Routine obstetric ultrasound: Effectiveness of cross-sectional screening for fetal growth retardation

✍ Scribed by Dr. Enrico Ferrazzi; Umberto Nicolini; Alessandra Kustermann; Giorgio Pardi

• Publisher: John Wiley and Sons
• Year: 1986
• Tongue: English
• Weight: 494 KB
• Volume: 14
• Category: Article
• ISSN: 0091-2751
• DOI: 10.1002/jcu.1870140105

✦ Synopsis

Sonographic detection of fetal growth retardation was evaluated on a sam- ple of 778 patients routinely scanned over a 16-month period. From the 29th week to term, the sensitivity of abdominal circumference measurement progressively increased from 41% to 88% (P < 0.01). Higher rates were achieved by using the biparietal diameter but false-positive diagnoses were twice as frequent as with the abdominal measurements. When the limitations in precision of abdominal circumference were considered, the screening rate of this parameter increased about 16%. Moreover, 50% of the falsenegative diagnoses were made on fetuses weighing between the fifth and 10th centiles at birth. These diagnostic indices for biparietal diameter and abdominal circumference evaluated on a retrospective series proved to be lower than those reported for the prospective selected series. However, the results yielded by routine ultrasound were better than those obtained with clinical or traditional biochemical methods. These findings underline the importance of sonography not only in serial control of high-risk pregnancies but also in cross-sectional screening programs. Indexing words: U1trasound -Cross-sectional screening * Fetal growth retardation

In different reports, depending on the parameters used, the percentage of correct diagnoses of small fetuses obtained with ultrasound ranges between 50% and 80%.' However, questions as to the efficacy of routine screening of a nonselected population still exist. Moreover, in routine work, when commonly used real-time equipment is used, doubts can be raised about the reliability of fetal abdomen measurements.' Another question concerns the stage of gestation at which ultrasound should be performed. Sonographic examinations can be repeated several times in high-risk pregnancies, whereas in a nonselected population it is generally true that only a single ultrasonic examination can be performed in the third trimester. The highest detection rate is achieved close to delivery3 but the earlier fetuses at risk are identified, the better obstetric management is likely to be.