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Am J Perinatol 2016; 33(10): 957-965
DOI: 10.1055/s-0036-1579652
Original Article
Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

The Performance of First-Trimester Anatomy Scan: A Decision Analysis

Lorie M. Harper
1   Department of Obstetrics and Gynecology, The University of Alabama at Birmingham, Center for Women's Reproductive Health, Birmingham, Alabama
,
S. Lindsay Wood
1   Department of Obstetrics and Gynecology, The University of Alabama at Birmingham, Center for Women's Reproductive Health, Birmingham, Alabama
,
Sheri M. Jenkins
1   Department of Obstetrics and Gynecology, The University of Alabama at Birmingham, Center for Women's Reproductive Health, Birmingham, Alabama
,
John Owen
1   Department of Obstetrics and Gynecology, The University of Alabama at Birmingham, Center for Women's Reproductive Health, Birmingham, Alabama
,
Joseph R. Biggio
1   Department of Obstetrics and Gynecology, The University of Alabama at Birmingham, Center for Women's Reproductive Health, Birmingham, Alabama
› Author Affiliations
Further Information

Publication History

18 December 2015

18 January 2016

Publication Date:
22 April 2016 (online)

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Abstract

Introduction First-trimester ultrasound (US) for anatomy assessment may improve anomaly detection, but it may also increase overall US utilization. We sought to assess the utility of first-trimester US for evaluation of fetal anatomy.

Materials and Methods A decision analytic model was created to compare first- plus second-trimester anatomy scans to second-trimester scan alone in four populations: general, normal weight women, obese women, and diabetics. Probability estimates were obtained from the literature. Outcomes considered were number of: major structural anomalies detected, US performed, and false-positive US. Multivariable sensitivity analyses were performed to evaluate the consistency of the model with varying assumptions.

Results A strategy of first- plus second-trimester US detected the highest number of anomalies but required more US examinations per anomaly detected. The addition of a first-trimester anatomy US was associated with a small increase in the false-positive US (< 10/10,000). In populations with higher anomaly prevalence and lower second-trimester US sensitivity (i.e., diabetes, obesity), the number of additional US performed per anomaly detected with the first-trimester US was < 60.

Discussion In high-risk populations, a first-trimester US in addition to a second-trimester US may be a beneficial approach to detecting anomalies.

Keywords

anatomy ultrasound - first trimester - second trimester - decision analysis - sensitivity

Abstract presented as a poster at 35th Annual Meeting of the Society for Maternal-Fetal Medicine, The Pregnancy Meeting; February 2–7, 2015; San Diego, CA.


 

  • References

  • 1 Callen PW. Ultrasonography in Obstetrics and Gynecology. 5th ed. Philadelphia, PA: Saunders Elsevier; 2008. :xiv, 1239
    Google Scholar
  • 2 Dugoff L. Ultrasound diagnosis of structural abnormalities in the first trimester. Prenat Diagn 2002; 22 (4) 316-320
    CrossrefPubMedGoogle Scholar
  • 3 Kontopoulos E, Odibo A, Wilson RD. Current controversies in prenatal diagnosis 2: are we ready to screen for fetal anomalies with first trimester ultrasound?. Prenat Diagn 2013; 33 (1) 9-12
    CrossrefPubMedGoogle Scholar
  • 4 Rossi AC, Prefumo F. Accuracy of ultrasonography at 11-14 weeks of gestation for detection of fetal structural anomalies: a systematic review. Obstet Gynecol 2013; 122 (6) 1160-1167
    CrossrefPubMedGoogle Scholar
  • 5 Salomon LJ, Alfirevic Z, Bilardo CM , et al. ISUOG practice guidelines: performance of first-trimester fetal ultrasound scan. Ultrasound Obstet Gynecol 2013; 41 (1) 102-113
    CrossrefPubMedGoogle Scholar
  • 6 Ebrashy A, El Kateb A, Momtaz M , et al. 13-14-week fetal anatomy scan: a 5-year prospective study. Ultrasound Obstet Gynecol 2010; 35 (3) 292-296
    CrossrefPubMedGoogle Scholar
  • 7 Woodward PJ. Diagnostic Imaging: Obstetrics. 2nd ed. Salt Lake City, UT: Amirsys; 2011
    Google Scholar
  • 8 Abu-Rustum RS, Daou L, Abu-Rustum SE. Role of first-trimester sonography in the diagnosis of aneuploidy and structural fetal anomalies. J Ultrasound Med 2010; 29 (10) 1445-1452
    CrossrefPubMedGoogle Scholar
  • 9 Achiron R, Weissman A, Rotstein Z, Lipitz S, Mashiach S, Hegesh J. Transvaginal echocardiographic examination of the fetal heart between 13 and 15 weeks' gestation in a low-risk population. J Ultrasound Med 1994; 13 (10) 783-789
    CrossrefPubMedGoogle Scholar
  • 10 Borrell A, Robinson JN, Santolaya-Forgas J. Clinical value of the 11- to 13+6-week sonogram for detection of congenital malformations: a review. Am J Perinatol 2011; 28 (2) 117-124
    Article in Thieme ConnectPubMedGoogle Scholar
  • 11 Carvalho MH, Brizot ML, Lopes LM, Chiba CH, Miyadahira S, Zugaib M. Detection of fetal structural abnormalities at the 11-14 week ultrasound scan. Prenat Diagn 2002; 22 (1) 1-4
    CrossrefPubMedGoogle Scholar
  • 12 Cedergren M, Selbing A. Detection of fetal structural abnormalities by an 11-14-week ultrasound dating scan in an unselected Swedish population. Acta Obstet Gynecol Scand 2006; 85 (8) 912-915
    CrossrefPubMedGoogle Scholar
  • 13 Chen M, Lam YH, Lee CP, Tang MH. Ultrasound screening of fetal structural abnormalities at 12 to 14 weeks in Hong Kong. Prenat Diagn 2004; 24 (2) 92-97
    CrossrefPubMedGoogle Scholar
  • 14 Iliescu D, Tudorache S, Comanescu A , et al. Improved detection rate of structural abnormalities in the first trimester using an extended examination protocol. Ultrasound Obstet Gynecol 2013; 42 (3) 300-309
    CrossrefPubMedGoogle Scholar
  • 15 Khalil A, Nicolaides KH. Fetal heart defects: potential and pitfalls of first-trimester detection. Semin Fetal Neonatal Med 2013; 18 (5) 251-260
    CrossrefPubMedGoogle Scholar
  • 16 Lim J, Whittle WL, Lee YM, Ryan G, Van Mieghem T. Early anatomy ultrasound in women at increased risk of fetal anomalies. Prenat Diagn 2013; 33 (9) 863-868
    CrossrefPubMedGoogle Scholar
  • 17 Srisupundit K, Tongsong T, Sirichotiyakul S, Chanprapaph P. Fetal structural anomaly screening at 11-14 weeks of gestation at Maharaj Nakorn Chiang Mai Hospital. J Med Assoc Thai 2006; 89 (5) 588-593
    PubMedGoogle Scholar
  • 18 Volpe P, Ubaldo P, Volpe N , et al. Fetal cardiac evaluation at 11-14 weeks by experienced obstetricians in a low-risk population. Prenat Diagn 2011; 31 (11) 1054-1061
    CrossrefPubMedGoogle Scholar
  • 19 Becker R, Wegner RD. Detailed screening for fetal anomalies and cardiac defects at the 11-13-week scan. Ultrasound Obstet Gynecol 2006; 27 (6) 613-618
    CrossrefPubMedGoogle Scholar
  • 20 Moon-Grady A, Shahanavaz S, Brook M, Rodriguez H, Hornberger LK. Can a complete fetal echocardiogram be performed at 12 to 16 weeks' gestation?. J Am Soc Echocardiogr 2012; 25 (12) 1342-1352
    CrossrefPubMedGoogle Scholar
  • 21 Syngelaki A, Chelemen T, Dagklis T, Allan L, Nicolaides KH. Challenges in the diagnosis of fetal non-chromosomal abnormalities at 11-13 weeks. Prenat Diagn 2011; 31 (1) 90-102
    CrossrefPubMedGoogle Scholar
  • 22 Rhode island birth defects data book 2014. Available at: http://www.health.ri.gov/publications/databooks/2014BirthDefects.pdf . Accessed Nov 2014
    PubMedGoogle Scholar
  • 23 D'Ottavio G, Mandruzzato G, Meir YJ , et al. Comparisons of first and second trimester screening for fetal anomalies. Ann N Y Acad Sci 1998; 847: 200-209
    CrossrefPubMedGoogle Scholar
  • 24 Persico N, Moratalla J, Lombardi CM, Zidere V, Allan L, Nicolaides KH. Fetal echocardiography at 11-13 weeks by transabdominal high-frequency ultrasound. Ultrasound Obstet Gynecol 2011; 37 (3) 296-301
    CrossrefPubMedGoogle Scholar
  • 25 Pilalis A, Basagiannis C, Eleftheriades M , et al. Evaluation of a two-step ultrasound examination protocol for the detection of major fetal structural defects. J Matern Fetal Neonatal Med 2012; 25 (9) 1814-1817
    CrossrefPubMedGoogle Scholar
  • 26 Saltvedt S, Almström H, Kublickas M, Valentin L, Grunewald C. Detection of malformations in chromosomally normal fetuses by routine ultrasound at 12 or 18 weeks of gestation-a randomised controlled trial in 39,572 pregnancies. BJOG 2006; 113 (6) 664-674
    CrossrefPubMedGoogle Scholar
  • 27 Westin M, Saltvedt S, Bergman G , et al. Routine ultrasound examination at 12 or 18 gestational weeks for prenatal detection of major congenital heart malformations? A randomised controlled trial comprising 36,299 fetuses. BJOG 2006; 113 (6) 675-682
    CrossrefPubMedGoogle Scholar
  • 28 Baronciani D, Scaglia C, Corchia C, Torcetta F, Mastroiacovo P. Ultrasonography in pregnancy and fetal abnormalities: screening or diagnostic test? IPIMC 1986-1990 register data. Indagine Policentrica Italiana sulle Malformazioni Congenite. Prenat Diagn 1995; 15 (12) 1101-1108
    CrossrefPubMedGoogle Scholar
  • 29 Crane JP, LeFevre ML, Winborn RC , et al; The RADIUS Study Group. A randomized trial of prenatal ultrasonographic screening: impact on the detection, management, and outcome of anomalous fetuses. Am J Obstet Gynecol 1994; 171 (2) 392-399
    CrossrefPubMedGoogle Scholar
  • 30 Hildebrand E, Gottvall T, Blomberg M. Maternal obesity and detection rate of fetal structural anomalies. Fetal Diagn Ther 2013; 33 (4) 246-251
    CrossrefPubMedGoogle Scholar
  • 31 Levi S, Schaaps JP, De Havay P, Coulon R, Defoort P. End-result of routine ultrasound screening for congenital anomalies: the Belgian Multicentric Study 1984-92. Ultrasound Obstet Gynecol 1995; 5 (6) 366-371
    CrossrefPubMedGoogle Scholar
  • 32 McAuliffe FM, Fong KW, Toi A, Chitayat D, Keating S, Johnson JA. Ultrasound detection of fetal anomalies in conjunction with first-trimester nuchal translucency screening: a feasibility study. Am J Obstet Gynecol 2005; 193 (3 Pt 2) 1260-1265
    CrossrefPubMedGoogle Scholar
  • 33 Novotná M, Hašlík L, Svabík K , et al. Detection of fetal major structural anomalies at the 11-14 ultrasound scan in an unselected population. Ceska Gynekol 2012; 77 (4) 330-335
    PubMedGoogle Scholar
  • 34 Oztekin O, Oztekin D, Tinar S, Adibelli Z. Ultrasonographic diagnosis of fetal structural abnormalities in prenatal screening at 11-14 weeks. Diagn Interv Radiol 2009; 15 (3) 221-225
    PubMedGoogle Scholar
  • 35 Papp Z, Tóth-Pál E, Papp C , et al. Impact of prenatal mid-trimester screening on the prevalence of fetal structural anomalies: a prospective epidemiological study. Ultrasound Obstet Gynecol 1995; 6 (5) 320-326
    CrossrefPubMedGoogle Scholar
  • 36 Whitworth M, Bricker L, Neilson JP, Dowswell T. Ultrasound for fetal assessment in early pregnancy. Cochrane Database Syst Rev 2010; (4) CD007058
    PubMedGoogle Scholar
  • 37 Biggio Jr JR, Chapman V, Neely C, Cliver SP, Rouse DJ. Fetal anomalies in obese women: the contribution of diabetes. Obstet Gynecol 2010; 115 (2 Pt 1) 290-296
    CrossrefPubMedGoogle Scholar
  • 38 Dashe JS, McIntire DD, Twickler DM. Effect of maternal obesity on the ultrasound detection of anomalous fetuses. Obstet Gynecol 2009; 113 (5) 1001-1007
    CrossrefPubMedGoogle Scholar
  • 39 Anderson JL, Waller DK, Canfield MA, Shaw GM, Watkins ML, Werler MM. Maternal obesity, gestational diabetes, and central nervous system birth defects. Epidemiology 2005; 16 (1) 87-92
    CrossrefPubMedGoogle Scholar
  • 40 Callaway LK, Prins JB, Chang AM, McIntyre HD. The prevalence and impact of overweight and obesity in an Australian obstetric population. Med J Aust 2006; 184 (2) 56-59
    PubMedGoogle Scholar
  • 41 Naeye RL. Maternal body weight and pregnancy outcome. Am J Clin Nutr 1990; 52 (2) 273-279
    PubMedGoogle Scholar
  • 42 Moore LL, Singer MR, Bradlee ML, Rothman KJ, Milunsky A. A prospective study of the risk of congenital defects associated with maternal obesity and diabetes mellitus. Epidemiology 2000; 11 (6) 689-694
    CrossrefPubMedGoogle Scholar
  • 43 Queisser-Luft A, Kieninger-Baum D, Menger H, Stolz G, Schlaefer K, Merz E. Does maternal obesity increase the risk of fetal abnormalities? Analysis of 20,248 newborn infants of the Mainz Birth Register for detecting congenital abnormalities [in German]. Ultraschall Med 1998; 19 (1) 40-44
    Article in Thieme ConnectPubMedGoogle Scholar
  • 44 Stothard KJ, Tennant PW, Bell R, Rankin J. Maternal overweight and obesity and the risk of congenital anomalies: a systematic review and meta-analysis. JAMA 2009; 301 (6) 636-650
    CrossrefPubMedGoogle Scholar
  • 45 Watkins ML, Scanlon KS, Mulinare J, Khoury MJ. Is maternal obesity a risk factor for anencephaly and spina bifida?. Epidemiology 1996; 7 (5) 507-512
    CrossrefPubMedGoogle Scholar
  • 46 Watkins ML, Botto LD. Maternal prepregnancy weight and congenital heart defects in offspring. Epidemiology 2001; 12 (4) 439-446
    CrossrefPubMedGoogle Scholar
  • 47 Chung CS, Myrianthopoulos NC. Factors affecting risks of congenital malformations. II. Effect of maternal diabetes on congenital malformations. Birth Defects Orig Artic Ser 1975; 11 (10) 23-38
    PubMedGoogle Scholar
  • 48 Hernádi L, Töröcsik M. Screening for fetal anomalies in the 12th week of pregnancy by transvaginal sonography in an unselected population. Prenat Diagn 1997; 17 (8) 753-759
    CrossrefPubMedGoogle Scholar
  • 49 Souka AP, Nicolaides KH. Diagnosis of fetal abnormalities at the 10-14-week scan. Ultrasound Obstet Gynecol 1997; 10 (6) 429-442
    CrossrefPubMedGoogle Scholar
  • 50 Weiner Z, Goldstein I, Bombard A, Applewhite L, Itzkovits-Eldor J. Screening for structural fetal anomalies during the nuchal translucency ultrasound examination. Am J Obstet Gynecol 2007; 197 (2) 181.e1-181.e5
    CrossrefPubMedGoogle Scholar
  • 51 Whitlow BJ, Chatzipapas IK, Lazanakis ML, Kadir RA, Economides DL. The value of sonography in early pregnancy for the detection of fetal abnormalities in an unselected population. Br J Obstet Gynaecol 1999; 106 (9) 929-936
    CrossrefPubMedGoogle Scholar
  • 52 Souka AP, Pilalis A, Kavalakis I , et al. Screening for major structural abnormalities at the 11- to 14-week ultrasound scan. Am J Obstet Gynecol 2006; 194 (2) 393-396
    CrossrefPubMedGoogle Scholar
  • 53 Best KE, Tennant PW, Bell R, Rankin J. Impact of maternal body mass index on the antenatal detection of congenital anomalies. BJOG 2012; 119 (12) 1503-1511
    CrossrefPubMedGoogle Scholar
  • 54 Saari-Kemppainen A, Karjalainen O, Ylöstalo P, Heinonen OP. Fetal anomalies in a controlled one-stage ultrasound screening trial. A report from the Helsinki Ultrasound Trial. J Perinat Med 1994; 22 (4) 279-289
    CrossrefPubMedGoogle Scholar
  • 55 Tabor A, Zdravkovic M, Perslev A, Møller LK, Pedersen BL. Screening for congenital malformations by ultrasonography in the general population of pregnant women: factors affecting the efficacy. Acta Obstet Gynecol Scand 2003; 82 (12) 1092-1098
    CrossrefPubMedGoogle Scholar
  • 56 Miller JL, de Veciana M, Turan S , et al. First-trimester detection of fetal anomalies in pregestational diabetes using nuchal translucency, ductus venosus Doppler, and maternal glycosylated hemoglobin. Am J Obstet Gynecol 2013; 208 (5) 385.e1-385.e8
    CrossrefPubMedGoogle Scholar
  • 57 Dashe JS, McIntire DD, Twickler DM. Maternal obesity limits the ultrasound evaluation of fetal anatomy. J Ultrasound Med 2009; 28 (8) 1025-1030
    CrossrefPubMedGoogle Scholar
  • 58 Fuchs F, Houllier M, Voulgaropoulos A , et al. Factors affecting feasibility and quality of second-trimester ultrasound scans in obese pregnant women. Ultrasound Obstet Gynecol 2013; 41 (1) 40-46
    CrossrefPubMedGoogle Scholar
  • 59 Phatak M, Ramsay J. Impact of maternal obesity on procedure of mid-trimester anomaly scan. J Obstet Gynaecol 2010; 30 (5) 447-450
    CrossrefPubMedGoogle Scholar
  • 60 Thornburg LL, Miles K, Ho M, Pressman EK. Fetal anatomic evaluation in the overweight and obese gravida. Ultrasound Obstet Gynecol 2009; 33 (6) 670-675
    CrossrefPubMedGoogle Scholar
  • 61 Tsai LJ, Ho M, Pressman EK, Thornburg LL. Ultrasound screening for fetal aneuploidy using soft markers in the overweight and obese gravida. Prenat Diagn 2010; 30 (9) 821-826
    CrossrefPubMedGoogle Scholar
  • 62 Chung JH, Pelayo R, Hatfield TJ, Speir VJ, Wu J, Caughey AB. Limitations of the fetal anatomic survey via ultrasound in the obese obstetrical population. J Matern Fetal Neonatal Med 2012; 25 (10) 1945-1949
    CrossrefPubMedGoogle Scholar