Early anatomy ultrasound in women at increased risk of fetal anomalies

Lim, Joseph; Whittle, Wendy; Lee, Yee-Man; Ryan, Greg; Mieghem, Tim Van

doi:10.1002/pd.4145

Cited by 12 publications

(13 citation statements)

References 25 publications

(47 reference statements)

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“…This increase reflected a gradual change in clinic policy to accept patients with more advanced gestations, more requests for late termination of pregnancy because of fewer options being available elsewhere, and advances in fetal diagnosis. [31][32][33][34][35][36][37][38][39][40][41][42][43][44][45][46] More than 95% of patients in this series of 1005 patients had uncomplicated pregnancy terminations with complete evacuation of the uterus The 26 patients presenting with a spontaneous fetal demise late in pregnancy were managed by a D & E procedure following serial multiple laminaria dilation of the cervix. For 12 patients with a single live abnormal fetus, fetal demise was induced at the patient′s request followed by management of the delivery by the patient′s own obstetrician.…”

Section: Resultsmentioning

confidence: 97%

Fetal diagnostic indications for second and third trimester outpatient pregnancy termination

Hern

2014

Prenat Diagn

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ObjectiveTo determine the frequency of diagnostic indications among women seeking to terminate pregnancies for reasons of fetal abnormality, spontaneous fetal demise, or a genetic disorder in a private outpatient clinic specializing in late outpatient abortion procedures.MethodA total of 1005 women requested termination of pregnancy for reasons of genetic disorder, fetal anomaly, or fetal demise over 20 years (1992–2012). Gestational ages ranged from 12 to 39 weeks. In all cases, a documented diagnosis of fetal abnormality or fetal demise was made prior to referral. Records were reviewed to verify fetal diagnosis for all patients seeking termination of pregnancy for reasons of fetal disorder. Major complications included major unintended surgery, hemorrhage requiring transfusion, or pelvic infection.ResultsPreoperative diagnoses included the following: chromosomal abnormalities (n = 378), genetic syndromes and single gene disorders (n = 30), structural anomalies (n = 494), and other conditions (n = 103). These include 26 cases of spontaneous fetal demise and nine selective terminations of one abnormal twin. The major complication rate was 0.5%.ConclusionsThe majority of diagnoses were in the categories of genetic disorder and neurologic abnormality. © 2014 The Authors. Prenatal Diagnosis published by John Wiley & Sons Ltd.

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Section: Resultsmentioning

confidence: 97%

Fetal diagnostic indications for second and third trimester outpatient pregnancy termination

Hern

2014

Prenat Diagn

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“…We have previously suggested that the addition of a US examination in early gestation (between 13 weeks and 15 weeks 6 days) may be of the highest benefit in patients with class 3 obesity to improve the rate of completion of anatomic surveys . Many studies have reported US in early gestation for visualizing fetal anatomy in general . However, to our knowledge, no study investigated the role of early US in cardiac screening.…”

Section: Discussionmentioning

confidence: 99%

“…16 Many studies have reported US in early gestation for visualizing fetal anatomy in general. [17][18][19][20] However, to our knowledge, no study investigated the role of early US in cardiac screening.…”

Section: Discussionmentioning

confidence: 99%

Can Ultrasound in Early Gestation Improve Visualization of Fetal Cardiac Structures in Obese Pregnant Women?

Majeed

Abuhamad

Romary

et al. 2018

J of Ultrasound Medicine

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Objectives To determine whether ultrasound (US) imaging of obese pregnant women in early gestation improves fetal cardiac visualization. Methods We report a prospective longitudinal trial comparing late first‐ and early second‐trimester US to traditional second‐trimester US for fetal cardiac screening in maternal obesity. All study participants received US for fetal cardiac screening at a gestational age of 13 weeks to 15 weeks 6 days using a transvaginal or transabdominal approach (UST1). All patients also underwent a traditional transabdominal examination at 20 to 22 weeks (UST2). If UST2 failed to complete the cardiac visualization, a follow up examination (second UST2) was performed 2 to 4 weeks later. Imaging was considered complete if the visceral situs, 4 chambers, outflow tracts, and 3 vessels were visualized. The completion rates between UST1 and UST2 were the primary outcomes. A power analysis (85%) and sample size calculation (n = 145) were performed. Results A total of 152 pregnancies met study criteria. Completion rates of cardiac screening were 77% for UST1 and 70% for UST2 (P = .143). This comparison reached statistical significance in patients with a body mass index of greater than 40 kg/m2 (UST1 [69%] versus UST2 [38%]; P = .001). Sixty‐two percent of patients with a body mass index of greater than 40 kg/m2 required second UST2. The highest fetal cardiac screening completion rate was achieved when UST1 was combined with UST2 (96.1%). In 1 fetus, congenital heart disease was detected at UST1 and later confirmed. Conclusions This study represents the largest prospective trial assessing early‐gestation US for fetal cardiac screening in the setting of maternal obesity. In obese pregnancies, the addition of early‐gestation US to the 20‐ to 22‐week US substantially improves the visualization of fetal cardiac anatomy.

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“…5,6 Although the transabdominal approach is most frequently used in routine screening, complementing it with a transvaginal scan is often useful in early pregnancy. Indeed, even though transvaginal probes cannot be manipulated with as many freedom as transabdominal probes, they are closer to the fetus and have better resolution, 7,8 thereby allowing a more detailed evaluation in cases of suspected anomalies.…”

Section: Introductionmentioning

confidence: 99%

Sonographic detection of central nervous system defects in the first trimester of pregnancy

et al. 2016

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The fetal central nervous system can already be examined in the first trimester of pregnancy. Acrania, alobar holoprosencephaly, cephaloceles, and spina bifida can confidently be diagnosed at that stage and should actively be looked for in every fetus undergoing first-trimester ultrasound. For some other conditions, such as vermian anomalies and agenesis of the corpus callosum, markers have been identified, but the diagnosis can only be confirmed in the second trimester of gestation. For these conditions, data on sensitivity and more importantly specificity and false positives are lacking, and one should therefore be aware not to falsely reassure or scare expecting parents based on first-trimester findings. This review summarizes the current knowledge of first-trimester neurosonography in the normal and abnormal fetus and gives an overview of which diseases can be diagnosed.

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Early anatomy ultrasound in women at increased risk of fetal anomalies

Abstract: The high rate of visualization of anatomic structures between 12-17 weeks gestation allows for either early detection of fetal anomalies or parental reassurance in many cases. Subtle anomalies of the heart remain difficult to diagnose.

Cited by 12 publications

References 25 publications

Fetal diagnostic indications for second and third trimester outpatient pregnancy termination

Fetal diagnostic indications for second and third trimester outpatient pregnancy termination

Can Ultrasound in Early Gestation Improve Visualization of Fetal Cardiac Structures in Obese Pregnant Women?

Sonographic detection of central nervous system defects in the first trimester of pregnancy

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