Ultrasound for fetal assessment in early pregnancy

Neilson, James P

doi:10.1002/14651858.cd000182.pub2

Cited by 42 publications

(53 citation statements)

References 27 publications

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“…2,[38][39][40] Most of the reported increases in adverse maternal and perinatal outcome rates associated with induction of labor (emergency cesarean delivery, instrumental delivery and post-partum hemorrhage) are related to either attempted induction at an early gestation or in older age groups. [41][42][43] Accurate determination of gestational age with ultrasound as early as possible reduces the risk of inadvertent premature delivery and failed induction, 44 the major contributors to adverse outcomes in subsequent pregnancy after unexplained stillbirth.…”

Section: Early Pregnancymentioning

confidence: 99%

Management of subsequent pregnancy after an unexplained stillbirth

Robson

Leader

2009

J Perinatol

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Purpose: To review the management of pregnancy after an unexplained stillbirth.Epidemiology: Approximately 1 in 200 pregnancies will end in stillbirth, of which about one-third will remain unexplained. Unexplained stillbirth is the largest single contributor to perinatal mortality. Subsequent pregnancies do not appear to have an increased risk of stillbirth, but are characterized by increased rates of intervention (induction of labor, elective cesarean section) and iatrogenic adverse outcomes (low birth weight, prematurity, emergency cesarean section and post-partum hemorrhage). Conclusions:There is no level-one evidence to guide management in this situation. Pre-pregnancy counseling is very important to detect and correct potential risk factors such as obesity, smoking and maternal disease. As timely delivery is the mainstay of management, early accurate determination of gestational age is vital. There is controversy regarding the pattern of surveillance, but evidence exists only for ultrasound and not for regular non-stress testing, nor formal fetal movement charting. There is an urgent need for more studies in this important area.

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Section: Early Pregnancymentioning

confidence: 99%

Management of subsequent pregnancy after an unexplained stillbirth

Robson

Leader

2009

J Perinatol

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“…5,6 Ultrasound biometry before the 24th week of gestation is routinely used to predict the expected date of delivery. 7 It is generally considered that fetal growth restriction occurs in the second half of gestation and that variation in fetal size before 24 weeks is explained by delayed ovulation or uncertain indication of last menstrual period (LMP). 8,9 It has been shown, however, that small fetal size at gestational weeks [16][17][18][19][20] increases the risks of several obstetric outcomes that are typically associated with intrauterine growth restriction, such as perinatal death, preterm and/or small-for-gestational-age (SGA) birth.…”

Section: Introductionmentioning

confidence: 99%

Expected day of delivery from ultrasound dating versus last menstrual period—obstetric outcome when dates mismatch

Thorsell

Kaijser

Almström

et al. 2008

BJOG

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Objective To analyse the association between fetal size at time of dating ultrasound and risk for preterm delivery and small‐for‐gestational‐age (SGA) birth and to evaluate if timing of ultrasound, that is before 14 weeks of gestation or after 16 weeks affects this association. Design Retrospective cohort study. Setting Ultrasound departments of Ultragyn, Stockholm, Sweden. Population A total of 28 776 singleton pregnancies dated between 1998 and 2004. Methods Obstetric outcome was assessed through linkage of the cohort to the Swedish Medical Birth Register. Main outcome measures Risks of preterm delivery, low birthweight for gestational age, pre‐eclampsia, asphyxia, respiratory distress, instrumental delivery, caesarean section, and postterm birth were calculated for the groups dated early and late. Results When the expected date of delivery was postponed after ultrasound dating by 7 days or more, there was an increased risk for preterm delivery and pre‐eclampsia in the late dating group (OR 1.49, 95% CI 1.27–1.73 and OR 1.27, 95% CI 1.02–1.60, respectively) but not in the early dating group. In both dating groups, there was an increased risk for SGA birth (OR 1.77, 95% CI 1.13–2.78 and OR 2.09, 95% CI 1.59–2.73, respectively) There was no increased risk for any of the other diagnoses. Conclusion Our study gives further support to the notion that intrauterine growth restriction may be present as early as the first trimester. Accordingly, our study also suggests that surveillance of pregnancies with postponed estimated date of delivery may provide means for increased detection of fetal growth restriction.

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“…While the utility of ultrasound for prenatal screening and diagnosis has been debated, 15 ultrasound has additional benefits, including accurate pregnancy dating and early detection of unexpected problems. 16,17 Fetal ultrasound also appears to be popular with parents and primary health care providers, which will probably improve the link between primary and tertiary care.…”

Section: Discussionmentioning

confidence: 99%

Effectiveness of prenatal screening for Down syndrome on the basis of maternal age in Cape Town

et al. 2011

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Down syndrome (DS) is the most common genetic cause of intellectual disability. Evidence suggests that live-birth prevalence of DS is high in South Africa: 1.33 -1.8 per 1 000 live births in two urban areas, 1,2 and 2.1 per 1 000 in a rural area. 3 Prenatal screening for DS was established in the 1970s using advanced maternal age (AMA) as a risk factor, and this remains the standard of care in the public health sector of South Africa. National policy provides for free amniocentesis to be offered to AMA women, whereas biochemical screening is not offered and access to fetal ultrasound is limited.Cape Town's public health services are among the best developed in South Africa. Although access to fetal ultrasound has increased in recent years, AMA remains a frequent indication for prenatal genetic counselling. The study focused on the Cape Town Metropole West health district (CT West) to obtain evidence regarding the effectiveness of age-based screening for the prevention of DS, and preliminary evidence regarding factors affecting utilisation of prenatal diagnosis. We assessed (i) laboratory trends in prenatal diagnostic testing over a 30-year period, (ii) trends in uptake of prenatal diagnostic testing among women receiving genetic counselling and (iii) the referral pathway from primary care to tertiary care. MethodsStudy population. Women attending state antenatal health care services in CT West, which comprises a large and diverse urban population, with a majority coloured population, and minorities of whites and blacks. The district has experienced rapid urbanisation and considerable demographic changes. In 2005, there were approximately 34 000 deliveries in the district (Patel, unpublished data).Study sites and services. The antenatal health service and cytogenetic laboratory service in CT West have been stable since the 1970s. The health service includes several primary and secondary level facilities, and tertiary level fetal medicine and pregnancy counselling services at Groote Schuur Hospital (GSH). The University of Cape Town (UCT) Cytogenetic Laboratory (CL) has provided prenatal and postnatal diagnostic laboratory services to CT West throughout the period. Prenatal diagnostic testing is almost exclusively by amniocentesis, and indications have included increased risk of DS (most commonly AMA, but more recently also based on ultrasound markers (first trimester nuchal translucency thickness and second trimester soft markers) and fetal anomalies detected on ultrasound. The age cut-off for AMA counselling has varied over the years.UCT CL database. The laboratory has maintained a database of samples received since the early 1970s. Initially this was a written record but all records were transferred to Microsoft Access in the mid-1990s, and a parallel written and computerised database was maintained. To improve data quality, the database was cleaned by cross-referencing blank or unclear computer data fields with the written records -the remaining missing data represented less than 5% of data points per category...

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Ultrasound for fetal assessment in early pregnancy

Cited by 42 publications

References 27 publications

Management of subsequent pregnancy after an unexplained stillbirth

Management of subsequent pregnancy after an unexplained stillbirth

Expected day of delivery from ultrasound dating versus last menstrual period—obstetric outcome when dates mismatch

Effectiveness of prenatal screening for Down syndrome on the basis of maternal age in Cape Town

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