Standardisation and quality control of ultrasound measurements taken in the <scp>INTERGROWTH</scp>‐21<sup>st</sup> Project

Sarris, Ippokratis; Ioannou, Christos; Ohuma, E O; Altman, DG; Hoch, Laura; Cosgrove, Candace M.; Fathima, Sana; Salomon, L. J.; Papageorghiou, A.T.

doi:10.1111/1471-0528.12315

Cited by 72 publications

(95 citation statements)

References 7 publications

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“…Ultrasound examinations are carried out or supervised by accredited sonographers or fetal medicine doctors using standard ultrasound equipment. For quality control measures, the stored images and the reliability of measurements are regularly assessed using the INTERGROWTH‐21 st quality control criteria. Inclusion criteria were maternal age > 18 years of age and the ability to provide verbal and written informed consent in English.…”

Section: Methodsmentioning

confidence: 99%

Expected‐value bias in routine third‐trimester growth scans

Drukker

Droste

Chatelain

et al. 2020

Ultrasound in Obstet & Gyne

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Objectives Operators performing fetal growth scans are usually aware of the gestational age of the pregnancy, which may lead to expected‐value bias when performing biometric measurements. We aimed to evaluate the incidence of expected‐value bias in routine fetal growth scans and assess its impact on standard biometric measurements. Methods We collected prospectively full‐length video recordings of routine ultrasound growth scans coupled with operator eye tracking. Expected value was defined as the gestational age at the time of the scan, based on the estimated due date that was established at the dating scan. Expected‐value bias was defined as occurring when the operator looked at the measurement box on the screen during the process of caliper adjustment before saving a measurement. We studied the three standard biometric planes on which measurements of head circumference (HC), abdominal circumference (AC) and femur length (FL) are obtained. We evaluated the incidence of expected‐value bias and quantified the impact of biased measurements. Results We analyzed 272 third‐trimester growth scans, performed by 16 operators, during which a total of 1409 measurements (354 HC, 703 AC and 352 FL; including repeat measurements) were obtained. Expected‐value bias occurred in 91.4% of the saved standard biometric plane measurements (85.0% for HC, 92.9% for AC and 94.9% for FL). The operators were more likely to adjust the measurements towards the expected value than away from it (47.7% vs 19.7% of measurements; P < 0.001). On average, measurements were corrected by 2.3 ± 5.6, 2.4 ± 10.4 and 3.2 ± 10.4 days of gestation towards the expected gestational age for the HC, AC, and FL measurements, respectively. Additionally, we noted a statistically significant reduction in measurement variance once the operator was biased (P = 0.026). Comparing the lowest and highest possible estimated fetal weight (using the smallest and largest biased HC, AC and FL measurements), we noted that the discordance, in percentage terms, was 10.1% ± 6.5%, and that in 17% (95% CI, 12–21%) of the scans, the fetus could be considered as small‐for‐gestational age or appropriate‐for‐gestational age if using the smallest or largest possible measurements, respectively. Similarly, in 13% (95% CI, 9–16%) of scans, the fetus could be considered as large‐for‐gestational age or appropriate‐for‐gestational age if using the largest or smallest possible measurements, respectively. Conclusions During routine third‐trimester growth scans, expected‐value bias frequently occurs and significantly changes standard biometric measurements obtained. © 2019 the Authors. Ultrasound in Obstetrics & Gynecology published by John Wiley & Sons Ltd on behalf of the International Society of Ultrasound in Obstetrics and Gynecology.

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Section: Methodsmentioning

confidence: 99%

Expected‐value bias in routine third‐trimester growth scans

Drukker

Droste

Chatelain

et al. 2020

Ultrasound in Obstet & Gyne

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“…In FGLS, fetal biometry was measured by ultrasound using a highly standardised, blinded and scientifically rigorous protocol designed to minimise intra-and inter-observer bias. [11][12][13] Measurements were repeated every five weeks until birth. At birth, the same rigour was applied to measure the weight, length and head circumference of all newborns in the entire population.…”

Section: The Intergrowth-21st Projectmentioning

confidence: 99%

INTERGROWTH‐21st – Time to standardise fetal measurement in Australia

Westerway

Papageorghiou

Hirst

et al. 2015

Australas J Ultrason Med

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“…A study team for the Fetal Growth Longitudinal Study (FGLS) was recruited in early 2009 comprising a research midwife, two experienced ultrasonographers and a data manager. The ultrasonographers and data manager attended centralised training sessions in April 2009, 5,6 prior to the launch of FGLS in May 2009 (Figure 3). Access to rooms within the Outpatient Department for screening and scanning purposes was negotiated with the hospital management in early 2009.…”

Section: Preparatory Activitiesmentioning

confidence: 99%

Implementation of the INTERGROWTH‐21^st Project in the UK

Roseman

Knight

Giuliani

et al. 2013

BJOG

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Please cite this paper as: Roseman F, Knight H, Giuliani F, Lloyd S, Di Nicola P, Laister A, Roseman S, Kennedy K, Burnham O, Patel B, Puglia F, Blakey I, Cheikh Ismail L, for the International Fetal and Newborn Growth Consortium for the 21st Century (INTERGROWTH‐21st). Implementation of the INTERGROWTH‐21st Project in the UK. BJOG 2013; 120 (Suppl. 2): 117–122. There are approximately 10 000 births per year in the county of Oxfordshire in the UK, which is one of the two European sites for the International Fetal and Newborn Growth Consortium for the 21st Century (INTERGROWTH‐21st) Project. The samples for both components of the project – the Fetal Growth Longitudinal Study (FGLS) and Newborn Cross‐Sectional Study (NCSS) – were drawn from the John Radcliffe Hospital, a major university hospital with a large regional role that covers more than 75% of deliveries in the county. Special activities to encourage participation in this population included the formation of a research coalition to streamline recruitment in the Maternity Unit and the distribution of study information leaflets to women using the hospital’s antenatal care service. This was a demanding project and several challenges were overcome to reach recruitment targets and to maintain high standards of data quality. Amongst the major challenges for FGLS at this study site was the level of ineligibility because of maternal age, smoking and body mass index (BMI) ≥ 30. The major challenge for the NCSS field teams was to ensure that all anthropometric data were collected before the early discharge of uncomplicated deliveries, often within 6 hours of birth. It is evident from our experience in implementing this project that, when large‐scale clinical studies are meticulously planned and avoid major disruption to routine clinical care, they are well received by hospital staff and can contribute to the improvement of the overall standard of clinical care.

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Standardisation and quality control of ultrasound measurements taken in the INTERGROWTH‐21^st Project

Cited by 72 publications

References 7 publications

Expected‐value bias in routine third‐trimester growth scans

Expected‐value bias in routine third‐trimester growth scans

INTERGROWTH‐21st – Time to standardise fetal measurement in Australia

Implementation of the INTERGROWTH‐21^st Project in the UK

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Standardisation and quality control of ultrasound measurements taken in the INTERGROWTH‐21st Project

Cited by 72 publications

References 7 publications

Expected‐value bias in routine third‐trimester growth scans

Expected‐value bias in routine third‐trimester growth scans

INTERGROWTH‐21st – Time to standardise fetal measurement in Australia

Implementation of the INTERGROWTH‐21st Project in the UK

Contact Info

Product

Resources

About

Standardisation and quality control of ultrasound measurements taken in the INTERGROWTH‐21^st Project

Implementation of the INTERGROWTH‐21^st Project in the UK