Skip to main content
PMC home page
The BMJ logoLink to The BMJ
. 1991 Nov 9;303(6811):1165–1169. doi: 10.1136/bmj.303.6811.1165

Effectiveness of routine ultrasonography in detecting fetal structural abnormalities in a low risk population.

L S Chitty 1, G H Hunt 1, J Moore 1, M O Lobb 1
PMCID: PMC1671512  PMID: 1747613

Abstract

OBJECTIVE--To review the efficacy of routine prenatal ultrasonography for detecting fetal structural abnormalities. DESIGN--Retrospective study of the ultrasonographic findings and outcome of all pregnancies in women scanned in 1988-9. SETTING--Maternity ultrasonography department of a district general hospital. SUBJECTS--8785 fetuses. MAIN OUTCOME MEASURES--Correlation of prenatal ultrasonographic findings with outcome in the neonate. RESULTS--8733 babies were born during 1988-9, and 52 pregnancies were terminated after a fetal malformation was identified. 8432 (95%) of the fetuses were examined by ultrasonography in the second trimester. 130 fetuses (1.5%) were found to have an abnormality at birth or after termination of pregnancy, 125 of which had been examined in the second trimester. In 93 cases the abnormality was detected before 24 weeks (sensitivity 74.4%, 95% confidence interval to 66.7% to 82.1%. Two false positive diagnoses occurred, in both cases the pregnancies were not terminated and apparently normal infants were born. This gives a specificity of 99.98% (99.9% to 99.99%). The positive predictive value of ultrasonography in the second trimester was 97.9% (92.6% to 99.7%). Of the 125 abnormalities, 87 were lethal or severely disabling; 72 of the 87 were detected by the routine screening programme (sensitivity 82.8%, 73.2% to 90.0%). CONCLUSION--Routine fetal examination by ultrasonography in a low risk population detects many fetal structural abnormalities but can present several dilemmas in counselling.

Full text

PDF
1169

Selected References

These references are in PubMed. This may not be the complete list of references from this article.

  1. Ash P., Vennart J., Carter C. O. The incidence of hereditary disease in man. Lancet. 1977 Apr 16;1(8016):849–851. doi: 10.1016/s0140-6736(77)92792-1. [DOI] [PubMed] [Google Scholar]
  2. Benacerraf B. R., Adzick N. S. Fetal diaphragmatic hernia: ultrasound diagnosis and clinical outcome in 19 cases. Am J Obstet Gynecol. 1987 Mar;156(3):573–576. doi: 10.1016/0002-9378(87)90053-6. [DOI] [PubMed] [Google Scholar]
  3. Benacerraf B. R. Fetal hydrocephalus: diagnosis and significance. Radiology. 1988 Dec;169(3):858–859. doi: 10.1148/radiology.169.3.3055042. [DOI] [PubMed] [Google Scholar]
  4. Benacerraf B. R. Prenatal sonography of autosomal trisomies. Ultrasound Obstet Gynecol. 1991 Jan 1;1(1):66–75. doi: 10.1046/j.1469-0705.1991.01010066.x. [DOI] [PubMed] [Google Scholar]
  5. Campbell S. Ian Donald's child comes of age. Ultrasound Obstet Gynecol. 1991 Jan 1;1(1):1–3. doi: 10.1046/j.1469-0705.1991.01010001.x. [DOI] [PubMed] [Google Scholar]
  6. Chittty L. S., Pembrey M. E., Chudleigh P. M., Campbell S. Multicentre study of antenatal calyceal dilatation detected by ultrasound. Lancet. 1990 Oct 6;336(8719):875–875. doi: 10.1016/0140-6736(90)92378-u. [DOI] [PubMed] [Google Scholar]
  7. Chitty L. S., Winter R. M. Perinatal mortality in different ethnic groups. Arch Dis Child. 1989 Jul;64(7):1036–1041. doi: 10.1136/adc.64.7.1036. [DOI] [PMC free article] [PubMed] [Google Scholar]
  8. Levi S., Crouzet P., Schaaps J. P., Defoort P., Coulon R., Buekens P., de Brier M. Ultrasound screening for fetal malformations. Lancet. 1989 Mar 25;1(8639):678–678. doi: 10.1016/s0140-6736(89)92192-2. [DOI] [PubMed] [Google Scholar]
  9. Nicolaides K. H., Campbell S. Diagnosis and management of fetal malformations. Baillieres Clin Obstet Gynaecol. 1987 Sep;1(3):591–622. doi: 10.1016/s0950-3552(87)80008-1. [DOI] [PubMed] [Google Scholar]
  10. Persson P. H., Kullander S. Long-term experience of general ultrasound screening in pregnancy. Am J Obstet Gynecol. 1983 Aug 15;146(8):942–947. doi: 10.1016/0002-9378(83)90970-5. [DOI] [PubMed] [Google Scholar]
  11. Rosendahl H., Kivenen S. Antenatal detection of congenital malformations by routine ultrasonography. Obstet Gynecol. 1989 Jun;73(6):947–951. doi: 10.1097/00006250-198906000-00008. [DOI] [PubMed] [Google Scholar]
  12. Saari-Kemppainen A., Karjalainen O., Ylöstalo P., Heinonen O. P. Ultrasound screening and perinatal mortality: controlled trial of systematic one-stage screening in pregnancy. The Helsinki Ultrasound Trial. Lancet. 1990 Aug 18;336(8712):387–391. doi: 10.1016/0140-6736(90)91941-3. [DOI] [PubMed] [Google Scholar]

Articles from BMJ : British Medical Journal are provided here courtesy of BMJ Publishing Group

RESOURCES