TY - JOUR
TI - Improved detection rate of structural abnormalities in the first trimester using an extended examination protocol
AU - Iliescu, D.
AU - Tudorache, S.
AU - Comanescu, A.
AU - Antsaklis, P.
AU - Cotarcea, S.
AU - Novac, L.
AU - Cernea, N.
AU - Antsaklis, A.
JO - Ultrasound in Obstetrics and Gynecology
PY - 2013
VL - 42
TODO - 3
SP - 300-309
PB - 
SN - 0960-7692, 1469-0705
TODO - 10.1002/uog.12489
TODO - 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
TODO - 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.
ER -