Use of third trimester scanning to determine optimal time for delivery; TRUFLE II is an RCT … 60. The findings do not support routine ultrasonography in the third trimester for low risk pregnancies. Policies for routine third trimester obstetrical ultrasound examinations differ among countries. Because of the cluster randomised design, we included midwifery practice as a random effect in the multilevel regression models. 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. technical support for your product directly (links go to external sites): Thank you for your interest in spreading the word about The BMJ. both the second and third trimesters are necessary. With gel on your abdomen, the device will show an image of your baby to the sonographer conducting the scan. We performed a multilevel analysis only if the expected number of events per cluster was at least one, as advocated previously.33 We used an intention to treat approach. Offering all women third trimester ultrasounds did not reduce the rate of serious illness or death in babies in the first week of life. Inducing labour artificially is more invasive than augmentation of labour that has started spontaneously, and overuse of induction of labour in the absence of clear beneficial effects is a growing concern.4142 Overall, the findings of this pragmatic trial do not support a policy of routine ultrasound screening in the third trimester for low risk pregnant women to reduce severe adverse perinatal outcomes. Ultrasound is not as useful for imaging air-filled lungs, but it may be used to detect fluid around or within the lungs. a third trimester routine ultrasound on feelings experienced during pregnancy. Although we found a difference of only 0.1% between the two strategies, it is unlikely that this difference would have met the preset meaningful difference of 0.54% had the sample size been larger. For the indication biometry, the values were lower (mean 1.84 (0.82) v 0.72 (0.90), respectively, P<0.001). … gene disorders such as achondroplasia, thus providing a noninvasive tool for diagnosing skeletal dysplasia . Authors. View options for downloading these results. Other secondary outcomes were the individual components of the perinatal and maternal composite outcomes and the secondary outcomes non-cephalic presentation at the start of labour in midwife led care and birth in midwife led or obstetrician led care. We did not achieve our required sample size of 15 000 women. In low-risk pregnancies, routine ultrasonography in the third trimester detected more babies who were small for gestational age compared with usual care alone: 32% (179/556) versus 19% (78/407), though still fewer than a third of those found to be small for gestational age. Reasons for deviations from these recommendations should be documented. A study also showed that a suspicion of SGA was associated with a higher incidence of initiated delivery by the provider.9 The incidence of augmentation of labour was lower in the intervention strategy. Maternal outcomes and other obstetric interventions did not differ between the strategies. 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. In a multilevel multivariable logistic regression adjusted for confounders, routine ultrasonography in the third trimester was associated with a higher incidence of induction of labour (1.16, 1.04 to 1.30) and a lower incidence of augmentation of labour (0.78, 0.71 to 0.85). BJOG. The remaining 13 520 women were enrolled in mid-pregnancy (mean 22.8 (SD 2.4) weeks’ gestation) and provided baseline characteristics. NVOG-richtlijn Foetale groeirestrictie (FGR). The post hoc sensitivity analysis showed similar results (0.83, 0.59 to 1.34). Description: A well defined, anechoic rounded cystic structure is seen in the fetal lower abdomen. Routine mid-trimester fetal ultrasound scan Consideration must be given to local circumstances and medical practices. 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. But we do not expect that this has biased the comparison between the two strategies as the incidence of adverse outcomes was similar to our estimations. Caption: View of the fetal abdomen. Owing to the stepped wedge design, it was not possible to extend the data collection period because the midwifery practices had adopted the intervention strategy at the end of the study period. Various third trimester ultrasound markers have been investigated to predict small-for-gestational-age fetuses at risk of adverse perinatal outcome. Presentation This 18 year old woman, primigravida, presented for a routine antenatal scan at 31 weeks of gestation. Possible explanations for our findings are: routine ultrasound fetal biometry is ineffective in detecting fetal growth restriction and preventing subsequent adverse outcomes in low risk pregnancies; adding routine ultrasound scans in the third trimester to usual care does not yield major benefits because women receiving such care already undergo one clinically indicated ultrasound scan on average in the third trimester; the quality of ultrasonography was insufficient; and using fetal abdominal circumference below the 10th centile (in combination with biometric measures of slow growth) on a population based curve is ineffective in detecting fetal growth restriction, and better methods are required. How often do we identify fetal abnormalities during routine third-trimester ultrasound? In Canada, a routine third trimester ultrasound scan is not offered in the low-risk pregnancy population. Routine versus indicated third trimester ultrasound: is a randomized trial feasible? Data were retrieved from hospital records for 2339 cases, selected for additional in-depth data collection. | If you are unable to import citations, please contact COVID-19 is an emerging, rapidly evolving situation. We cannot therefore completely rule out that the study lacked the statistical power to determine if routine ultrasonography has a beneficial or harmful effect on perinatal outcomes compared with usual care. Similarly, ultrasound cannot penetrate bone, but may be used for imaging bone fractures or for infection surrounding a bone. 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