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%), P<0.001). Ultrasound is not as useful for imaging air-filled lungs, but it may be used to detect fluid around or within the lungs. Routine ultrasound examination at 35–37 weeks' gestation may reveal new fetal abnormalities that could not be diagnosed at earlier examinations. both the second and third trimesters are necessary. *Crossover postponed after one month because of fewer than expected inclusions †One midwifery practice dropped out in April 2015, after the first randomisation, The logistics of the study and enrolment procedures were piloted in January 2015. 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 … USA.gov. Is a routine ultrasound in the third trimester justified? In this large, pragmatic, nationwide, stepped wedge cluster randomised trial in low risk pregnant women, using a multidisciplinary protocol for detecting and managing fetal growth restriction, routine ultrasonography in the third trimester improved prenatal detection of neonates who were small for gestational age (SGA) compared with usual care. Competing interests: All authors have completed the ICMJE uniform disclosure form at www.icmje.org/coi_disclosure.pdf and declare: for the current study (the IRIS study), AdJ and JW received funding from the Netherlands Organisation for Health Research and Development; no financial relationships with any organisations that might have an interest in the submitted work in the previous three years; no other relationships or activities that could appear to have influenced the submitted work. Based on our findings, we cannot recommend routine ultrasonography in the third trimester in low risk pregnancies. The psychological burden of routine prenatal ultrasound on women's state anxiety across the three trimesters of pregnancy Caterina Businelli , Stefano Bembich , Cristina Vecchiet, Caterina Cortivo, Alessia Norcio, Maria Francesco Risso, Mariachiara Quadrifoglio, Tamara Stampalija In the intervention strategy, for an abdominal circumference below the 10th centile or slow growth in abdominal circumference the sensitivity in detecting birth weight below the 10th centile was 32% and the positive predictive value was 22%. Some growth charts are universal and prescriptive, which means they show optimal growth in a healthy population, whereas others are customised for maternal characteristics, such as parity and ethnicity. Data on severe adverse perinatal outcomes were available for 12 993 of 13 046 (99.6%) women, 7040 in the intervention strategy and 5953 in the control strategy (fig 2). We set the level of significance at P<0.05. Prediction of large-for-gestational-age neonate by routine third-trimester ultrasound. Fetal gestational age corresponded to 34 weeks. Standard Second- or Third-Trimester Examination A standard obstetric sonogram in the second or third trimester includes an evaluation of fetal presentation, amniotic fluid volume, cardiac activity, placental position, fetal biome-try, and fetal number, plus an anatomic survey. OBJECTIVE: An adequate and contemporary randomized trial is needed to resolve whether routine third trimester ultrasound followed by adapted perinatal management … To estimate the diagnostic accuracy of the two third trimester screening strategies to detect SGA at birth (birth weight <10th centile based on the Dutch reference curve),27 we calculated sensitivity, specificity, and positive and negative predictive values of fetal abdominal circumference below the 10th centile, slow fetal abdominal growth, or a combination of the two.29 We compared sensitivity and specificity rates between the intervention and control strategies using the χ2 test and between the scans at 28-30 weeks’ gestation and 34-36 weeks’ gestation in the intervention strategy using the McNemar test. View options for downloading these results. 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. Inducing labour artificially is more invasive than augmentation of labour that has started spontaneously, and overuse of induction of labour in the absence of clear beneficial effects is a growing concern.4142 Overall, the findings of this pragmatic trial do not support a policy of routine ultrasound screening in the third trimester for low risk pregnant women to reduce severe adverse perinatal outcomes. Women in the intervention strategy had significantly more ultrasound scans than women in the control strategy (mean 2.04 (SD 0.75) v 0.88 (0.96), P<0.001). 2017 Oct;50(4):429-441. doi: 10.1002/uog.17246. Contributors: JH and VV contributed equally to the manuscript and are first authors. Six women did not fulfil the inclusion criteria and 797 refused to participate. 60. | Sort by Date Showing results 1 to 10. If the exam-ination cannot be performed completely in accordance with adopted guidelines, the scan should be repeated, at least in part, at a later time, or the patient can be … The remaining 13 520 women were enrolled in mid-pregnancy (mean 22.8 (SD 2.4) weeks’ gestation) and provided baseline characteristics. Clinical epidemiology: how to do clinical practice research. How often do we identify fetal abnormalities during routine third-trimester ultrasound? 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. NIH Then we conducted multilevel multivariable logistic regression analyses for the dichotomous primary and secondary outcomes. Manegold G(1), Tercanli S, Struben H, Huang D, Kang A. In a multilevel multivariable logistic regression analysis, routine ultrasonography in the third trimester was not related to the composite outcome of maternal peripartum morbidity or mortality (1.06, 0.95 to 1.18), or spontaneous labour and birth (1.00, 0.92 to 1.08). … gene disorders such as achondroplasia, thus providing a noninvasive tool for diagnosing skeletal dysplasia . Both approaches included a multidisciplinary protocol for detecting and treating fetal growth restriction. Women remained in the strategy that their midwifery practice was allocated to on enrolment. One of the authors (MW), who carried out all the interviews, first conducted a pilot interview to become familiar with the topic-list and to test the questions. Perinatal Care in the Netherlands 2014, New Dutch reference curves for birthweight by gestational age, Intracluster correlation coefficients and coefficients of variation for perinatal outcomes from five cluster-randomised controlled trials in low and middle-income countries: results and methodological implications, Collinearity: a review of methods to deal with it and a simulation study evaluating their performance, Maternal smoking and fetal growth characteristics in different periods of pregnancy: the generation R study, Determinants of low birth weight: methodological assessment and meta-analysis, A simulation study of sample size for multilevel logistic regression models, Variation of sensitivity, specificity, likelihood ratios and predictive values with disease prevalence, The systematic error in the estimation of fetal weight and the underestimation of fetal growth restriction, Quality control of ultrasound for fetal biometry: results from the INTERGROWTH-21, Current issues in the development of foetal growth references and standards, Did I really want to know this? Such methods include other ultrasound markers of fetal compromise, maternal and placental biomarkers, and maternal awareness of fetal wellbeing. Report from Norwegian Knowledge Centre for the Health Services (NOKC) No. Sonographers conducted third trimester biometry according to the guidelines of the Dutch Society of Obstetrics and Gynaecology (NVOG).2223 Sonographers who participated in the IRIS study were experienced in performing biometry and held a certificate for structural anomaly screening (73% of 154 participating sonographers) or passed a biometry quality test before the trial (27%), based on four biometry scans assessed by two experienced sonographers; had successfully completed a module on fetal biometry from a national Dutch medical e-learning education programme (see www.medicaleducation.nl); and used ultrasound equipment according to the standards of the Dutch Society of Obstetrics and Gynaecology.14 Two independent and experienced sonographers who were board members of the Dutch Professional Organisation of Sonographers carried out quality assessments of the sonographers during the trial. For about 90% of women in the Netherlands, antenatal care is midwife led initially, and about 50% of women start labour in midwife led care.26 Also, most of the recommendations of the multidisciplinary protocol for diagnosing and managing suspected fetal growth restriction in our study are similar to international guidelines in other countries (eg, the Royal College of Obstetricians and Gynaecologist),25 making our results relevant to low risk populations in other international care contexts. 11 15 Routine ultrasonography in the third trimester detects SGA at birth more often than usual care, which comprises serial fundal height measurements combined with clinically indicated ultrasonography. Perined. 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.  |  A change in fetal activity might be a sign of fetal growth restriction.44 Fetal death, often associated with fetal growth restriction, is usually preceded by reduced fetal movements.44 More research is needed, however, to determine what type of information women should receive about the wellbeing of the fetus.44 Further research is also needed to address the histopathological mechanisms that might underlie the association between fetal growth restriction and perinatal death, including sudden intrauterine unexplained death, and to improve preventive strategies.4546, Our study has strengths and limitations. COVID-19 is an emerging, rapidly evolving situation. The corresponding author attests that all listed authors meet authorship criteria and that no others meeting the criteria have been omitted. After adjustment for confounders, the difference between the groups was not significant (odds ratio 0.88, 95% confidence interval 0.70 to 1.20). J.J. Stirnemann, G. Benoist, L.J. At the onset of data collection on 1 February 2015 all the midwifery practices (n=60) carried out the control strategy, with a third sequentially crossing over to the intervention strategy at 3, 7, and 10 months (fig 1). The number of women who need serial ultrasound examinations in the third trimester to identify an abnormal condition is five (95% CI 3–11). *One midwifery practice withdrew from the study before crossover to the intervention strategy (59 practices participated in the study). Become apparent later in pregnancy in low risk singleton pregnancy ultrasound can not recommend routine ultrasonography was not associated other... 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