Ultrasound for fetal assessment in early pregnancy

Abstract

Background-Diagnostic ultrasound is a sophisticated electronic technology, which utilises pulses of high frequency sound to produce an image. Diagnostic ultrasound examination may be employed in a variety of specific circumstances during pregnancy such as after clinical complications, or where there are concerns about fetal growth. Because adverse outcomes may also occur in pregnancies without clear risk factors, assumptions have been made that routine ultrasound in all pregnancies will prove beneficial by enabling earlier detection and improved management of pregnancy complications. Routine screening may be planned for early pregnancy, late gestation, or both. The focus of this review is routine early pregnancy ultrasound. Objectives-To assess whether routine early pregnancy ultrasound for fetal assessment (i.e. its use as a screening technique) influences the diagnosis of fetal malformations, multiple pregnancies, the rate of clinical interventions, and the incidence of adverse fetal outcome when compared with the selective use of early pregnancy ultrasound (for specific indications). Search methods-We searched the Cochrane Pregnancy and Childbirth Group's Trials Register (September 2009). Selection criteria-Published, unpublished, and ongoing randomised controlled trials that compared outcomes in women who experienced routine versus selective early pregnancy ultrasound (i.e. less than 24 weeks' gestation). We have included quasi-randomised trials.

Long-Term Neurodevelopmental and Functional Outcomes of Infants Born Very Preterm and/or with a Very Low Birth Weight

“…The results of our study on long-term neurodevelopmental differences, as well as our previous study on long-term growth outcomes, have added to the available evidence, showing that the differences between VP and VLBW subjects remain present into adolescence [11]. Therefore, since prematurity is defined by GA and since pregnancy duration can be measured accurately with current technology [29, 30], we concur with the previous recommendations that GA should be used as an inclusion criterion instead of BW, at least in industrialized countries. Simultaneously, we also recommend adjusting for BW SD scores when analyzing (long-term) outcomes, since BW is a strong determinant of long-term neurodevelopmental outcomes [9, 31, 32].…”

Normal childbirth and evidence based practice

“…The Cochrane Library includes a review of nine randomised controlled trials. 14 The findings suggest that there are some advantages, such as earlier detection of twins, but most of all, fewer inductions for post-term pregnancy, due to more accurate estimation of the date of delivery. However, it has not been possible to show that these advantages affect infant or maternal health.…”

Postterm pregnancy

“…The most frequent cause of postterm pregnancy is an error in dating (1,3). See chapter 4 for accurate dating criteria and their benefits, as well as the following sections.…”