Open AccessA randomized controlled trial of third‐trimester routine ultrasound in a non‐selected population
Author(s) -
Skråstad Ragnhild B.,
EikNes Sturla H.,
Sviggum Oddvar,
Johansen Ole J.,
Salvesen Kjell Å.,
Romundstad Pål R.,
Blaas HarmGerd K.
Publication year - 2013
Publication title -
acta obstetricia et gynecologica scandinavica
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.401
H-Index - 102
eISSN - 1600-0412
pISSN - 0001-6349
DOI - 10.1111/aogs.12249
Subject(s) - medicine , gestational age , obstetrics , cardiotocography , fetus , small for gestational age , gestation , population , pregnancy , randomized controlled trial , ultrasound , surgery , radiology , genetics , environmental health , biology
Objective To compare detection rates of small‐for‐gestational‐age fetuses, large‐for‐gestational‐age fetuses, congenital anomalies and adverse perinatal outcomes in pregnancies randomized to third‐trimester routine ultrasound or ultrasound on clinical indication. Design Randomized controlled trial. Setting National Center for Fetal Medicine in Norway between 1989 and 1992. Population A total of 6780 pregnancies from a non‐selected population. Methods Two routine ultrasound examinations at 18 and 33 weeks were compared with routine ultrasound at 18 weeks and ultrasound on clinical indication. Suspected small‐for‐gestational‐age fetuses were followed with serial scans and cardiotocography. Doppler ultrasound was not used. Main outcome measures Detection rates of small‐for‐gestational‐age and large‐for‐gestational‐age fetuses, congenital anomalies and adverse perinatal outcomes. Results Third trimester routine ultrasound improved detection rates of small‐for‐gestational‐age fetuses from 46 to 80%, but overall perinatal morbidity and mortality remained unchanged. Detection of large‐for‐gestational‐age fetuses increased from 36 to 91%. There was a significant increase of induction of labor and elective cesarean sections due to suspected small‐for‐gestational‐age and a significant decrease of induction of labor and elective cesarean sections due to suspected large‐for‐gestational‐age in the study group; there were no other differences regarding intervention. The detection rate of congenital anomalies was 56%, with no significant difference between the groups. Conclusions Routine use of third‐trimester routine ultrasound increased detection rates of small‐for‐gestational‐age and large‐for‐gestational‐age fetuses. This did not alter perinatal outcomes. Third‐trimester ultrasound screening should not be rejected before a policy of adding Doppler surveillance to the high‐risk group identified has been investigated further.