Acta obstetricia et gynecologica Scandinavica · 2013
A randomized controlled trial of third-trimester routine ultrasound in a non-selected population.
Сравнительное исследованиеСтатьяРандомизированное исследованиеПоддержка исследования: вне правительства СШАНазвание и аннотация: Перевод в очереди
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Skråstad Ragnhild B, Eik-Nes Sturla H, Sviggum Oddvar, Johansen Ole J, Salvesen Kjell Å, Romundstad Pål R, Blaas Harm-Gerd K
Аннотация
OBJECTIVE: To compare detection rates of small-for-gestational-age fetuses, large-for-gestational-age fetuses, congenital anomalies and adverse perinatal outcomes in pregnancies randomized to third-trimester routine ultrasound or ultrasound on clinical indication.
DESIGN: Randomized controlled trial.
SETTING: National Center for Fetal Medicine in Norway between 1989 and 1992.
POPULATION: A total of 6780 pregnancies from a non-selected population.
METHODS: Two routine ultrasound examinations at 18 and 33 weeks were compared with routine ultrasound at 18 weeks and ultrasound on clinical indication. Suspected small-for-gestational-age fetuses were followed with serial scans and cardiotocography. Doppler ultrasound was not used.
MAIN OUTCOME MEASURES: Detection rates of small-for-gestational-age and large-for-gestational-age fetuses, congenital anomalies and adverse perinatal outcomes.
RESULTS: Third trimester routine ultrasound improved detection rates of small-for-gestational-age fetuses from 46 to 80%, but overall perinatal morbidity and mortality remained unchanged. Detection of large-for-gestational-age fetuses increased from 36 to 91%. There was a significant increase of induction of labor and elective cesarean sections due to suspected small-for-gestational-age and a significant decrease of induction of labor and elective cesarean sections due to suspected large-for-gestational-age in the study group; there were no other differences regarding intervention. The detection rate of congenital anomalies was 56%, with no significant difference between the groups.
CONCLUSIONS: Routine use of third-trimester routine ultrasound increased detection rates of small-for-gestational-age and large-for-gestational-age fetuses. This did not alter perinatal outcomes. Third-trimester ultrasound screening should not be rejected before a policy of adding Doppler surveillance to the high-risk group identified has been investigated further.
DESIGN: Randomized controlled trial.
SETTING: National Center for Fetal Medicine in Norway between 1989 and 1992.
POPULATION: A total of 6780 pregnancies from a non-selected population.
METHODS: Two routine ultrasound examinations at 18 and 33 weeks were compared with routine ultrasound at 18 weeks and ultrasound on clinical indication. Suspected small-for-gestational-age fetuses were followed with serial scans and cardiotocography. Doppler ultrasound was not used.
MAIN OUTCOME MEASURES: Detection rates of small-for-gestational-age and large-for-gestational-age fetuses, congenital anomalies and adverse perinatal outcomes.
RESULTS: Third trimester routine ultrasound improved detection rates of small-for-gestational-age fetuses from 46 to 80%, but overall perinatal morbidity and mortality remained unchanged. Detection of large-for-gestational-age fetuses increased from 36 to 91%. There was a significant increase of induction of labor and elective cesarean sections due to suspected small-for-gestational-age and a significant decrease of induction of labor and elective cesarean sections due to suspected large-for-gestational-age in the study group; there were no other differences regarding intervention. The detection rate of congenital anomalies was 56%, with no significant difference between the groups.
CONCLUSIONS: Routine use of third-trimester routine ultrasound increased detection rates of small-for-gestational-age and large-for-gestational-age fetuses. This did not alter perinatal outcomes. Third-trimester ultrasound screening should not be rejected before a policy of adding Doppler surveillance to the high-risk group identified has been investigated further.