Evidence-Based Case Report on the Effect of Ultrasound Screening to Pregnant Women at 11-14 Gestational Weeks on Fetus of Fetal Malformations_Chinese Journal of Evidence-Based Medicine

Authors：

TANG Ying ¹ , LIU Guanjian ² ,  YANG Taizhu ¹

1. Department of Ultrasound, West China Second Hospital, Sichuan University, Chengdu 610041, China2. Evidence-Based Medicine Center, West China Hospital, Sichuan University, Chengdu 610041, China;

Corresponding author：

YANG Taizhu, Email: tangy_cd@163.com

Keywords：

Ultrasonography screening; Malformation; Pregnant woman at 11-14 gestational weeks

DOI：

10.7507/1672-2531.20090124

Video：

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Abstract Full text Figures/Tables Video References Cited by

Objective To formulate an evidence-based conclusion concerning ultrasound screening for fetal malformations for a pregnant woman after 12 gestational weeks.
Methods Based on the clinical problem of whether pregnant women need ultrasound screening for fetal malformations after 11-14 gestational weeks, we used “ultrasound or sonography and prenatal or fetal at first trimester or 11-14 weeks; ultrasound exposure; fetal development” as the keywords and searched The Cochrane Library (Issue 4, 2008), MEDLINE (1981 to 2008), ACP Journal Club (1991 to 2008), and BMJ Clinical Evidence (1999 to 2008) for systematic reviews, randomized controlled trials (RCTs) and controlled clinical trials. The methodological quality of the included studies was assessed to identify the current best evidence.
Results Three systematic reviews, two RCTs and ten cohort studies were retrieved. The results showed ultrasound screening detected different fetal malformations in the first, second and third trimester. Not all of the fetal malformations could be detected through prenatal ultrasound screening. Nuchal translucency (NT) measurement as a tool for screening chromosomally abnormal fetuses and detecting fetal malformations by ultrasound proved to be effective if performed within 11-14 gestational weeks. The routine second trimester screening, however, could not be replaced by a detailed ultrasound examination at 11-14 gestational weeks. Most of the trials concluded that the effect of ultrasound on a fetus was not harmful.
Conclusion The findings of this study should reassure physicians and parents alike that ultrasound screening is an appropriate option for the pregnant women after 12 gestational weeks.

Citation： TANG Ying,LIU Guanjian,YANG Taizhu. Evidence-Based Case Report on the Effect of Ultrasound Screening to Pregnant Women at 11-14 Gestational Weeks on Fetus of Fetal Malformations. Chinese Journal of Evidence-Based Medicine, 2009, 09(6): 705-708. doi: 10.7507/1672-2531.20090124 Copy

1.	7 Saltvedt S, Almstro H, Kublickas M, et al. Detection of malformations in chromosomally normal fetuses by routine ultrasound at 12 or 18 weeks of gestation——a randomised controlled trial in 39 572 pregnancies. BJOG, 2006, 113(6): 664-674.
2.	Mau H, Scharf A, Baier P, et al. Ultrasound sinulators experience with the sana trainer and exparative review of other training systems. Ultrasound Obstet Gynecol, 2004, 24(4): 581-585.
3.	Wisem CS, Kiehi EM. Pience perfect anefits and risk of fetal 3D ultrasound. Am JM Atem Child Nurs, 2007, 32(2): 102-109.
4.	李胜利. 胎儿规范化的产前超声检查. 中国医疗器械信息, 2007, 13(3): 11-16.
5.	Nicolaides KH. The 11-13 weeks scan. Fetal Med Foun-dation, 2004, intraduction page: 71-88.
6.	Mary EN, Linda M, Sherri PENA, et al. First-trimester combined screening Experience with an instant approach. Amn J Obs Gyn, 2007, 19(6): 601-605.
7.	Chen M, Lee CP, Lam YH, et al. Comparison of nuchal and detailed morphology ultrasound examinations in early pregnancy for fetal structural abnormality screening: a randomized controlled trial. Ultrasound Obstet Gynecol, 2008, 31: 136-146.
8.	Westin M, Saltvedt S, Bergman G, et al. Routine ultrasound examination at 12 or 18 gestational weeks for prenatal detection of major congenital heart malformations? A randomized controlled trial comprising 36 299 fetuses. BJOG, 2006, 113(6): 675-682.
9.	Souka AP, Pilalis A, Kavalkis Y, et al, Assessment of fetal anatomy at the 11–14-week ultrasound Examination. Ultrasound Obstet Gynecol, 2004, 24: 730-734.
10.	Souka AP, Pilalis A, Kavalakis I, et al. Screening for major structural abnormalities at the 11- to 14-week ultrasound scan. Am J Obs Gyn, 2006, 194: 393-396.
11.	Becker R, Wegner RD. Detailed screening for fetal anomalies and cardiac defects at the 11–13-week scan. Ultrasound Obstet Gynecol, 2006, 27: 613-618.
12.	Chen M, Lam YH, Lee CP, et al. Ultrasound screening of fetal structural abnormalities at 12 to 14 weeks in Hong Kong. Prenat Diagn, 2004, 24: 92-97.
13.	Cedergren M, Selbing AJ. Detection of fetal structural abnormalities by a 10–14-week ultrasound dating scan in an unselected Swedish population, Oral communication abstracts, August–4 September 2004, Stockholm, Sweden.
14.	Carvalho MHB, Brizot ML. Detection of fetal structural abnormalities at the 11–14 week ultrasound scan. Prenat Diagn, 2002, 22: 1-4.
15.	Srisupundit K, Theera TS, Supatra S, et al. Fetal Structural Anomaly Screening at 11-14 Weeks of Gestation at Maharaj Nakorn Chiang Mai Hospital. J Med Assoc Thai, 2006, 89 (5): 588-593.
16.	Bricker L, Neilson JP. Routine ultrasound in late pregnancy (after 24 weeks gestation) (Cochrane Review) [CD/M]. The Cochrane Library, Issue 4, 2004. Chichester, UK: John Wiely and Sons, Ltd.
17.	Newnham JP, Evans SF, Michael CA, et al. Effects of ultrasound during pregnancy: a randomized controlled trial. Lancet, 1993, 342(8876): 887-891.
18.	Neilson JP. Ultrasound for fetal assessment in early pregnancy (Cochrane Review) [CD/M]. The Cochrane Library, Issue 4, 2004. Chichester, UK: John Wiley and Sonns, Ltd.
19.	Bricker L, Neilson JP. Routine Doppler ultrasound in pregnancy (Cochrane Review) [CD/M]. The Cochrane Library, Issue4, 2004. Chichester, UK: John Wiley and Sonns, Ltd.
20.	Campbell JD. Case-control study of prenatal ultrasnography exposure in children with delayed speech. CMAJ, 1993, 149(10): 1435-1440.
21.	Salvesen KA. Routine ultrasonography in utero and school performance at age 8-9years. Lancet, 1992, 339(8785): 85-89.
22.	Kieler H. Routine ultrasound screening in pregnancy and the childrens subsequent growth, vision and hearing. Br J Obstet Gynaecol, 1997, 104(11): 1267-1272.

1. 7 Saltvedt S, Almstro H, Kublickas M, et al. Detection of malformations in chromosomally normal fetuses by routine ultrasound at 12 or 18 weeks of gestation——a randomised controlled trial in 39 572 pregnancies. BJOG, 2006, 113(6): 664-674.
2. Mau H, Scharf A, Baier P, et al. Ultrasound sinulators experience with the sana trainer and exparative review of other training systems. Ultrasound Obstet Gynecol, 2004, 24(4): 581-585.
3. Wisem CS, Kiehi EM. Pience perfect anefits and risk of fetal 3D ultrasound. Am JM Atem Child Nurs, 2007, 32(2): 102-109.
4. 李胜利. 胎儿规范化的产前超声检查. 中国医疗器械信息, 2007, 13(3): 11-16.
5. Nicolaides KH. The 11-13 weeks scan. Fetal Med Foun-dation, 2004, intraduction page: 71-88.
6. Mary EN, Linda M, Sherri PENA, et al. First-trimester combined screening Experience with an instant approach. Amn J Obs Gyn, 2007, 19(6): 601-605.
7. Chen M, Lee CP, Lam YH, et al. Comparison of nuchal and detailed morphology ultrasound examinations in early pregnancy for fetal structural abnormality screening: a randomized controlled trial. Ultrasound Obstet Gynecol, 2008, 31: 136-146.
8. Westin M, Saltvedt S, Bergman G, et al. Routine ultrasound examination at 12 or 18 gestational weeks for prenatal detection of major congenital heart malformations? A randomized controlled trial comprising 36 299 fetuses. BJOG, 2006, 113(6): 675-682.
9. Souka AP, Pilalis A, Kavalkis Y, et al, Assessment of fetal anatomy at the 11–14-week ultrasound Examination. Ultrasound Obstet Gynecol, 2004, 24: 730-734.
10. Souka AP, Pilalis A, Kavalakis I, et al. Screening for major structural abnormalities at the 11- to 14-week ultrasound scan. Am J Obs Gyn, 2006, 194: 393-396.
11. Becker R, Wegner RD. Detailed screening for fetal anomalies and cardiac defects at the 11–13-week scan. Ultrasound Obstet Gynecol, 2006, 27: 613-618.
12. Chen M, Lam YH, Lee CP, et al. Ultrasound screening of fetal structural abnormalities at 12 to 14 weeks in Hong Kong. Prenat Diagn, 2004, 24: 92-97.
13. Cedergren M, Selbing AJ. Detection of fetal structural abnormalities by a 10–14-week ultrasound dating scan in an unselected Swedish population, Oral communication abstracts, August–4 September 2004, Stockholm, Sweden.
14. Carvalho MHB, Brizot ML. Detection of fetal structural abnormalities at the 11–14 week ultrasound scan. Prenat Diagn, 2002, 22: 1-4.
15. Srisupundit K, Theera TS, Supatra S, et al. Fetal Structural Anomaly Screening at 11-14 Weeks of Gestation at Maharaj Nakorn Chiang Mai Hospital. J Med Assoc Thai, 2006, 89 (5): 588-593.
16. Bricker L, Neilson JP. Routine ultrasound in late pregnancy (after 24 weeks gestation) (Cochrane Review) [CD/M]. The Cochrane Library, Issue 4, 2004. Chichester, UK: John Wiely and Sons, Ltd.
17. Newnham JP, Evans SF, Michael CA, et al. Effects of ultrasound during pregnancy: a randomized controlled trial. Lancet, 1993, 342(8876): 887-891.
18. Neilson JP. Ultrasound for fetal assessment in early pregnancy (Cochrane Review) [CD/M]. The Cochrane Library, Issue 4, 2004. Chichester, UK: John Wiley and Sonns, Ltd.
19. Bricker L, Neilson JP. Routine Doppler ultrasound in pregnancy (Cochrane Review) [CD/M]. The Cochrane Library, Issue4, 2004. Chichester, UK: John Wiley and Sonns, Ltd.
20. Campbell JD. Case-control study of prenatal ultrasnography exposure in children with delayed speech. CMAJ, 1993, 149(10): 1435-1440.
21. Salvesen KA. Routine ultrasonography in utero and school performance at age 8-9years. Lancet, 1992, 339(8785): 85-89.
22. Kieler H. Routine ultrasound screening in pregnancy and the childrens subsequent growth, vision and hearing. Br J Obstet Gynaecol, 1997, 104(11): 1267-1272.

Chinese Journal of Evidence-Based Medicine

Evidence-Based Case Report on the Effect of Ultrasound Screening to Pregnant Women at 11-14 Gestational Weeks on Fetus of Fetal Malformations

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