Women remained in the strategy that their midwifery practice was allocated to on enrolment. The overall incidence of error in data entry was 3.2% (2.6% for neonatal data and 3.7% for maternal data). 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. Methods This was a retrospective study of prospectively collected data from 100997 singleton pregnancies attending for a routine ultrasound examination of Perined. Prediction of large-for-gestational-age neonate by routine third-trimester ultrasound. Author information: (1)Obstetrics and Gynecology, Ultrasound Unit, University Women's Hospital of Basel, Basel, Switzerland. Routine third trimester ultrasonography: avoiding “too much too soon”. Please note: your email address is provided to the journal, which may use this information for marketing purposes. Secondary neonatal outcomes were also not significantly different between the two strategies. libr. Reasons for deviations from these recommendations should be documented. In 2010, the Dutch Ministry of Health considered introducing routine third trimester biometry as a … Methods A retrospective cohort study of 1008 pregnancies with maternal BMI ≥ 35 … The first composite outcome was at least one of four maternal adverse peripartum outcomes: maternal death within 42 days of birth, hypertensive disorders or pre-eclampsia (diastolic blood pressure ≥95 mm Hg with or without proteinuria, or ≥90 mm Hg with proteinuria), postpartum haemorrhage of 1000 mL or more, or anal sphincter damage. Maternal outcomes and other obstetric interventions did not differ between the strategies. | Sort by Date Showing results 1 to 50. NVOG-richtlijn Foetale groeirestrictie (FGR). Although higher numbers of births were observed in obstetrician led care in the intervention strategy compared with usual care strategy (65.0% v 63.3%; table 5), this association was not significant in a multilevel multivariable logistic regression adjusted for confounders (1.05, 0.96 to 1.14). email@example.com PURPOSE: The detection … Characteristics of participating midwifery practices, Personal and baseline characteristics of participants. The best performing indicators were the presence of a CPR < 10th centile, a mean UtA-PI > 95th centile or an EFW < 3rd centile . Severe adverse perinatal (composite) outcome and secondary neonatal outcomes, Maternal outcomes and peripartum interventions. HHS Caption: View of the fetal abdomen. Would you like email updates of new search results? Objectives To investigate the effectiveness of routine ultrasonography in the third trimester in reducing adverse perinatal outcomes in low risk pregnancies compared with usual care and the effect of this policy on maternal outcomes and obstetric interventions. For 103 of these 107 women, 97% (71 of 73) in the intervention strategy and 87% (26 of 30) in the usual care group had Doppler scans. Sensitivities of routine third trimester ultrasonography range from 22% to 57%.91116 Nevertheless, evidence based guidelines in many Western countries, including the Netherlands, do not recommend routine biometry scans in the third trimester because in previous clinical trials perinatal outcomes were not positively affected.714151718 Also, when evaluating the introduction of a new screening programme, adverse effects, such as unnecessary medical care, should be considered.19 Major limitations, however, have been identified in earlier trials.15 Firstly, almost all trials were underpowered to detect clinically significant differences in severe perinatal outcomes. Also, in the intervention strategy, significantly more SGA neonates (32%) had an abdominal circumference below the 10th centile or slow fetal growth compared with SGA neonates in the usual care strategy (19%; P<0.001) and specificity differed significantly (90% and 97%, respectively; P<0.001) (table 3). Additional fetal anomalies diagnosed after two previous unremarkable ultrasound examinations. Information was also obtained from many hospital records, but for most women only routine registration data for adverse outcomes were available. The intervention entails routine third trimester ultrasound screening combined with serial fundal height measurements and clinically indicated ultrasonography, while the control condition entails CAU (serial fundal height measurements and clinically indicated ultrasonography only). AdJ, PJ, LV, VV, and JH were involved in the development, implementation, or data collection of the study. From 1 February 2015 to 29 February 2016, pregnant women in the participating midwifery practices who fulfilled the inclusion criteria were informed about the study and given a trial information leaflet by their midwife during the first consultation. both the second and third trimesters are necessary. The positive predictive value of an abdominal circumference below the 10th centile was higher for the second routine scan (59%) at 34-36 weeks’ gestation than for the first scan at 28-30 weeks’ gestation (37%), whereas negative predictive values were similar, in line with the findings of the POP study.11 Thus late third trimester scans seem to have more diagnostic accuracy than earlier ones. 2008. If you are unable to import citations, please contact View options for downloading these results. Prenatal ultrasound screening: false positive soft markers may alter maternal representations and mother-infant interaction [correction in: Performance of the ATLAS trigger system in 2015, Screening for fetal growth restriction using ultrasound and the sFLT1/PlGF ratio in nulliparous women: a prospective cohort study, Fetal movement counting for assessment of fetal wellbeing, Anatomopathological changes of the cardiac conduction system in sudden cardiac death, particularly in infants: advances over the last 25 years, Editorial: New approaches to the pathogenesis of sudden intrauterine unexplained death and sudden infant death syndrome, Effectiveness of routine third trimester ultrasonography to reduce adverse perinatal outcomes in low risk pregnancy (the IRIS study): nationwide, pragmatic, multicentre, stepped wedge cluster randomised trial, http://creativecommons.org/licenses/by-nc/4.0/, Lincolnshire Partnership NHS Foundation Trust: CAMHS Consultant Psychiatrist, Cambridgeshire and Peterborough NHS Foundation Trust: Consultant General Adult Community Psychiatry, Hertfordshire Partnership University NHS Foundation Trust: Consultant Perinatal Psychiatrist, Hertfordshire Partnership University NHS Foundation Trust: Consultant Psychiatrist in General Adult Community, Women’s, children’s & adolescents’ health. Study sample in stepped wedge cluster randomised trial, showing numbers recruited in each cluster and period. Perined data suggested an incidence of 1.54% for the severe adverse perinatal composite outcome in low risk pregnant women in the Netherlands. METHODS: Women without complications between 24 Study design: Two university clinics using routine ultrasound screening in the third trimester were compared with seven county or district hospitals with no routine screening. Similar to the Pregnancy Outcome Prediction (POP) study, we found that sensitivity rates were higher for the intervention strategy with routine ultrasonography compared with usual care strategy with clinically indicated ultrasonography, although specificity rates were lower.11 Thus our findings suggest that repeated ultrasonography measures increase the detection of SGA but are also accompanied by higher false positive rates. Similarly, ultrasound cannot penetrate bone, but may be used for imaging bone fractures or for infection surrounding a bone. Pregnant women seem to appreciate a third trimester routine ultrasound, but it does not seem to reduce anxiety or to improve bonding with their baby. 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. Dutch Association of Obstetrics and Gynaecology (NVOG)-guideline Fetal Growth Restriction (FGR), Dutch Association of Obstetrics and Gynaecology, Routine ultrasound in late pregnancy (after 24 weeks’ gestation), Value of a single early third trimester fetal biometry for the prediction of birth weight deviations in a low risk population, Evidence-based national guidelines for the management of suspected fetal growth restriction: comparison, consensus, and controversy. As well as receiving usual care, women in the intervention strategy were offered two routine biometry scans at 28-30 and 34-36 weeks’ gestation. Prediction of large for gestational age neonates by routine third trimester ultrasound Naila KHAN,1,2 Anca CIOBANU,3 Argyro SYNGELAKI,3 Ranjit AKOLEKAR,1,2 Kypros H. NICOLAIDES.3 Short title: Third trimester screening for LGA Key words: Third trimester screening; Large for gestational age; Estimated fetal weight; Fetal biometry; Symphysial-fundal height; Pyramid of … Contributors: JH and VV contributed equally to the manuscript and are first authors. •Some abnormalities develop or first become apparent later in pregnancy. Two dichotomous maternal composite outcomes were defined as secondary outcomes. These include other ultrasound markers of fetal compromise, such as Doppler indices.18 The POP study showed that the combination of ultrasonography in the third trimester and measurement of placental biomarkers in the mother’s blood (the soluble fms-like tyrosine kinase 1:placental growth factor ratio) strongly predicted adverse pregnancy outcomes related to fetal growth restriction, suggesting that biomarkers might be useful in detecting growth restriction.43 Moreover, women are aware of fetal movements, which are a sign of fetal wellbeing. Neonates born before the second routine ultrasound scan were excluded from the additional analysis. Copyright © 2021 BMJ Publishing Group Ltd 京ICP备15042040号-3, Update on the diagnosis and classification of fetal growth restriction and proposal of a stage-based management protocol, Intrauterine growth restriction and later cardiovascular function, Intrauterine growth restriction: postnatal monitoring and outcomes, Major risk factors for stillbirth in high-income countries: a systematic review and meta-analysis, Restricted fetal growth in sudden intrauterine unexplained death, Altered small-world topology of structural brain networks in infants with intrauterine growth restriction and its association with later neurodevelopmental outcome, Risk factors for small for gestational age infants, Poor effectiveness of antenatal detection of fetal growth restriction and consequences for obstetric management and neonatal outcomes: a French national study, Comparison of fetal and neonatal growth curves in detecting growth restriction, Screening for fetal growth restriction with universal third trimester ultrasonography in nulliparous women in the Pregnancy Outcome Prediction (POP) study: a prospective cohort study, Consensus definition of fetal growth restriction: a Delphi procedure, Multidisciplinary consensus on screening for, diagnosis and management of fetal growth restriction in the Netherlands. Main outcome measures The primary outcome measure was a composite of severe adverse perinatal outcomes: perinatal death, Apgar score <4, impaired consciousness, asphyxia, seizures, assisted ventilation, septicaemia, meningitis, bronchopulmonary dysplasia, intraventricular haemorrhage, periventricular leucomalacia, or necrotising enterocolitis. Routine third trimester biometry ultrasound scans predict SGA at birth substantially better than care as usual, i.e. Epub 2013 Oct 15. 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 … For women referred for slow fetal abdominal growth (n=162), 91% (112 of 123) in the intervention strategy had additional ultrasounds compared with 90% (35 of 39) in the usual care strategy. Routine ultrasound examination at 35–37 weeks' gestation may reveal new fetal abnormalities that could not be diagnosed at earlier examinations. With gel on your abdomen, the device will show an image of your baby to the sonographer conducting the scan. Women’s appreciation of a third trimester routine ultrasound might arise from getting used to … 13 046 women (intervention n=7067, usual care n=5979) with data based on the national Dutch perinatal registry or hospital records were included in the analyses. In total, 13 046 women with Perined data or data from hospital records, or both were included in one or more analyses, with 5979 women in the usual care strategy and 7067 women in the intervention strategy. Salomon, J.-P. Bernard, Y. Ville. As a first step, we conducted univariable logistic regression analyses to see if routine ultrasonography in the third trimester was associated with a reduction in severe adverse perinatal outcomes and adverse secondary neonatal and maternal outcomes. March 2019 ] Le Ray C, Morin L. 2009 at risk of adverse perinatal outcomes collinearity of constraints... 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