Objective: This study aims to determine the incidence of ultrasound findings that may change clinical management on the day of blood-sampling for cell-free DNA (cfDNA) screening. Methods: A retrospective study was conducted at a tertiary provider of obstetric and gynecological ultrasound in Melbourne, Australia. Individual patient files were reviewed and results were collated for maternal characteristics, pre-cfDNA ultrasound reports, results and test characteristics of both cfDNA and diagnostic testing, and genetic counselling notes. The primary outcome was a potential change in patient management due to findings detected on the pre-cfDNA ultrasound. Results: Of 6250 pre-cfDNA ultrasounds, 6207 were included in analysis. Of these, 598 (9.6%) pregnancies had a finding on pre-cfDNA ultrasound that had the potential to change management. The reasons for this potential change in management were detection of gestational age below 10 weeks (245, 3.9%), miscarriage (175, 2.8%), demised twin (43, 0.7%), fetal edema (115, 1.9%) and major structural abnormalities (20, 0.3%). These findings were more common in patients of advanced maternal age and in spontaneous conceptions. Conclusions: An ultrasound prior to cfDNA screening has the potential to change clinical management in almost one in 10 women. The proportion is higher in older age groups and lower in IVF-conceived pregnancies.

Objective: To determine the proportion of major fetal structural abnormalities that can be detected before 11 gestational weeks. Methods:We conducted a retrospective study of individual patient files at a tertiary provider of obstetric and gynecological ultrasound in Melbourne, Australia. All women who had a pre-cell-free DNA ultrasound with a crown-rump length of less than 45 mm and had one or more ultrasounds at a later gestation were included in the analysis. The primary outcome was the incidence of a fetal structural abnormality.Results: A total of 3333 cases were included in the final analysis. Overall, 316 fetuses (9.5%) had a structural abnormality detected at any point throughout gestation, of which 86 were major structural abnormalities (2.6%). Sixteen fetal abnormalities were detected before 11 weeks of gestation, including 15 major abnormalities (17.4% of the major anomalies). All major fetal abnormalities detected before 11 gestational weeks were confirmed at later ultrasound examinations or the pregnancy did not continue (in four cases due to termination of pregnancy and in one case spontaneous miscarriage before first trimester morphology ultrasound). Conclusion:Detection of fetal abnormalities is possible before 11 weeks of gestation. Early suspicion is more likely in cases of major structural abnormalities. Key points What is already known about this topic?� Many fetal structural abnormalities are detectable in the antenatal period using obstetric ultrasound.� Fetal structural abnormalities are usually detected at the mid-trimester morphology ultrasound (performed at 18-24 weeks' gestation) or the first trimester morphology ultrasound (11-14 weeks' gestation).� Abnormalities are more likely to be diagnosed at a later gestation. What does this study add?� There has been little study to date on the detection of fetal structural abnormalities before 11 weeks of gestation.� This study investigates the proportion of fetal structural abnormalities detected at less than 11 weeks of gestation as compared with detection at a later gestation.

Objectives: The clinical workflow of the second trimester anomaly scan is not well studied and holds potential for efficiency improvement. We aimed to create a model for automatic anatomical description of full-length fetal anomaly scan videos using artificial intelligence. Methods: We prospectively recorded routine full-length second trimester anomaly scans, extracted short clips of important scan events by detecting video freeze, and image/clip save. For machine learning, we created a training dataset by manually labelling 12% of the scan events to one of 23 principal anatomical structures, trained a deep spatiotemporal neural network with the training dataset, cross-validated and applied the model to automatically label the rest of the scans. Finally, we retrospectively labelled a test dataset (48 scans) to compare with the automatically labelled scans. We report the model precision and workflow metrics. Results: 518 scans performed by 14 operators were analysed. The mean scan duration was 26.7 ± 15 minutes, and the mean number of scan events was 23.5 ± 14.4. The manual vs. automatic clips labelling agreement was 74.5%, ranging from 34% for placenta to 89% for heart. The brain, heart and spine were most often the first structure to be evaluated, in 18.8%, 17.6% and 17% of the scans, respectively. On average, 15% of the scan duration was dedicated to cardiac scanning, 10% to brain, and 7% to the spine (figure 1). Conclusions: Using big data, we present a model that describes how expert sonographers perform anomaly scans in a data science fashion. Understanding how operators scan and being able to measure the different operator elements will inform a better understanding of how to train operators, monitor learning progress, and enhance scanning workflow.

This audit collates data on alcohol‐related gastrointestinal (GI) admissions at Monash Health, Victoria, during the prolonged, coronavirus disease 2019 (COVID‐19)–related lockdown July to October 2020 compared with the same periods in 2019 and 2021. We found a 58% increase in admissions in 2020 and a 16% increase in 2021, which also increased disproportionately to overall health service emergency presentations. Self‐reported alcohol consumption increased by 2.5‐fold and was greatest in 2020. Clinical severity was unchanged and cirrhosis was the only factor associated with severe disease. This study suggests an association between the pandemic‐related lockdown, alcohol consumption and alcohol‐related GI hospitalisation. Our study provides support for resourcing and adapting alcohol and other drug services during and beyond the COVID‐19 lockdown.

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