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Improved detection rate of structural abnormalities in the first trimester using an extended examination protocol
Author(s) -
Iliescu D.,
Tudorache S.,
Comanescu A.,
Antsaklis P.,
Cotarcea S.,
Novac L.,
Cernea N.,
Antsaklis A.
Publication year - 2013
Publication title -
ultrasound in obstetrics and gynecology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 3.202
H-Index - 141
eISSN - 1469-0705
pISSN - 0960-7692
DOI - 10.1002/uog.12489
Subject(s) - medicine , fetus , pregnancy , ultrasound , first trimester , gestational age , obstetrics , gestation , radiology , genetics , biology
Objective To assess the potential of first‐trimester sonography in the detection of fetal abnormalities using an extended protocol that is achievable with reasonable resources of time, personnel and ultrasound equipment. Methods This was a prospective two‐center 2‐year study of 5472 consecutive unselected pregnant women examined at 12 to 13 + 6 gestational weeks. Women were examined using an extended morphogenetic ultrasound protocol that, in addition to the basic evaluation, involved a color Doppler cardiac sweep and identification of early contingent markers for major abnormalities. Results The prevalence of lethal and severe malformations was 1.39%. The first‐trimester scan identified 40.6% of the cases detected overall and 76.3% of major structural defects. The first‐trimester detection rate ( DR ) for major congenital heart disease (either isolated or associated with extracardiac abnormalities) was 90% and that for major central nervous system anomalies was 69.5%. In fetuses with increased nuchal translucency ( NT ), the first‐trimester DR for major anomalies was 96%, and in fetuses with normal NT it was 66.7%. Most (67.1%) cases with major abnormalities presented with normal NT . Conclusions A detailed first‐trimester anomaly scan using an extended protocol is an efficient screening method to detect major fetal structural abnormalities in low‐risk pregnancies. It is feasible at 12 to 13 + 6 weeks with ultrasound equipment and personnel already used for routine first‐trimester screening. Rate of detection of severe malformations is greater in early‐ than in mid‐pregnancy and on postnatal evaluation. Early heart investigation could be improved by an extended protocol involving use of color Doppler. Copyright © 2013 ISUOG. Published by John Wiley & Sons Ltd.