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ObjectiveTo explore procedures for providing information, assessment and documentation about ultrasound soft markers in Sweden. DesignDescriptive, quantitative, cross-sectional survey. SampleEighty-two percent of all obstetric ultrasound clinics in Sweden (covering >90% of routine fetal ultrasound examinations). MethodsPostal questionnaire survey between December 2010 and January 2011. Main outcome measuresItems about provision of information, risk estimation, and follow-up strategies in relation to observed ultrasound soft markers. ResultsMore than 96% of all fetal routine ultrasound examinations were performed at 15-21 gestational weeks, primarily by midwives. Half of the clinics replying wanted prospective parents to be provided with information, but 38 (78%) of the clinics did not routinely inform about assessment of soft markers before the examination. Follow up and decisions on whether to give information when soft markers were found were based on the number and type of the observed markers, whether other structural deviations existed, and on the woman's age and anxiety level. Only at eight clinics (17%) were parents informed about all soft marker findings. At 13 clinics (28%) observed markers were documented/recorded, even though the women were not informed. ConclusionsInformation regarding the assessment and importance of observed soft markers seems to be inconsistent and insufficient. Provision of information and documentation of findings appear to be handled differently at obstetric ultrasound clinics. This suggests that Swedish ethical principles relating to healthcare and ultrasound examinations are incompletely followed and national guidelines appear to be necessary.

This study assessed the sensitivity of routine ultrasound examination for the detection of abnormal chromosomes and structural malformations in fetuses in the second trimester in a non-selected population.Prenatal diagnoses of fetal abnormalities in 10 414 fetuses and newborns were reviewed and compared with all postnatal diagnoses of congenital abnormalities between 2006 and 2013.Overall, 243 fetuses and newborns had confirmed congenital abnormalities, with a prevalence of 2.3%. Of these fetuses and newborns, 23% (56/243) had chromosomal abnormalities (overall prevalence 0.5%), and 77% (187/243) had normal chromosomes with either major (44%; 82/187) or minor (56%; 105/187) structural malformations (overall prevalence 1.8%). One hundred and seven abnormalities were detected prenatally, yielding a total sensitivity for prenatal detection of fetal abnormalities of 44.0% (107/243; 95% CI 37.8-50.2), with specificity of 99.9%, a positive predictive value of 94.7%, and a negative predictive value of 98.7%. The sensitivity for prenatal detection before 22 weeks of gestation was 40.3% (98/243; 95% CI 34.1-46.5). The prenatal detection rate of chromosomal abnormalities was 60.7% (34/56) and, for structural malformations, was 39.0% (73/187).In a routine clinical setting at a county hospital with a non-selected population, half of the major structural malformations in chromosomally normal fetuses are detected by routine ultrasound examination in the second trimester. Chromosomal abnormalities have the highest probability for prenatal detection; the majority are diagnosed by amniocentesis before the routine ultrasound examination in high-risk women.

Background. To assess the sensitivity for detecting fetal congenital anomalies by a routine ultrasound examination program at midtrimester performed in an unselected population by midwives and specialists in obstetrics and gynecology.Methods. Six hundred seventy-six of the pregnancies had the midtrimester ultrasound examinations performed outside the county. Three hundred seventeen of the women had midtrimester ultrasound examinations performed in the county, but delivered outside the county. A total of 18 181 pregnancies were eligible for the study.Results. Altogether there were 267 fetuses and newborns with anomalies, which gives a prevalence of 1.5%. One hundred three of the 267 anomalies were detected at the midtrimester ultrasound examination, yielding a sensitivity of 39.0%. There were 11 false positives and 163 remained undiagnosed (false negatives), which gives a specificity of 99.9% and a positive predictive value of 90.4%. The sensitivity for detecting anomalies ranged from 74.4 to 8.3% accordin...

The patient was a 26-year-old primigravida who underwent routine ultrasound examination at gestational week 18 + 3 according to last menstrual period.The pregnancy had been uneventful with no signs...

Evaluation of the precision of routine ultrasound term prediction.Population based follow-up without intervention.Ultrasound screening in routine clinical practice.1650 women residing in one Norwegian county giving birth during a 12-month period. All pregnancies were singleton with spontaneous onset of labor, all records contained a term predicted with routine ultrasound in the second trimester.Difference between actual and predicted day of delivery, and difference between ultrasound predicted term and term calculated from last menstrual period.More women delivered within two weeks of ultrasound term than two weeks of term calculated from the last menstrual period (87.5% and 79.3%, p0.001). Deliveries were significantly closer to the ultrasound predicted term than the term calculated from the last menstrual period, with the exception of deliveries in the 39th week after LMP where no significant difference was found between ultrasound term and LMP-term. No difference was found in the mean performance of 14 different ultrasound operators.In a population representative of deliveries in one county, routine ultrasound term prediction performed in three medium sized hospitals more accurately predicted day of delivery than term calculated from the date of last menstrual period.

To assess and compare the sensitivity for detecting fetal anomalies and chromosomal aberrations by routine ultrasound examination performed in the second trimester with results from an examination performed at 11-14 weeks gestation.Observational study.Five centers in the southeast region of Sweden.A total of 21,189 unselected pregnant women.The scan was performed at one center in the first trimester and at the remaining four centers in the second trimester. Outcome measures resulting from first trimester scanning were compared with those from the second trimester scanning.Detection rates of fetal structural anomalies and chromosomal aberrations. Results. At the first trimester scan 13% of all anomalies were detected, and at the second trimester scan 29% were detected. Lethal anomalies were detected at a high level at both times: 88% in the first, 92% in the second. The percentage of chromosomal aberrations discovered at the early scan was 71%, in the later 42%. The percentage of heart malformations detected was surprisingly low.The results showed the advantages of the later scan in discovering anomalies of the heart, urinary tract and CNS, and of the early scan in discovering chromosomal aberrations. Lethal malformations were detected at a high level in both groups, but detection of heart malformations needs improvement.

The Danish National Board of Health recommended in 2004 routine ultrasound scanning in week 12 with nuchal translucency measurement, combined with the double test to all pregnant women. Those who were found to have a risk of trisomy 21 higher than 1:300 were offered amniocentesis or chorionic villus sampling (CVS). The total number of pregnancies in Denmark with an invasive prenatal procedure decreased from 6,929 in 1996 to 3,103 in 2006, the percentage of CVS increased from 45 to 69%, and the percentage of women below 35 years among those undergoing invasive procedures increased from 38 to 52%. The mean gestational age at which the procedures were done increased – for CVS from week 11 to 13, and for amniocentesis from week 16 to 17. We thus achieved to more than double the offer of prenatal screening and at the same time reduce the number of invasive procedures by 55%.

To estimate the detection rate of abnormal findings, especially fetal anomalies, at second trimester ultrasound screening performed in a way representative of Swedish antenatal clinics.A prospective study carried out over two years in Uppsala county, Sweden, including 8,228 unselected pregnant women (8,345 fetuses). The ultrasound scans were performed by specially trained midwives.The number of abnormalities suspected by the midwives and the number of abnormalities confirmed by the obstetricians were registered, as was pregnancy outcome for these cases.Midwives reported suspected abnormalities at the screening procedure in 59 cases (0.7%), abnormalities were confirmed by obstetricians in 42 cases (0.5%, of which 0.36% were fetal malformations). Seventeen of these 42 pregnancies were terminated and 11 ended with miscarriages or intrauterine fetal deaths. Fourteen of the 42 pregnancies ended with a live born infant, of which two died postnatally.The described ultrasound screening procedure led to suspected abnormalities in 0.7% of the scanned cases and to confirmed abnormalities in 0.5% of the cases. The outcome for the confirmed abnormalities was poor, as 71% were either terminated or ended with miscarriage or perinatal death.

This is a 5-year material of all singleton SGA (small for gestational age) infants born at the University Hospital in Lund, 1977-81, with a long-term follow-up. After the introduction of routine ultrasound scanning for all pregnancies in weeks 17 and 32 (1980-81), the rate of SGA-diagnosis before birth increased from 54.6% to 74.5% and the long-term outcome improved for term SGA infants. All women were treated according to a uniform policy regarding the termination of pregnancy--even in the early preterm period, if signs of fetal jeopardy appeared. More than half of all infants born before gestational week 34 died (40.0%) or showed major neurological handicap (16.0%) in spite of all being delivered by cesarean section. The corresponding figures for infants born in weeks 34-36 were 8.3% (deaths) and 8.3% (major handicaps); the cesarean section rate in this group was 83.3%. Term SGA-infants had an excellent outcome, with a low rate both for postnatal death (0.5%) and for major handicaps (2.0%). The results suggest that despite a high rate of antenatal diagnosis of intra-uterine growth retardation, and a uniform management of the pregnancy and the newborn, the high rate of cesarean delivery, and also intensive neonatal care, preterm SGA-infants are exposed to a greater risk of death or severe handicap.

Based upon 2 194 consecutive pregnancies with known gestational age, formulas for weight deviation predicted in the 32nd and 37th gestational week were estimated by multiple linear regression on the measurements of the abdominal d iameter (AD) and the biparietal diameter (BPD) of the first 64% of the pregnancies. The usefulness of the screening was evaluated on the remaining 36%. An attempt to diagnose light for gestational age (LGA) infants resulted in either a low sensitivity or a low predictive value of a positive test.The late third trimester screening was more sensitive than the early, indicating LGA as a late phenomenon in pregnancy. Knowing the result from the late scanning, the result from the early scanning contributed almost no further information about whether the infant would be LGA at birth. Basic epidemiological characteristics of other comparable investigations on high-risk pregnancies and non selected pregnancies are presented.