1. Axelsson O. Estimation of gestational age by measurement of the biparietal diameter in the second trimester: preliminary results of a randomized trial. Proceedings of 6th Congress of the European Federation of Societies for Ultrasound in Medicine and Biology; 1987 June 14‐18; Helsinki, Finland. 1987.
    1. Kieler H, Ahlsten G, Haglund B, Salvesen K, Axelsson O. Routine ultrasound screening in pregnancy and the children's subsequent neurologic development. Obstetrics & Gynecology 1998;91(5 Pt 1):750‐6. - PubMed
    1. Kieler H, Axelsson O, Haglund B, Nilsson S, Salvesen KA. Routine ultrasound screening in pregnancy and the children's subsequent handedness. Early Human Development 1998;50(2):233‐45. - PubMed
    1. Kieler H, Haglund B, Waldenstrom U, Axelsson O. Routine ultrasound screening in pregnancy and the children's subsequent growth, vision and hearing. British Journal of Obstetrics and Gynaecology 1997;104(11):1267‐72. - PubMed
    1. Stalberg K, Axelsson O, Haglund B, Hultman CM, Lambe M, Kieler H. Prenatal ultrasound exposure and school achievement in teenagers; follow‐up of a randomized controlled trial. Ultrasound in Obstetrics and Gynecology 2008;32(3):306. - PubMed
Trondheim 1984 {published data only}
    1. Bakketeig LS, Jacobsen G, Brodtkorb CJ, Eriksen BC, Eik‐Nes SH, Ulstein MK, et al. Randomised controlled trial of ultrasonographic screening in pregnancy. Lancet 1984;2:207‐10. - PubMed
Tygerberg 1996 {published data only}
    1. Geerts L, Brand E, Theron GB. Routine obstetric ultrasound examinations in South Africa: Cost and effect on perinatal outcome ‐ A prospective randomised controlled trial. Proceedings of the 14th Conference on Priorities in Perinatal Care in South Africa; 1995 March 7‐10; South Africa. 1995:130‐3. - PubMed
    1. Geerts LTGM, Brand EJ, Theron GB. Routine obstetric ultrasound examinations in South Africa: cost and effect on perinatal outcome ‐ a prospective randomised controlled trial. British Journal of Obstetrics and Gynaecology 1996;103:501‐7. - PubMed

References to studies excluded from this review

Belanger 1996 {published data only}
    1. 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.
Bennett 2004 {published data only}
    1. 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
    1. 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
Duff 1993 {published data only}
    1. 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; 1993 Sept 7‐10; Hong Kong. 1993:90. - PubMed
    1. 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
Georgsson Ohman 2010 {published data only}
    1. Georgsson Ohman S, Waldenstrom U, Georgsson Ohman S, Waldenstrom U. Effect of first‐trimester ultrasound screening for Down syndrome on maternal‐fetal attachment‐‐a randomized controlled trial. Sexual & Reproductive Healthcare 2010;1(3):85‐90. - PubMed
Hong Kong {published data only}
    1. Chen M, Lee CP, Lam YH, Tang RY, Chan BC, Wong SF, et al. Comparison of nuchal and detailed morphology ultrasound examinations in early pregnancy for fetal structural abnormality screening: a randomized controlled trial. Ultrasound in Obstetrics and Gynecology 2008;31(2):136‐46. - PubMed
Larsen 1992 {published data only}
    1. Larsen T, Larsen JK, Petersen S, Greisen G. Detection of small‐for‐gestational‐age fetuses by ultrasound screening in a high risk population: a randomized controlled study. British Journal of Obstetrics and Gynaecology 1992;99:469‐74. - PubMed
Leung 2006 {published data only}
    1. Leung KY, Ngai CS, Lee A, Chan HY, Leung WC, Lee CP, et al. The effects on maternal anxiety of two‐dimensional versus two‐ plus three‐/four‐dimensional ultrasound in pregnancies at risk of fetal abnormalities: A randomized study. Ultrasound in Obstetrics and Gynecology 2006;28(3):249‐54. - PubMed
Owen 1994 {published data only}
    1. Owen P, Donnet L, Ogston S, Christie A, Patel N, Howie P. A study of fetal growth velocity. British Journal of Obstetrics and Gynaecology 1994;101:270. - PubMed
Rustico 2005 {published data only}
    1. Righetti PL, Dell'Avanzo M, Grigio M, Nicolini U. Maternal/paternal antenatal attachment and fourth‐dimensional ultrasound technique: a preliminary report. British Journal of Psychology 2005;96(Pt 1):129‐37. - PubMed
    1. Rustico MA, Mastromatteo C, Grigio M, Maggioni C, Gregori D, Nicolini U. Two‐dimensional vs. two‐ plus four‐dimensional ultrasound in pregnancy and the effect on maternal emotional status: a randomized study. Ultrasound in Obstetrics & Gynecology 2005;25:468‐72. - PubMed
Saltvedt 2006 {published data only}
    1. Georgsson Ohman S, Saltvedt S, Grunewald C, Waldenstrom U. Does fetal screening affect the 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 Obstetricia et Gynecologica Scandinavica 2004;83:634‐40. - PubMed
    1. Saltvedt S, Almstrom H, Kublick M, Reilly M, Valentin L, Grunewald C. Ultrasound dating at 12‐14 or 15‐20 weeks of gestation? A prospective cross‐validation of established dating formulae in a population of in‐vitro fertilized pregnancies randomized to early or late dating scan. Ultrasound in Obstetrics & Gynecology 2004;24:42‐50. - PubMed
    1. Saltvedt S, Almstrom H, Kublickas M, Valentin L, Bottinga R, Bui TH, et al. Screening for Down syndrome based on maternal age or fetal nuchal translucency: a randomized controlled trial in 39 572 pregnancies. Ultrasound in Obstetrics and Gynecology 2005;25:537‐45. - PubMed
    1. Saltvedt S, Almstrom H, Kublickas M, Valentin L, Grunewald C. Detection of malformations in chromosomally normal fetuses by routine ultrasound at 12 or 18 weeks of gestation ‐ a randomised controlled trial in 39,572 pregnancies. BJOG: an international journal of obstetrics and gynaecology 2006;113(6):664‐74. - PubMed
    1. Westin M, Saltvedt S, Bergman G, Kublickas M, Almstrom H, Grunewald C, et al. Routine ultrasound examination at 12 or 18 gestational weeks for prenatal detection of major congenital heart malformations? A randomised controlled trial comprising 36,299 fetuses. BJOG: an international journal of obstetrics and gynaecology 2006;113(6):675‐82. - PubMed
Schifano 2010 {published data only}
    1. Schifano M, Luchi C, Sceusa F, Nanini C, Pepe A, Mannella P, et al. Women's attitude towards ultrasound scanning in the first trimester of pregnancy: two‐dimensional versus two‐plus four‐dimensional ultrasound effects on maternal emotional status. Journal of Psychosomatic Obstetrics and Gynecology 2010;31(s1):65.
Schwarzler 1999 {published data only}
    1. Schwarzler P, Senat MV, Holden D, Bernard JP, Masroor T, Ville Y. Feasibility of the second‐trimester ultrasound examination in an unselected population at 18, 20 or 22 weeks of pregnancy: a randomised trial. Ultrasound in Obstetrics & Gynecology 1999;14:92‐7. - PubMed
Votino 2012 {published data only}
    1. Votino C, Kacem Y, Dobrescu O, Dessy H, Cos T, Foulon W, et al. Use of a high‐frequency linear transducer and MTI filtered color flow mapping in the assessment of fetal heart anatomy at the routine 11 to 13 + 6‐week scan: a randomized trial. Ultrasound in Obstetrics & Gynecology 2012;39(2):145‐51. - PubMed
Wald 1988 {unpublished data only}
    1. Wald NJ. Randomised controlled trial of routine dating ultrasound in pregnancy. Personal communication 1988.

References to studies awaiting assessment

Newcastle 2004 {published data only}
    1. 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.
    1. 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.
    1. 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.
    1. 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.

References to ongoing studies

McClure 2014 {published data only}
    1. McClure EM, Nathan RO, Saleem S, Esamai F, Garces A, Chomba E, et al. First look: a cluster‐randomized trial of ultrasound to improve pregnancy outcomes in low income country settings. BMC Pregnancy and Childbirth. NCT01990625 2014; Vol. 14, issue 1:73. - PMC - PubMed

Additional references

Barrett 1991
    1. Barrett J, Brinson J. Evaluation of obstetric ultrasonography at the first prenatal visit. American Journal of Obstetrics and Gynecology 1991;165:1002‐5. - PubMed
Berghella 2013
    1. Berghella V, Baxter JK, Hendrix NW. Cervical assessment by ultrasound for preventing preterm delivery. Cochrane Database of Systematic Reviews 2013, Issue 1. [DOI: 10.1002/14651858.CD007235.pub3] - DOI - PMC - PubMed
Bricker 2000
    1. 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
Bricker 2008
    1. Bricker L, Neilson JP, Dowswell T. Routine ultrasound in late pregnancy (after 24 weeks' gestation). Cochrane Database of Systematic Reviews 2008, Issue 4. [DOI: 10.1002/14651858.CD001451.pub3] - DOI - PMC - PubMed
Crane 2008
    1. 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
Dodd 2005
    1. Dodd JM, Crowther CA. Evidence‐based care of women with a multiple pregnancy. Best Practice & Research. Clinical Obstetrics & Gynaecology 2005;19:131‐53. - PubMed
Drysdale 2002
    1. Drysdale K, Ridley D, Walker K, Higgins B, Dean T. First‐trimester pregnancy scanning as a screening tool for high‐risk and abnormal pregnancies in a district general hospital setting. Journal of Obstetrics and Gynaecology 2002;22(2):159‐65. - PubMed
EFSUMB 1995
    1. European Federation of Societies for Ultrasound in Medicine and Biology. Watchdog Committee, 1994 clinical safety statement. European Journal of Ultrasound 1995;2:77.
Garcia 2002
    1. Garcia J, Bricker L, Henderson J, Martin MA, Mugford M, Neilson J, et al. Women's views of pregnancy ultrasound: a systematic review. Birth 2002;29(4):225‐50. - PubMed
Geirsson 1991
    1. Geirsson R, Busby‐Earle R. Certain dates may not provide a reliable estimate of gestational age. British Journal of Obstetrics and Gynaecology 1991;98:108‐9. - PubMed
GRADEpro 2014 [Computer program]
    1. McMaster University. GRADEpro. [Computer program on www.gradepro.org]. Version 2015. McMaster University, 2014.
Gulmezoglu 2012
    1. Gulmezoglu AM, Crowther CA, Middleton P, Heatley E. Induction of labour for improving birth outcomes for women at or beyond term. Cochrane Database of Systematic Reviews 2012, Issue 6. [DOI: 10.1002/14651858.CD004945.pub3] - DOI - PMC - PubMed
Henderson 2002
    1. Henderson J, Bricker L, Roberts T, Mugford M, Garcia J, Neilson J. British National Health Service's and women's costs of antenatal ultrasound screening and follow‐up tests. Ultrasound in Obstetrics & Gynecology 2002;20(2):154‐62. - PubMed
Higgins 2011
    1. Higgins JPT, Green S, editors. Cochrane Handbook for Systematic Reviews of Interventions Version 5.1.0 [updated March 2011]. The Cochrane Collaboration, 2011. Available from www.cochrane‐handbook.org.
Lalor 2007
    1. Lalor JG, Devane D. Information, knowledge and expectations of the routine ultrasound scan. Midwifery 2007;23(1):13‐22. - PubMed
Lee 2006
    1. Lee YM, Cleary‐Goldman J, Thaker HM, Simpson LL. Antenatal sonographic prediction of twin chorionicity. American Journal of Obstetrics and Gynecology 2006;195:863‐7. [MEDLINE: ] - PubMed
LeFevre 1993
    1. LeFevre ML, Bain RP, Ewigman BG, Frigoletto FD, Crane JP, McNellis D, et al. A randomized trial of prenatal ultrasonographic screening: impact on maternal management and outcome. American Journal of Obstetrics and Gynecology 1993;169:483‐9. - PubMed
Leivo 1996
    1. Leivo T, Tuominen R, Saari Kemppainen A, Ylostalo P, Karjalainen O, Heinonen OP. Cost‐effectiveness of one‐stage ultrasound screening in pregnancy: a report from the Helsinki ultrasound trial. Ultrasound in Obstetrics & Gynecology 1996;7(5):309‐14. - PubMed
Neilson 1995
    1. Neilson JP. High vs low feedback to mother at fetal ultrasound. [revised 12 May 1994]. In: Enkin MW, Keirse MJNC, Neilson JP, Crowther CA (eds) Pregnancy and Childbirth Module. In: The Cochrane Pregnancy and Childbirth Database [database on disk and CDROM] The Cochrane Collaboration; Issue 2, Oxford: Update Software; 1995.
Owen 1997
    1. Owen J, Wenstrom K. The effect of inaccurate gestational age estimation on the multiple marker screening test (MMST) for fetal Down Syndrome. American Journal of Obstetrics and Gynecology 1997;176:A297.
Paneth 1998
    1. Paneth N. Prenatal sonography ‐ safe or sinister?. Lancet 1998;352:5‐6. - PubMed
Peek 1994
    1. Peek M, Devonald K, Beilby R, Ellwood D. The value of routine early pregnancy ultrasound in the antenatal booking clinic. Australian and New Zealand Journal of Obstetrics and Gynaecology 1994;34:140‐3. - PubMed
Persson 1983
    1. Persson PH, Kullander S. Long‐term experience of general ultrasound screening in pregnancy. American Journal of Obstetrics and Gynecology 1983;146:942‐7. - PubMed
RevMan 2014 [Computer program]
    1. The Nordic Cochrane Centre, The Cochrane Collaboration. Review Manager (RevMan). Version 5.3. Copenhagen: The Nordic Cochrane Centre, The Cochrane Collaboration, 2014.
Roberts 2002
    1. Roberts T, Henderson J, Mugford M, Bricker L, Neilson J, Garcia J, et al. Antenatal ultrasound screening for fetal abnormalities: a systematic review of studies of cost and cost effectiveness. BJOG: an international journal of obstetrics and gynaecology 2002;109(1):44‐56. - PubMed
Rossi 2013
    1. Rossi AC, Prefumo F. Accuracy of ultrasonography at 11‐14 weeks of gestation for detection of fetal structural anomalies: a systematic review. Obstetrics and Gynecology 2013;122(6):1160‐7. - PubMed
Saari‐Kemppainen 1990
    1. Saari‐Kemppainen A, Karjalainen O, Ylostalo P, Heinonen OP. Ultrasound screening and perinatal mortality: controlled trial of systematic one‐stage screening in pregnancy. Lancet 1990;336:387‐91. - PubMed
Schunemann 2009
    1. Schunemann HJ. GRADE: from grading the evidence to developing recommendations. A description of the system and a proposal regarding the transferability of the results of clinical research to clinical practice [GRADE: Von der Evidenz zur Empfehlung. Beschreibung des Systems und Losungsbeitrag zur Ubertragbarkeit von Studienergebnissen]. Zeitschrift fur Evidenz, Fortbildung und Qualitat im Gesundheitswesen 2009;103(6):391‐400. [PUBMED: 19839216] - PubMed

References to other published versions of this review

Whitworth 2010
    1. Whitworth M, Bricker L, Neilson JP, Dowswell T. Ultrasound for fetal assessment in early pregnancy. Cochrane Database of Systematic Reviews 2010, Issue 4. [DOI: 10.1002/14651858.CD007058.pub2] - DOI - PMC - PubMed

Publication types