@article{2986148,
    title = "Improved detection rate of structural abnormalities in the first trimester using an extended examination protocol",
    author = "Iliescu, D. and Tudorache, S. and Comanescu, A. and Antsaklis, P. and Cotarcea, S. and Novac, L. and Cernea, N. and Antsaklis, A.",
    journal = "Ultrasound in Obstetrics and Gynecology",
    year = "2013",
    volume = "42",
    number = "3",
    pages = "300-309",
    issn = "0960-7692, 1469-0705",
    doi = "10.1002/uog.12489",
    keywords = "adult;  central nervous system;  clinical trial;  congenital heart malformation;  Doppler echocardiography;  echography;  feasibility study;  female;  fetus echography;  first trimester pregnancy;  human;  multicenter study;  pregnancy;  procedures;  prospective study;  article;  color ultrasound flowmetry;  congenital disorder;  congenital heart malformation;  congenital malformation;  Doppler echocardiography;  echography;  fetus echography;  methodology;  prenatal diagnosis;  screening;  ultrasound, Adult;  Central Nervous System;  Echocardiography, Doppler, Color;  Feasibility Studies;  Female;  Heart Defects, Congenital;  Humans;  Pregnancy;  Pregnancy Trimester, First;  Prospective Studies;  Ultrasonography, Prenatal, color Doppler;  congenital abnormalities;  first trimester;  prenatal diagnosis;  screening;  ultrasound, Adult;  Central Nervous System;  Echocardiography, Doppler, Color;  Feasibility Studies;  Female;  Heart Defects, Congenital;  Humans;  Pregnancy;  Pregnancy Trimester, First;  Prospective Studies;  Ultrasonography, Prenatal",
    abstract = "Objective: To assess the potential of first-trimester sonography in the detection of fetal abnormalities using an extended protocol that is achievable with reasonable resources of time, personnel and ultrasound equipment. Methods: This was a prospective two-center 2-year study of 5472 consecutive unselected pregnant women examined at 12 to 13 + 6 gestational weeks. Women were examined using an extended morphogenetic ultrasound protocol that, in addition to the basic evaluation, involved a color Doppler cardiac sweep and identification of early contingent markers for major abnormalities. Results: The prevalence of lethal and severe malformations was 1.39%. The first-trimester scan identified 40.6% of the cases detected overall and 76.3% of major structural defects. The first-trimester detection rate (DR) for major congenital heart disease (either isolated or associated with extracardiac abnormalities) was 90% and that for major central nervous system anomalies was 69.5%. In fetuses with increased nuchal translucency (NT), the first-trimester DR for major anomalies was 96%, and in fetuses with normal NT it was 66.7%. Most (67.1%) cases with major abnormalities presented with normal NT. Conclusions: A detailed first-trimester anomaly scan using an extended protocol is an efficient screening method to detect major fetal structural abnormalities in low-risk pregnancies. It is feasible at 12 to 13 + 6 weeks with ultrasound equipment and personnel already used for routine first-trimester screening. Rate of detection of severe malformations is greater in early- than in mid-pregnancy and on postnatal evaluation. Early heart investigation could be improved by an extended protocol involving use of color Doppler. Copyright © 2013 ISUOG. Published by John Wiley & Sons Ltd."
}