The value of the routine third trimester ultrasound scan in antenatal care

Feasibility of extended ultrasound examination of the fetal brain between 24 and 37 weeks' gestation in low-risk pregnancies

OBJECTIVES

To assess the feasibility of identifying fetal brain structures and anatomic landmarks included in the anterior complex (AC) and posterior complex (PC), as well as the proximal hemisphere (PH).

METHODS

This was a prospective observational multicenter study of healthy pregnant women evaluated by ultrasound screening at 24 to 36 + 6 weeks' gestation. Six physicians performed transabdominal ultrasound, to obtain the planes required to visualize the AC, PC, and PH. Blind analysis by an expert and non-expert operator in fetal neurosonography was used to assess the structures included in each plane view.

RESULTS

In the population studied (n=366), structure detection rates for AC were over 95 %, with an agreement of 96 % when comparing expert and non-expert examiners. Visualization of the corpus callosum crossing the midline was detected in over 97 and 96 % of cases for the AC and PC, respectively, with an agreement of over 96 %. The PH plane, particularly through the posterior access via the mastoid fontanelle, enabled visualization of the proximal anatomical structures in almost 95 % of cases. Detection of the corpus callosum through the AC and PC, both proximal/distal germinal matrix (AC) and proximal Sylvian fissure through the anterior access (PH) in the 24-25 + 6, 26-31 + 6 and 32-36 + 6 weeks' gestation groups were successful in over 96 % of cases with high level of agreement.

CONCLUSIONS

Inclusion of AC, PC, and PH later in pregnancy proves feasible with a high level of agreement between both expert and non-expert operators.

Universal third-trimester obstetrical ultrasonography: a cross-sectional analysis of a national survey

BACKGROUND

Universal third-trimester obstetrical ultrasonography represents a medical debate. The current survey was conducted to evaluate the actual use of third-trimester scan and understand gynecologists' aptitude.

METHODS

A survey was mailed to 128 gynecologists between January and February 2020. Data about their demographic's characteristics, hospital ward, and self-assessment questionnaires were recorded. Results were evaluated by using combined analysis.

RESULTS

Overall, 128 (29.8%) gynecologists answered. Their age ranged between 45 and 64 years (70.3% of the total, 90/128). The half part worked in hospitals and university hospitals (39.8%, 51/128 and 10.1%, 13/128, respectively), 26.5% (34/128) worked in private hospitals and 23.4% (30/128) in public ambulatories. The neonatal intensive care unit was present in 37.5% (48/128) of the cases. 96.0% of gynecologists surveyed (123/128) offered the universal third-trimester scan (28-32 weeks) and 78.1% of the physician recommended the universal 35-37 weeks ultrasonographical exam. A subanalysis among third level hospital gynecologists versus gynecologists without neonatal intensive care unit showed no statistical difference.

CONCLUSIONS

This survey reveals extensive use of third-trimester scan in low-risk pregnancy. Nevertheless, randomized controlled trials concerning the universal third-trimester scan are required to validate this clinical attitude.

Third trimester ultrasound. A long-standing debate

Third trimester ultrasound has long been in obstetrics a topic of debate. This issue is framed in a historical debate on the effectiveness of routine obstetrical ultrasound and two opposing trends originated in America and Europe, respectively. Primary function of this ultrasound has been to detect fetal growth restriction, but no study has shown evidence of improving perinatal outcomes. Other secondary functions are detection of fetal abnormalities or evaluation of fetal presentation, and they have also shown no evidence. Despite the continuous appearance of works in this regard, health policies of both american and european trends have not been modified. Future seems to show a prolongation of the stalemate. Those health systems with a universal third trimester policy should propose an optimization of the test, in order to improve the benefits and obtain data for future studies that could resolve this longstanding debate.

FIGO (international Federation of Gynecology and obstetrics) initiative on fetal growth: best practice advice for screening, diagnosis, and management of fetal growth restriction

Fetal growth restriction (FGR) is defined as the failure of the fetus to meet its growth potential due to a pathological factor, most commonly placental dysfunction. Worldwide, FGR is a leading cause of stillbirth, neonatal mortality, and short- and long-term morbidity. Ongoing advances in clinical care, especially in definitions, diagnosis, and management of FGR, require efforts to effectively translate these changes to the wide range of obstetric care providers. This article highlights agreements based on current research in the diagnosis and management of FGR, and the areas that need more research to provide further clarification of recommendations. The purpose of this article is to provide a comprehensive summary of available evidence along with practical recommendations concerning the care of pregnancies at risk of or complicated by FGR, with the overall goal to decrease the risk of stillbirth and neonatal mortality and morbidity associated with this condition. To achieve these goals, FIGO (the International Federation of Gynecology and Obstetrics) brought together international experts to review and summarize current knowledge of FGR. This summary is directed at multiple stakeholders, including healthcare providers, healthcare delivery organizations and providers, FIGO member societies, and professional organizations. Recognizing the variation in the resources and expertise available for the management of FGR in different countries or regions, this article attempts to take into consideration the unique aspects of antenatal care in low-resource settings (labelled “LRS” in the recommendations). This was achieved by collaboration with authors and FIGO member societies from low-resource settings such as India, Sub-Saharan Africa, the Middle East, and Latin America.