Incidental Fetal Ultrasound Findings: Interpretation and Management

Kaplan, Rebekah; Adams, Sharon

doi:10.1111/jmwh.12754

Cited by 6 publications

(5 citation statements)

References 33 publications

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“…In the study by Åhman et al [21], women diagnosed with soft markers in pregnancy stated that they would have preferred not to have known, or were hesitant about receiving, this information. The clinical value and management of soft markers are described in a number of articles [33][34][35]. These vary as to the type of follow-up care recommended, and how far soft markers should be considered significant or normal variants.…”

Section: Discussionmentioning

confidence: 99%

A qualitative study of the work experiences of midwives performing obstetric ultrasound in Norway

Reiso

Langli

Sommerseth

et al. 2020

BMC Pregnancy Childbirth

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Background Performing obstetric ultrasound is part of midwifery practice in Norway. Knowledge of these midwives’ working situation can enhance understanding of what their work involves and the challenges they encounter in their practice. The aim of this study was to gain insight into how midwife sonographers perceive their work in obstetric ultrasound. Methods A qualitative study with individual interviews was conducted in 2018. Midwives (n = 13) with a postgraduate ultrasound qualification who performed obstetric ultrasound in private clinics and/or the public health sector were included. All four regional health authorities in Norway were represented. The data gathered were analysed using content analysis. Results The analysis resulted in three main themes. (1) Working as a midwife sonographer involves a holistic approach. By practising their competence, in both midwifery and sonography, they could answer questions and reassure pregnant women. The participants also had a feeling of great responsibility in their work. (2) Being part of a professional environment in obstetric ultrasound was important for professional interaction, belonging and learning. (3) Developing and maintaining competence as a midwife sonographer had a positive influence on midwives’ motivation and confidence, and allowed for more variety in their work. Conclusions Holistic care of the pregnant woman, her partner and the unborn baby was an important part of the participants’ work. They wanted to meet colleagues within their field, develop their expertise and have influence over their work situation. Organizational factors seemed to affect the participants’ overall ability to practise their skills and thus also their job satisfaction.

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Section: Discussionmentioning

confidence: 99%

A qualitative study of the work experiences of midwives performing obstetric ultrasound in Norway

Reiso

Langli

Sommerseth

et al. 2020

BMC Pregnancy Childbirth

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“…Ultrasound screening is typically scheduled in the second trimester to visualize fetal anatomy and confirm gestational age. Most ultrasound examinations are reassuring, but some incidentally identify structural anomalies and soft markers for aneuploidy, making it necessary for health care providers to correctly interpret these findings [1].…”

Section: Introductionmentioning

confidence: 99%

“…Fetal Soft markers are incidental ultrasound findings of uncertain clinical significance. Soft markers found during second-trimester ultrasound imaging can include nuchal thickening, echogenic cardiac focus or foci, echogenic bowel, pyelectasis, choroid plexus cysts, shortened femur or humerus, absent nasal bone, and single umbilical artery [1]. They are usually normal variants, have no clinical sequelae, and are transient, resolving with advancing gestation or after birth [3].…”

Section: Introductionmentioning

confidence: 99%

Fetal Soft Markers in Obstetric Ultrasound

ALGARHY¹,

ABDELMOTALEB²

2022

The Medical Journal of Cairo University

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Background: The use of ultrasound in pregnancy has significant health and economic outcomes for families and the health care system. With high resolution ultrasound, it is possible to examine fetal anatomy in great detail. The quality of images obtained today is such that minor deviations from normal can be clearly identified. Aim of Study:The purpose of this prospective study is the observation after detection of ultrasound soft markers, and to evaluate the usefulness of each ultrasound soft marker, and assess whether a specific soft marker should be looked for routinely on screening ultrasound.Patients and Methods: This was a prospective studyin 270 pregnant women at 16-24 weeks of gestation. All women were examined twice with ultrasonography for detection of any tissue abnormalities. First at 16-24 weeks of pregnancy and repeated for follow-up of the soft marker once detected at 32-36 weeks of pregnancy.Results: This study has demonstrated that when a soft marker is identified, there must be a careful search for other markers. The study showed a total of 27 (10%) of the studied women had tissue anomalies; 25 (9.3%) women had isolated soft tissue anomalies while 2 (0.7%) women had mixed anomalies. Three markers were not found in any woman, namely, increased nuchal fold thickness, absent nasal bone and ventriculomegaly. While the most frequent tissue anomalies were pyelectasis (3.7%) and choroid plexus cyst (2.2%). Another finiding in our study was echogenic bowel (EB) by 1.5%, EIF and shortened long bone by 1.10% and 0.75%, respectively; and the outcome of the new born are normal. There are some ultrasound findings commonly seen on second trimester routine scan that are associated with possible progression (e.g. renal pelvis dilatation). These findings should be reported as anatomical variants and appropriate follow-up arranged. For renal pelvis dilatation, then it is common practice to re-scan in the third trimester to see if there is progression. Conclusion:Soft markers in second-trimester ultrasonography have limited use in screening for fetal aneuploidy. However, these markers can be used as a screening tool for adverse outcomes other than chromosomal abnormality.

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“…As imaging has become more sophisticated, there has been increasing potential to identify markers of uncertain significance [ 7 ]. This can bring many benefits, but it has also resulted in concerns relating to overdiagnosis as well as the psychological risks for women, birthing people, and partners when the implications of these markers are not clear [ 8 , 9 ]. Some have expressed eugenic concerns, as ultrasound-identified fetal abnormalities force parents to decide between giving birth to a child with disabilities, or termination [ 10 ], while in some social, cultural and religious contexts, termination is not an option [ 11 ].…”

Section: Introductionmentioning

confidence: 99%

First and second trimester ultrasound in pregnancy: A systematic review and metasynthesis of the views and experiences of pregnant women, partners, and health workers

et al. 2021

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Background The World Health Organization (WHO) recommends one ultrasound scan before 24 weeks gestation as part of routine antenatal care (WHO 2016). We explored influences on provision and uptake through views and experiences of pregnant women, partners, and health workers. Methods We undertook a systematic review (PROSPERO CRD42021230926). We derived summaries of findings and overarching themes using metasynthesis methods. We searched MEDLINE, CINAHL, PsycINFO, SocIndex, LILACS, and AIM (Nov 25th 2020) for qualitative studies reporting views and experiences of routine ultrasound provision to 24 weeks gestation, with no language or date restriction. After quality assessment, data were logged and analysed in Excel. We assessed confidence in the findings using Grade-CERQual. Findings From 7076 hits, we included 80 papers (1994–2020, 23 countries, 16 LICs/MICs, over 1500 participants). We identified 17 review findings, (moderate or high confidence: 14/17), and four themes: sociocultural influences and expectations; the power of visual technology; joy and devastation: consequences of ultrasound findings; the significance of relationship in the ultrasound encounter. Providing or receiving ultrasound was positive for most, reportedly increasing parental-fetal engagement. However, abnormal findings were often shocking. Some reported changing future reproductive decisions after equivocal results, even when the eventual diagnosis was positive. Attitudes and behaviours of sonographers influenced service user experience. Ultrasound providers expressed concern about making mistakes, recognising their need for education, training, and adequate time with women. Ultrasound sex determination influenced female feticide in some contexts, in others, termination was not socially acceptable. Overuse was noted to reduce clinical antenatal skills as well as the use and uptake of other forms of antenatal care. These factors influenced utility and equity of ultrasound in some settings. Conclusion Though antenatal ultrasound was largely seen as positive, long-term adverse psychological and reproductive consequences were reported for some. Gender inequity may be reinforced by female feticide following ultrasound in some contexts. Provider attitudes and behaviours, time to engage fully with service users, social norms, access to follow up, and the potential for overuse all need to be considered.

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Incidental Fetal Ultrasound Findings: Interpretation and Management

Cited by 6 publications

References 33 publications

A qualitative study of the work experiences of midwives performing obstetric ultrasound in Norway

A qualitative study of the work experiences of midwives performing obstetric ultrasound in Norway

Fetal Soft Markers in Obstetric Ultrasound

First and second trimester ultrasound in pregnancy: A systematic review and metasynthesis of the views and experiences of pregnant women, partners, and health workers

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