technical support for your product directly (links go to external sites): Thank you for your interest in spreading the word about The BMJ. Prevention and treatment information (HHS), NLM Methods A retrospective cohort study of 1008 pregnancies with maternal BMI ≥ 35 … The remaining 13 520 women were enrolled in mid-pregnancy (mean 22.8 (SD 2.4) weeks’ gestation) and provided baseline characteristics. 60. In a multilevel multivariable logistic regression analysis, routine ultrasonography in the third trimester was not related to the composite outcome of maternal peripartum morbidity or mortality (1.06, 0.95 to 1.18), or spontaneous labour and birth (1.00, 0.92 to 1.08). 2008.  |  After the 20 week anomaly screening had been conducted if desired, the women were invited to take part in the study. This Case presentation aims to highlight several learning points and to discuss the importance integrating colour Doppler Studies with routine 3 rd trimester ultrasound exams . Antenatal care for uncomplicated pregnancies. Secondary neonatal outcomes were also not significantly different between the two strategies. A randomized controlled study to assess the role of routine third trimester ultrasound in low-risk pregnancy on antenatal interventions and perinatal outcome. Fetal gestational age corresponded to 34 weeks.  |  Funding: This study was supported by a grant from the Netherlands Organisation for Health Research and Development (ZonMw; grant No 209030001).  |  In both strategies, women with suspected fetal growth restriction were referred to obstetrician led care for further diagnosis and management. This practice is based mainly on results of a meta-analysis published in 2001 that concluded "routine late pregnancy ultrasound in low-risk or unselected populations … This is an Open Access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. These 5840 non-referred pregnant women had a mean number of 1.91 (SD 0.8) scans for the indication biometry. 11 15 Routine ultrasonography in the third trimester detects SGA at birth more often than usual care, which comprises serial fundal height measurements combined with clinically indicated ultrasonography. NICE. Manegold G(1), Tercanli S, Struben H, Huang D, Kang A. The corresponding author attests that all listed authors meet authorship criteria and that no others meeting the criteria have been omitted. The effect estimates of our main analyses might therefore be overestimated. Identify common indications for third‐trimester ultrasound Role of late ultrasound in detection of fetal abnormalities. This question is for testing whether or not you are a human visitor and to prevent automated spam submissions. 139-143. … gene disorders such as achondroplasia, thus providing a noninvasive tool for diagnosing skeletal dysplasia . Skråstad RB, Eik-Nes SH, Sviggum O, Johansen OJ, Salvesen KÅ, Romundstad PR, Blaas HG. Through the pregnancy ultrasound, a doctor can ensure that everything looks good. Description: A well defined, anechoic rounded cystic structure is seen in the fetal lower … The maternal cervix and adnexa should be examined as clinically appropriate when technically feasible. Epub 2020 Sep 20. None of these results was significantly different between the two strategies. For suspected severe adverse perinatal outcomes based on the Perined database, five trained research assistants retrieved detailed clinical data from hospital files using standard case report forms. View Record in Scopus Google Scholar. Clipboard, Search History, and several other advanced features are temporarily unavailable. Competing interests: All authors have completed the ICMJE uniform disclosure form at www.icmje.org/coi_disclosure.pdf and declare: for the current study (the IRIS study), AdJ and JW received funding from the Netherlands Organisation for Health Research and Development; no financial relationships with any organisations that might have an interest in the submitted work in the previous three years; no other relationships or activities that could appear to have influenced the submitted work. We recommend to examine the psychological impact of third trimester routine ultrasounds in future studies. Study sample in stepped wedge cluster randomised trial, showing numbers recruited in each cluster and period. Dutch Association of Obstetrics and Gynaecology (NVOG)-guideline Fetal Growth Restriction (FGR), Dutch Association of Obstetrics and Gynaecology, Routine ultrasound in late pregnancy (after 24 weeks’ gestation), Value of a single early third trimester fetal biometry for the prediction of birth weight deviations in a low risk population, Evidence-based national guidelines for the management of suspected fetal growth restriction: comparison, consensus, and controversy. AdJ, AF, HEvdH, PJ, VV, and EP conceived and designed the study. Also, we used registration data as an initial screening for potential severe adverse perinatal outcomes. •Some abnormalities develop or first become apparent later in pregnancy. Oxytocin would, however, have been used as part of the induction of labour strategy but this would not have been recorded separately in the Perined database. Because of the nature of the intervention, it was not possible to blind participants, care providers, and researchers to group allocation. We defined prenatal SGA as a fetal abdominal circumference below the 10th centile based on a population based Dutch reference growth curve.24 Slow fetal abdominal growth was defined as a decrease in abdominal circumference of at least 20 centiles (eg, from the 70th to 50th centile, with a minimum interval of two weeks) on the Dutch reference curve.1324 A volume of amniotic fluid of less than 2 cm in the deepest vertical pocket was also an indication of suspected fetal growth restriction. How often do we identify fetal abnormalities during routine third-trimester ultrasound? In this large, pragmatic, nationwide, stepped wedge cluster randomised trial in low risk pregnant women, using a multidisciplinary protocol for detecting and managing fetal growth restriction, routine ultrasonography in the third trimester improved prenatal detection of neonates who were small for gestational age (SGA) compared with usual care. For this trial, we developed a multidisciplinary protocol based on consensus for detecting and managing suspected fetal growth restriction.13 We chose a cluster randomised design to roll-out the intervention and to avoid contamination bias due to the women’s preferences for or against ultrasound scans.20 The stepped wedge design facilitated the participation of a large number of midwifery practices, even if they had a preference for one of the screening strategies. Pregnant women’s reaction to detection of a soft marker during ultrasound screening. *One midwifery practice withdrew from the study before crossover to the intervention strategy (59 practices participated in the study). We cannot therefore completely rule out that the study lacked the statistical power to determine if routine ultrasonography has a beneficial or harmful effect on perinatal outcomes compared with usual care. We performed double entry analyses in a 5% sample of the hospital record forms collected. In both strategies, women with suspected fetal growth restriction were referred to obstetrician led care for further diagnosis and management. The routine use of 3rd trimester Doppler Ultrasound studies resulted in the identification of an additional 30.28% fetuses in the EFW 10-50th centile or 11.26% of overall screened population (n=76 of 675 fetuses) to be at risk for adverse perinatal outcomes. Data sharing: No additional data available. Authors. Of the pregnant women (n=107) referred to obstetrician led care because of a fetal abdominal circumference below the 10th centile, 97% (74 of 76) in the intervention strategy had additional ultrasound scans compared with 97% (30 of 31 women) receiving usual care. A study also showed that a suspicion of SGA was associated with a higher incidence of initiated delivery by the provider.9 The incidence of augmentation of labour was lower in the intervention strategy. : Just wondering if most OB's offer a routine ultrasound at some point in your third trimester. The primary outcome was a dichotomous composite measure of 12 adverse perinatal outcomes occurring up to seven days after birth: perinatal death between 28 weeks’ gestation and seven days after birth; Apgar score <4 at five minutes; impaired consciousness (coma, stupor, or decreased response to pain); asphyxia, with arterial base excess of cord blood less than −12 mmol/L; seizures on at least two occasions within 72 hours of birth; assisted ventilation by endotracheal tube for more than 24 hours started within 72 hours of birth; septicaemia confirmed by blood culture; meningitis confirmed by culture of cerebrospinal fluid; bronchopulmonary dysplasia requiring oxygen after 36 weeks’ gestation and confirmed by radiography; intraventricular haemorrhage grade 3 or 4 confirmed by ultrasonography or autopsy; cystic periventricular leucomalacia confirmed by ultrasonography; or necrotising enterocolitis confirmed by radiography, surgery, or autopsy. The control strategy (usual care) comprised fetal growth monitored by serial fundal height measurements and ultrasonography if clinically indicated. Some growth charts are universal and prescriptive, which means they show optimal growth in a healthy population, whereas others are customised for maternal characteristics, such as parity and ethnicity. 205 results for routine third trimester ultrasound Sorted by Relevance . | Sort by Date Showing results 1 to 10. Challenges for future research are to identify the most appropriate fetal growth and birth weight charts and to develop more sensitive and effective methods to detect fetal growth restriction. A stratified computer generated randomisation sequence determined the order in which practices changed from the control to intervention strategy. Routine ultrasound screening in the second trimester is used to confirm gestation age, and to diagnose multiple pregnancy and major fetal malformation. The non integration of colour Doppler studies and reliance only on fetal biometry and estimated fetal weight will have led us to miss the diagnosis of Stage 1 FGR. In the Netherlands, hospitals provide secondary and tertiary antenatal care, whereas primary care midwives are independent medical practitioners qualified to provide full maternity care for women with uncomplicated low risk pregnancies.21 Midwifery practices were invited to participate in the IRIS study at meetings, at postgraduate courses, and through social media and professional journals.20 Practices were included if the midwives had completed the postgraduate registration training in the detection of fetal growth restriction based on the guideline of the Royal Dutch Association of Midwives (KNOV).17 Biometry scans were performed in sonography centres or in midwifery practices. •The detection of fetal structural abnormalities is a routine part of antenatal care. Study design: Two university clinics using routine ultrasound screening in the third trimester were compared with seven county or district hospitals with no routine screening. Such methods include other ultrasound markers of fetal compromise, maternal and placental biomarkers, and maternal awareness of fetal wellbeing. Women’s appreciation of a third trimester routine ultrasound might arise from getting used to routine ultrasounds throughout pregnancy. Policies for routine third trimester obstetrical ultrasound examinations differ among countries. Le Ray C(1), Morin L. Author information: (1)Département d'obstétrique gynécologie, CHU Sainte Justine, Montréal (Québec). Karim JN, Roberts NW, Salomon LJ, Papageorghiou AT. Table 1 shows the baseline characteristics of the participating midwifery practices. For every topic, specific questions were formulated (see Table 2 in Appendix). 2008. Some sonographers worked in both primary care centres and hospitals and others worked in primary care only. Conclusion In low risk pregnancies, routine ultrasonography in the third trimester along with clinically indicated ultrasonography was associated with higher antenatal detection of small for gestational age fetuses but not with a reduced incidence of severe adverse perinatal outcomes compared with usual care alone. Secondary outcomes were two composite measures of severe maternal morbidity, and spontaneous labour and birth. Objectives To investigate the effectiveness of routine ultrasonography in the third trimester in reducing adverse perinatal outcomes in low risk pregnancies compared with usual care and the effect of this policy on maternal outcomes and obstetric interventions. Would you like email updates of new search results? In the intervention and control strategies, we used prenatal SGA and slow fetal abdominal growth as indicators for suspected fetal growth restriction. In a multilevel multivariable logistic regression adjusted for confounders, routine ultrasonography in the third trimester was associated with a higher incidence of induction of labour (1.16, 1.04 to 1.30) and a lower incidence of augmentation of labour (0.78, 0.71 to 0.85). We set the level of significance at P<0.05. Flow chart of IRIS study. Knowledge Centre for the Health Services at The Norwegian Institute of Public Health (NIPH). Compare the evidence for and against routine third‐trimester ultrasound screening. Also, in the intervention strategy, significantly more SGA neonates (32%) had an abdominal circumference below the 10th centile or slow fetal growth compared with SGA neonates in the usual care strategy (19%; P<0.001) and specificity differed significantly (90% and 97%, respectively; P<0.001) (table 3). Copyright © 2021 BMJ Publishing Group Ltd     京ICP备15042040号-3, Update on the diagnosis and classification of fetal growth restriction and proposal of a stage-based management protocol, Intrauterine growth restriction and later cardiovascular function, Intrauterine growth restriction: postnatal monitoring and outcomes, Major risk factors for stillbirth in high-income countries: a systematic review and meta-analysis, Restricted fetal growth in sudden intrauterine unexplained death, Altered small-world topology of structural brain networks in infants with intrauterine growth restriction and its association with later neurodevelopmental outcome, Risk factors for small for gestational age infants, Poor effectiveness of antenatal detection of fetal growth restriction and consequences for obstetric management and neonatal outcomes: a French national study, Comparison of fetal and neonatal growth curves in detecting growth restriction, Screening for fetal growth restriction with universal third trimester ultrasonography in nulliparous women in the Pregnancy Outcome Prediction (POP) study: a prospective cohort study, Consensus definition of fetal growth restriction: a Delphi procedure, Multidisciplinary consensus on screening for, diagnosis and management of fetal growth restriction in the Netherlands. Routine third trimester biometry ultrasound scans predict SGA at birth substantially better than care as usual, i.e. The overall incidence of a severe adverse perinatal composite outcome was 1.7% (n=224); 1.7% (n=118) for the intervention strategy and 1.8% (n=106) for the usual care strategy (table 4). Information was also obtained from many hospital records, but for most women only routine registration data for adverse outcomes were available. Diagnostic accuracy of two screening strategies with small for gestational age (SGA) at birth as outcome. The intervention entails routine third trimester ultrasound screening combined with serial fundal height measurements and clinically indicated ultrasonography, while the control condition entails CAU (serial fundal height measurements and clinically indicated ultrasonography only). Table 3 shows the diagnostic accuracy for detecting SGA at birth (birth weight <10th centile) for both screening strategies. The incidence of severe adverse perinatal outcomes was 1.7% (n=118) for the intervention strategy and 1.8% (n=106) for usual care. Practices were stratified before randomisation into large and small practices, with the median practice size (300 women annually) as a cut‐off. The first composite outcome was at least one of four maternal adverse peripartum outcomes: maternal death within 42 days of birth, hypertensive disorders or pre-eclampsia (diastolic blood pressure ≥95 mm Hg with or without proteinuria, or ≥90 mm Hg with proteinuria), postpartum haemorrhage of 1000 mL or more, or anal sphincter damage. What Is Different In A Third Trimester Ultrasound? The positive predictive value of an abdominal circumference below the 10th centile was higher for the second routine scan (59%) at 34-36 weeks’ gestation than for the first scan at 28-30 weeks’ gestation (37%), whereas negative predictive values were similar, in line with the findings of the POP study.11 Thus late third trimester scans seem to have more diagnostic accuracy than earlier ones. Based on the hospital records, we also calculated the number of women who received additional ultrasound and Doppler scans in obstetrician led care after they were referred for suspected fetal growth restriction by midwives because of fetal abdominal circumference below the 10th centile or slow fetal abdominal growth. Large patients are more difficult to image by ultrasound because greater amounts of tissue attenuate (weaken) the sound waves as they … In the second or third trimester a standard ultrasound is done to evaluate several features of the pregnancy, including fetal anatomy. This will have limited the … Although the accuracy of ultrasonography in detecting low birth weight is higher than that of fundal height measurement, systematic errors in the prediction of SGA neonates using fetal abdominal circumference or estimated fetal weight limit its accuracy because these predictions are based on an estimation with an algorithm.35 Nevertheless, even if not used routinely, fetal biometry is frequently performed. Pregnant women seem to appreciate a third trimester routine ultrasound, but it does not seem to reduce anxiety or to improve bonding with their baby. Find out what to expect at your first and second trimester ultrasound appointments, what you can learn from those ultrasounds, and why you might need an ultrasound (or a few) in the third trimester. We performed a multilevel analysis only if the expected number of events per cluster was at least one, as advocated previously.33 We used an intention to treat approach. After the first randomisation in April 2015, one midwifery practice withdrew from the study because of time constraints. Trial registration Netherlands Trial Register NTR4367. Client organisations will be involved in communicating the findings of the study to the general public. No significant differences were found in maternal morbidity and mortality between the groups (table 5). Double entry analyses on hospital case report forms of 111 women were carried out. With an α of 5% and 80% power, inclusion of 13 536 women was required. Sonographers conducted third trimester biometry according to the guidelines of the Dutch Society of Obstetrics and Gynaecology (NVOG).2223 Sonographers who participated in the IRIS study were experienced in performing biometry and held a certificate for structural anomaly screening (73% of 154 participating sonographers) or passed a biometry quality test before the trial (27%), based on four biometry scans assessed by two experienced sonographers; had successfully completed a module on fetal biometry from a national Dutch medical e-learning education programme (see www.medicaleducation.nl); and used ultrasound equipment according to the standards of the Dutch Society of Obstetrics and Gynaecology.14 Two independent and experienced sonographers who were board members of the Dutch Professional Organisation of Sonographers carried out quality assessments of the sonographers during the trial. , and adj drafted the manuscript and interpreted the results practices changed from the control to intervention strategy ( care.: ( 1 ) Obstetrics and Gynecology, ultrasound Unit, University women 's med. 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