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Prenatal diagnosis of major malformations: quality control of routine ultrasound examinations based on a five‐year study of 20 248 newborn fetuses and infants
Author(s) -
QueisserLuft Annette,
Stopfkuchen Herwig,
Stolz Gabriela,
Schlaefer Klaus,
Merz Eberhard
Publication year - 1998
Publication title -
prenatal diagnosis
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.956
H-Index - 97
eISSN - 1097-0223
pISSN - 0197-3851
DOI - 10.1002/(sici)1097-0223(199806)18:6<567::aid-pd302>3.0.co;2-3
Subject(s) - medicine , obstetrics , pregnancy , prenatal care , urinary system , fetus , prenatal diagnosis , ultrasound , gynecology , pediatrics , population , radiology , genetics , environmental health , biology , endocrinology
Antenatal ultrasound screening for birth defects is increasingly becoming a routine procedure of prenatal care. Prenatal detection of malformations and subsequent adjustment of obstetric management are essential for secondary prevention. It is unknown whether ultrasound screening is effective in all pregnant women, or should only be performed in high risk populations. From 1990–1994, 20 248 livebirths, stillbirths and abortions underwent physical and sonographic examinations and anamnestic data were collected. To identify the high risk group, case control analyses of births with one of the 23 selected major malformations (cases) and births without malformations (controls) were performed with respect to anamnestic risk factors. All women had at least three routine ultrasound scans. The selected malformations were diagnosed in 298 children; 95 (30·3 per cent) were diagnosed antenatally. Detection rates were: CNS (68·6 per cent), gastro‐intestinal tract (42·3 per cent), urinary system (24·1 per cent), heart (5·9 per cent). Complications during pregnancy were calculated as indicators of congenital anomalies: premature labour (<28 week) OR 4·7 (3·8–5·9), placental insufficiency OR 1·9 (1·1–2·7) and vaginal bleeding OR 1·5 (1·2–1·8), etc. Antenatal routine ultrasound screening is not effective in low risk populations. Anamnestic risk factors during pregnancy may be essential indicators for identifying high risk populations. We propose screening of the described high risk pregnancies (about 22 per cent of all pregnancies) to be performed by specially trained and highly experienced ultrasonographers to increase sensitivity rates and benefit cost effectiveness. © 1998 John Wiley & Sons, Ltd.