J.J. Stirnemann, G. Benoist, L.J. For 103 of these 107 women, 97% (71 of 73) in the intervention strategy and 87% (26 of 30) in the usual care group had Doppler scans. View Record in Scopus Google Scholar. Even if birth weight can be estimated accurately, many small babies are constitutionally small but healthy.11 In the POP study, about 70% of fetuses with an estimated fetal weight below the 10th centile were not growth restricted and had similar perinatal outcomes compared to those with a greater estimated fetal weight.11 Disadvantages associated with routine ultrasound scans in the third trimester might be increased levels of emotional distress in women because of an inaccurate suspicion of fetal growth restriction and increased exposure to additional diagnostic tests, monitoring, and obstetric interventions.3940 That the incidence of most obstetric interventions was not significantly different between the groups is reassuring but we found a higher incidence of induction of labour associated with the intervention strategy, with no evidence of better perinatal outcomes. Practices were stratified before randomisation into large and small practices, with the median practice size (300 women annually) as a cut‐off. In the United Kingdom, United States of America, and many European countries, third trimester ultrasound is not performed as routine clinical practice, although this trend is changing, with the primary clinical driver being attempting to … Author information: (1)Obstetrics and Gynecology, Ultrasound Unit, University Women's Hospital of Basel, Basel, Switzerland. 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. Le Ray C(1), Morin L. Author information: (1)Département d'obstétrique gynécologie, CHU Sainte Justine, Montréal (Québec). In some units in Sweden, a second ultrasound screening examination is offered in the third trimester to identify small‐for‐gestational age fetuses (SGA). This strategy was not, however, associated with a reduction in the incidence of severe adverse perinatal outcomes in low risk pregnancies compared with usual care including clinically indicated ultrasonography. From 1 February 2015, 60 midwifery practices participated in the IRIS study (about 12% of practices in the Netherlands). Also, sensitivity was 22% for an abdominal circumference below the 10th centile in the intervention strategy, similar to the findings of a large nationwide French population based study (n=14 100).9 Single centre studies with smaller sample sizes, however, showed better accuracy, which might be because a limited number of dedicated sonographers performed the ultrasound scans.1116 Sensitivity and specificity rates vary with the prevalence of disease.34 As our study was conducted in a low risk population, a lower sensitivity and higher specificity might be expected than in the general population. Description: A well defined, anechoic rounded cystic structure is seen in the fetal lower … Information was also obtained from many hospital records, but for most women only routine registration data for adverse outcomes were available. Routine ultrasound examination at 35–37 weeks' gestation may reveal new fetal abnormalities that could not be diagnosed at earlier examinations. Some sonographers worked in both primary care centres and hospitals and others worked in primary care only. The stepped wedge design reduced confounding owing to differences between midwifery practices because each practice applied the control and intervention strategy for some of the time. Midwifery practices formed the unit of cluster randomisation. Even if the quality of ultrasonography is improved, the most appropriate screening test for fetal growth restriction is not clear. 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. Also, we adjusted our main analyses for potential confounders selected a priori and based on previous literature: maternal age; body mass index; smoking, alcohol, or recreational drug use; parity; educational level; employment status; marital status; infant’s sex; and size of the midwifery practice (≤300 or >300 women annually).3132 Analyses were performed on complete case analysis given that less than 5% of the data on confounders were missing. Epub 2017 Sep 7. Assuming an intracluster correlation coefficient of 0.0003 based on previous literature,28 and an a priori assumed average cluster size (ie, practice size of 250 women annually), we aimed to include 15 000 pregnant women (7500 for each strategy) to be able to take possible clustering effects into account.20. Routine mid-trimester fetal ultrasound scan Consideration must be given to local circumstances and medical practices. Diagnostic Obstetric Ultrasound. Authors. The incidence of severe adverse perinatal outcomes was 1.7% (n=118) for the intervention strategy and 1.8% (n=106) for usual care. •A 1998 to 2008 study scanned 5044 fetuses between 28 and 32 … Nevertheless, our findings are in line with a previous meta-analysis, which failed to show better perinatal outcomes in women who received routine ultrasound scans after 24 weeks’ gestation, based on 13 previous trials (n=34 980).15. JH, JW, and VV conducted data analyses. In the second or third trimester a standard ultrasound is done to evaluate several features of the pregnancy, including fetal anatomy. Similarly, ultrasound cannot penetrate bone, but may be used for imaging bone fractures or for infection surrounding a bone. Third, to define the predictive performance for a LGA neonate of different EFW cut-offs on routine ultrasound examination at 35+0to36+6weeks’ gestation. Introduction. From 1 February 2015 to 29 February 2016, pregnant women in the participating midwifery practices who fulfilled the inclusion criteria were informed about the study and given a trial information leaflet by their midwife during the first consultation. Sonographers met predefined quality criteria, and a multidisciplinary protocol was developed for detecting and managing fetal growth restriction to achieve the best quality care possible in a pragmatic nationwide study.1320. But we do not expect that this has biased the comparison between the two strategies as the incidence of adverse outcomes was similar to our estimations. With this design, each practice first applied usual care and then switched to offering routine ultrasonography in the third trimester at a defined moment during the study, depending on the randomisation scheme. •An additional ultrasound for fetal structural anomalies in the 3rd trimester seems important for many reasons ????? Perined. Although routine comprehensive third trimester ultrasound examination is not standardly performed for routine low-risk pregnancy care, indications commonly arise for ultrasound assessment of fetal well-being in both low- and high-risk pregnancies. Reinar LM, Smedslund G, Fretheim A, Hofmann B, Thürmer H. Oslo, Norway: Knowledge Centre for the Health Services at The Norwegian Institute of Public Health (NIPH); 2008 Jun. Additional fetal anomalies diagnosed after two previous unremarkable ultrasound examinations. Our randomized trial suggests that among women with uncomplicated pregnancies at 24 0/7 to 30 6/7 weeks of gestation, serial third-trimester ultrasound examinations are more likely to identify a composite of abnormalities of fetal growth or amniotic fluid than routine care. This site needs JavaScript to work properly. 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. Severe adverse perinatal (composite) outcome and secondary neonatal outcomes, Maternal outcomes and peripartum interventions. Large patients are more difficult to image by ultrasound because greater amounts of tissue attenuate (weaken) the sound waves as they … 1;31(2):113-9. Minimal changes were made. Manegold G(1), Tercanli S, Struben H, Huang D, Kang A. Twenty practices provided the intervention in the second period (May to August 2015), 40 in the third period (September to November 2016), and 59 in the fourth period (December 2015 to February 2016) (fig 1). Our trial addressed important shortcomings of previous studies.15 Modern ultrasound equipment was used, sonographers met predefined quality criteria, and a multidisciplinary protocol was applied. Time of inclusion, divided into four groups according to the crossover from usual care to the intervention strategy, was considered as a fixed factor. While occasional false contractions are expected, regular contractions should wait until close to your due date. 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 … Methods A retrospective cohort study of 1008 pregnancies with maternal BMI ≥ 35 … Although higher numbers of births were observed in obstetrician led care in the intervention strategy compared with usual care strategy (65.0% v 63.3%; table 5), this association was not significant in a multilevel multivariable logistic regression adjusted for confounders (1.05, 0.96 to 1.14). 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. OBJECTIVE: To evaluate whether serial ultrasound ex-aminations in the third trimester increase identification of a composite of growth or amniotic fluid abnormalities when compared with routine care among pregnancies that are uncomplicated between 24 0/7 and 30 6/7 weeks of gestation. 60. This funding source had no role in study design, data collection, data analysis, data interpretation, writing of the scientific article, or the decision to submit the paper for publication. Previous research suggests that most of these babies are likely to be constitutionally small rather than growth restricted and would not be at increased risk of severe adverse perinatal outcomes.11 Women assigned to the usual care strategy had one clinically indicated ultrasound scan on average in the third trimester of pregnancy. Neonates of the participating women were born between June 2015 and August 2016. Such methods include other ultrasound markers of fetal compromise, maternal and placental biomarkers, and maternal awareness of fetal wellbeing. Le Ray C, Lacerte M, Iglesias MH, et al. What Is Different In A Third Trimester Ultrasound? In 2010, the Dutch Ministry of Health considered introducing routine third trimester biometry as a … ... Third, to define the predictive performance for a LGA neonate of different EFW cut-offs on routine ultrasound examination at 35 + 0 to 36 + 6 weeks' gestation. This exam is typically done between weeks 18 and 20 of pregnancy. Acta Obstet Gynecol Scand. Of 5049 women (84.4% of 5979 women) receiving usual care, who were not referred to obstetrician led care before 37 weeks’ gestation, 41.0% (n=2072) did not receive a third trimester ultrasound scan. 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. Deliveries between 1985 and 1996 were included. Caption: View of the fetal abdomen. 139-143. Both approaches included a multidisciplinary protocol for detecting and treating fetal growth restriction. Second, data from 14,497 singleton pregnancies that had undergone routine ultrasound examination at 35+0 - 36+6 weeks’ gestation and had a previous scan at 30+0 – 34+6 weeks were used to determine, through multivariable logistic regression analysis, whether addition of growth velocity, defined by a difference in EFW and AC Z-scores between the early and late third trimester … Two dichotomous maternal composite outcomes were defined as secondary outcomes. The remaining 59 practices participated in the study until 29 February 2016. Setting 60 midwifery practices in the Netherlands. Nineteen practices performed biometry scans and the others referred women to one of the 18 sonography centres involved in the study. Prediction of large-for-gestational-age neonate by routine third-trimester ultrasound. Deliveries between 1985 and 1996 were included. The IRIS study was a nationwide, stepped wedge cluster randomised trial conducted in 60 primary care midwifery practices in the Netherlands in low risk pregnant women. METHODS: Women without complications between 24 Routine antenatal ultrasonography might therefore have little or no added benefit in detecting SGA neonates at risk of adverse outcomes compared with clinically indicated ultrasonography as part of usual care in the third trimester. 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. Ethical approval: The IRIS study was approved by the Dutch Institutional Review Board of the VU Medical University Centre Amsterdam (reference No 2013.409). NVOG-richtlijn Foetale groeirestrictie (FGR). … gene disorders such as achondroplasia, thus providing a noninvasive tool for diagnosing skeletal dysplasia . After the first randomisation in April 2015, one midwifery practice withdrew from the study because of time constraints. In the intervention and control strategies, we used prenatal SGA and slow fetal abdominal growth as indicators for suspected fetal growth restriction. Secondary neonatal outcomes were also not significantly different between the two strategies. Data from 13 024 (96.3%) women and neonates were linked to data in the Perined database. Of 5840 women (82.6% of 7067 women) in the intervention strategy, who were not referred to obstetrician led care before 37 weeks’ gestation, 3.0% (n=177) did not receive a third trimester ultrasound scan. 201 results for routine third trimester ultrasound Sorted by Relevance . Finally, our study was conducted in one country (the Netherlands) where primary antenatal care of uncomplicated pregnancies is provided by midwives who are educated, trained, and officially registered as independent health practitioners.21 When risk factors or complications occur, women are referred to obstetrician led care. An independent statistician performed randomisation on anonymous data from the midwifery practices. Possible explanations for our findings are: routine ultrasound fetal biometry is ineffective in detecting fetal growth restriction and preventing subsequent adverse outcomes in low risk pregnancies; adding routine ultrasound scans in the third trimester to usual care does not yield major benefits because women receiving such care already undergo one clinically indicated ultrasound scan on average in the third trimester; the quality of ultrasonography was insufficient; and using fetal abdominal circumference below the 10th centile (in combination with biometric measures of slow growth) on a population based curve is ineffective in detecting fetal growth restriction, and better methods are required. Obstetrics » Obstetrics 2nd And 3rd Trimester.  |  The manuscript’s guarantor (AdJ) affirms that this manuscript is an honest, accurate, and transparent account of the study being reported; that no important aspects of the study have been omitted; and that any discrepancies from the study as planned have been explained.  |  Design Pragmatic, multicentre, stepped wedge cluster randomised trial. Objective To compare in low‐risk pregnancies the proportion of small‐for‐gestational‐age (SGA) infants detected by routine third trimester ultrasound versus by selective ultrasound … Identify common indications for third‐trimester ultrasound Role of late ultrasound in detection of fetal abnormalities. NIH | Sort by Date Showing results 1 to 50. Suspected fetal growth restriction was detected and managed based on a protocol specifically developed for this study in a Delphi study incorporating recommendations from national and international guidelines (see appendix 1).13141725. 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