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Effectiveness of routine third trimester ultrasonography to reduce adverse perinatal outcomes in low risk pregnancy (the IRIS study)
- Source :
- BMJ (e), 367:5517, 1-13. BMJ Publishing Group, BMJ. British Medical Journal (Online), 367, BMJ-British medical journal, 367:l5517. BMJ Publishing Group, BMJ-British Medical Journal, 367:5517. BMJ PUBLISHING GROUP, Henrichs, J, Verfaille, V, Jellema, P, Viester, L, Pajkrt, E, Wilschut, J, Van Der Horst, H E, Franx, A & De Jonge, A 2019, ' Effectiveness of routine third trimester ultrasonography to reduce adverse perinatal outcomes in low risk pregnancy (the IRIS study) : nationwide, pragmatic, multicentre, stepped wedge cluster randomised trial ', The BMJ, vol. 367, l5517 . https://doi.org/10.1136/bmj.l5517, BMJ (Clinical research ed.), 367:l5517. British Medical Association, British Medical Journal, 367. BMJ PUBLISHING GROUP, The BMJ, 367:l5517. BMJ Publishing Group, The BMJ
- Publication Year :
- 2019
-
Abstract
- ObjectivesTo 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.DesignPragmatic, multicentre, stepped wedge cluster randomised trial.Setting60 midwifery practices in the Netherlands.Participants13 046 women aged 16 years or older with a low risk singleton pregnancy.Interventions60 midwifery practices offered usual care (serial fundal height measurements with clinically indicated ultrasonography). After 3, 7, and 10 months, a third of the practices were randomised to the intervention strategy. As well as receiving usual care, women in the intervention strategy were offered two routine biometry scans at 28-30 and 34-36 weeks’ gestation. The same multidisciplinary protocol for detecting and managing fetal growth restriction was used in both strategies.Main outcome measuresThe primary outcome measure was a composite of severe adverse perinatal outcomes: perinatal death, Apgar score ResultsBetween 1 February 2015 and 29 February 2016, 60 midwifery practices enrolled 13 520 women in mid-pregnancy (mean 22.8 (SD 2.4) weeks’ gestation). 13 046 women (intervention n=7067, usual care n=5979) with data based on the national Dutch perinatal registry or hospital records were included in the analyses. Small for gestational age at birth was significantly more often detected in the intervention group than in the usual care group (179 of 556 (32%) v 78 of 407 (19%), PConclusionIn 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. The findings do not support routine ultrasonography in the third trimester for low risk pregnancies.Trial registrationNetherlands Trial Register NTR4367.
- Subjects :
- PREDICTION
Psychological intervention
INFANTS
Infant, Newborn, Diseases
law.invention
0302 clinical medicine
Randomized controlled trial
Pregnancy
law
Cluster Analysis
030212 general & internal medicine
Cluster randomised controlled trial
ULTRASOUND
Netherlands
Fetal Growth Retardation
030219 obstetrics & reproductive medicine
STILLBIRTH
Obstetrics
Incidence
Pregnancy Outcome
General Medicine
medicine.anatomical_structure
Infant, Small for Gestational Age
Pregnancy in Adolescence
Gestation
Female
Apgar score
Ultrasonography
medicine.medical_specialty
Adolescent
Pregnancy Trimester, Third
Birth weight
Midwifery
Third trimester
Ultrasonography, Prenatal
Healthcare improvement science Radboud Institute for Health Sciences [Radboudumc 18]
03 medical and health sciences
Low risk pregnancy
All institutes and research themes of the Radboud University Medical Center
medicine
MANAGEMENT
Humans
Stepped wedge
Fundal height
Iris (anatomy)
Perinatal Mortality
business.industry
Research
Other Research Radboud Institute for Health Sciences [Radboudumc 0]
Infant, Newborn
NULLIPAROUS WOMEN
medicine.disease
BIRTH-WEIGHT
Apgar Score
Small for gestational age
business
FETAL-GROWTH RESTRICTION
CONSENSUS
Subjects
Details
- Language :
- English
- ISSN :
- 17561833 and 09598146
- Volume :
- 367
- Database :
- OpenAIRE
- Journal :
- BMJ (e)
- Accession number :
- edsair.doi.dedup.....8098c8044a99c1cd930ee1c55895a04d