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.

Physicians' experiences and views on the role of obstetric ultrasound in rural and urban Rwanda: a qualitative study

“…Ultrasound in pregnancy management has become an indispensible part of practice in high‐income countries, where it is universally used for screening, diagnostic and surveillance purposes. Its use has shown benefits including assessment of the number of fetuses placental location, estimation of gestational age and detection of fetal anomalies . In low‐ and middle‐income countries, where the vast majority of maternal and neonatal deaths occur, ultrasound may be poorly utilised , or in some countries misused for purposes that do not confer benefits to maternal, fetal or newborn health, such as sex determination for sex‐selective abortions .…”

Reliability and validity of last menstrual period for gestational age estimation in a low‐to‐middle‐income setting

“…However, due to its poor sensitivity, LMP should not be used to inform clinical decisions around delivery beyond 39 weeks gestation. Gestational age dating by ultrasound has been shown to reduce the need for post‐term induction . Therefore, while ultrasound equipment is expensive and requires trained operators, the long‐term benefits of using ultrasound to date pregnancies and to inform clinical decisions may in fact turn out to be the more cost‐effective option.…”

Selective Serotonin Reuptake Inhibitor (SSRI) Antidepressants in Pregnancy and Congenital Anomalies: Analysis of Linked Databases in Wales, Norway and Funen, Denmark

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Consider offering women prescribed SSRIs in pregnancy third trimester scans or alternative continuous monitoring technology to:

take advantage of advances in monitoring and surgery in utero

ensure appropriate levels of neonatal care are available at birth.

Consider whether there is now sufficient evidence and clinical indication to offer a modified care pathway to include detailed ultrasound scans with views of the 4 cardiac chambers, outflow tracts and aortic arch plus Doppler investigation of blood flow [150], even if not otherwise indicated. Ultrasound is not considered to be associated with risk, and there are no reported harms [151], with follow up to age 15–16 [152]; some may consider that the injunction “Do no harm” [140] might justify the additional clinical work, and any additional anxiety for parents associated with clinically unimportant incidental findings.

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“…Ultrasound is not considered to be associated with risk, and there are no reported harms [151], with follow up to age 15–16 [152]; some may consider that the injunction “Do no harm” [140] might justify the additional clinical work, and any additional anxiety for parents associated with clinically unimportant incidental findings.…”