2021, Number 01
<< Back Next >>
Ginecol Obstet Mex 2021; 89 (01)
Diagnostic performance of the first trimester ultrasound for structural anomalies
Núñez-Sánchez GC, Gallardo-Gaona JM, Velázquez-Torres B, Camarena-Cabrera DM, Acevedo-Gallegos S, Ramírez-Calvo JA
Language: Spanish
References: 24
Page: 5-13
PDF size: 185.44 Kb.
ABSTRACT
Objective: To evaluate the diagnostic performance of first trimester ultrasound in
the identification of structural defects that are detectable and potentially detectable at
this stage of gestation.
Materials and Methods: Transversal and descriptive study carried out at the
Maternal-Fetal Medicine Department of the Instituto Nacional de Perinatología Isidro
Espinosa de los Reyes between March 2017 and October 2018. Inclusion criteria:
Patients who attended the first trimester screening ultrasound and underwent early
fetal anatomical evaluation. A diagnostic test-type study with calculation of diagnostic
indices was performed.
Results:1652 first-trimester ultrasounds were found in which the prevalence of structural
defects was 2%. Due to circumstances beyond the research, the gold standard
could only be applied to 1610 patients from whom a detection rate of 83.62% of structural
alterations and 100% specificity was obtained with the first-trimester ultrasound.
Conclusion: The first-trimester ultrasound is ideal for performing the first fetal anatomical
evaluation, with high acceptance among patients and physicians. This study
does not replace but rather complements the fetal morphological assessment carried
out in the second trimester; by combining both assessments the sensitivity is over 90%
for detecting structural alterations.
REFERENCES
Liff I, Bromley B. Fetal anatomic imaging between 11 and 14 gestation. Clin Obstet Gynecol. 2017; 60 (3): 621-635. https://doi.org/10.1097/GRF.0000000000000296.
ACOG Practice Bulletin No. 163: screening for fetal aneuploidy. Obstet Gynecol. 2016;127:e123-e137. doi. 10.1097/ AOG.0000000000001406.
Liff I, Bromley B. Fetal Anatomic Imaging Between 11 and 14 Weeks Gestation. Vol. 60, Clinical Obstet and Gyneco. 2017; 60 (3). https://doi.org/10.1097/GRF.0000000000000296.
McAuliffe FM, Fong KW, Toi A, Chitayat D, Keating S, Johnson JA. Ultrasound detection of fetal anomalies in conjunction with first-trimester nuchal translucency screening: A feasibility study. Am J Obstet Gynecol 2005; 1260-5. https://doi.org/10.1016/j.ajog.2005.06.075.
Donnelly JC, Malone FD. Early fetal anatomical sonography. Vol. 26, Best Practice & Research Clinical Obstetrics & Gynaecology. 2012; 26 (5): 561-73. https://doi.org/10.1016/j. bpobgyn.2012.06.002.
Edwards L, Hui L. First and second trimester screening for fetal structural anomalies. Seminars in Fetal & Neonatal Medicine 2017; 23 (2): 102-11. https://doi.org/10.1016/j. siny.2017.11.005.
Syngelaki A, Chelemen T, Dagklis T, Allan L, Nicolaides KH. Challenges in the diagnosis of fetal non-chromosomal abnormalities at 11-13 weeks. Prenatal Diagn. 2011; 31: 90-102. https://doi.org/10.1002/pd.2642.
Borrell A, Robinson J, Santolaya-Forgas J. Clinical value of the 11- to 13 6-week sonogram for detection of congenital malformations: A Review. Am J Perinatol 2011; 28: 117-24. doi.10.1055/s-0030-1263302.
Kenkhuis MJA, Bakker M, Bardi F, Fontanella F, Fleurke- Rozema JH. Effectiveness of 12-13-week scan for early diagnosis of fetal congenital anomalies in the cell-free DNA era. Ultrasound Obstet Gynecol. 2018 Apr;51(4):463-69. https://doi.org/10.1002/uog.17487
Karim JN, Roberts NW, Salomon LJ, Papageorghiou AT. Systematic review of first-trimester ultrasound screening for detection of fetal structural anomalies and factors that affect screening performance. Ultrasound Obstet Gynecol 2017; 50: 429-41. https://doi.org/10.1002/uog.17246.
Gutiérrez-Gutiérrez H, Velázquez-Torres B. Eficacia de detección de defectos estructurales con ultrasonido de la semana 11 a la 13.6 de gestación. Tesis para obtener el título de especialista en Medicina Materno fetal. Instituto Nacional de Perinatología, Ciudad de México.
Bardi F, Smith E, Kuilman M, Snijders RJM, Bilardo CM. Early detection of structural anomalies in a primary care setting in the Netherlands. Fetal Diagn Ther 2019; 46: 12- 19. https://doi.org/10.1159/000490723.
Sonek JD, Kagan KO, Nicolaides KH. Inverted pyramid of care. Clinics in Laboratory Medicine. 2016; 36: 305-17. doi.10.1016/j.cll.2016.01.009.
Yagel S, Achiron R, Ron M, Revel A, Anteb E. Transvaginal ultrasonography at early pregnancy cannot be used alone for targeted organ ultrasonographic examination in a high-risk population. J of Diagnostic Medical Sonography. 1995; 272-3. https://doi.org/10.1016/0002- 9378(95)90029-2
15. Westin M, Saltvedt S, Bergman G, Kublickas M, Almstrom H, Grunewald C, et al. Routine ultrasound examination at 12 or 18 gestational weeks for prenatal detection of major congenital heart malformations? A randomised controlled trial comprising 36 299 fetuses. Vol. 113, BJOG: An International J of Obstet and Gynaecol. 2006; 675-82. https://doi.org/10.1111/j.1471-0528.2006.00951.x.
Lim J, Whittle WL, Lee YM, Ryan G, Van Mieghem T. Early anatomy ultrasound in women at increased risk of fetal anomalies. Prenat Diagn 2013 Sep;33(9):863-8. https:// doi.org/10.1002/pd.4145
Volpe P, Ubaldo P, Volpe N, Campobasso G, De Robertis V, Tempesta A, et al. Fetal cardiac evaluation at 11-14 weeks by experienced obstetricians in a low-risk population. Prenat Diagn. 2011; 31: 1054-61. https://doi.org/10.1002/ pd.2831
García Fernández S, JArenas Ramírez J, Otero Chouza MT, Rodríguez Vijande B, et al. Early fetal ultrasound screening for major congenital heart defects without Doppler. Euro pean Journal of Obstetrics & Gynecology and Reproductive Biology 2019; 233: 93-97. https://doi.org/10.1016/j. ejogrb.2018.11.030
Hernandez-Andrade E. Patwardhan M. Early Evaluation of the Fetal Heart. Fetal Diagn Ther 2017; 42:161-173. https:// doi.org/10.1159/000477564
Petousis S, Sotidiaris A, Margioula-Starkou Ch, et al. Detection of structural abnormalities in fetuses with normal karyotype at 11-13 weeks using the anatomic examination protocol of the International Society of Ultrasound in Obstet and Gynecology (ISUOG). J Matern Fetal Neonatal Med. 2019:1-7. https://doi. org/10.1080/14767058.2018.1555807
Vayna AM, Veduta A. Diagnosis of Fetal Structural Anomalies at 11 to 14 Weeks. J Ultrasound Med. 2018; 37 (8): 2063-73. https://doi.org/10.1002/jum.14561.
Becker R, Wegner RD. Detailed screening for fetal anomalies and cardiac defects at the 11-13-week scan. Ultrasound Obstet Gynecol. 2006; 27 (6): 613-18. https://doi. org/10.1002/uog.2709.
Kenkhuis MJA, Bakker M, Bardi F, Fontanella F, et al. Effectiveness of 12-13-week scan for early diagnosis of fetal congenital anomalies in the cell-free DNA era. Ultrasound Obstet Gynecol. 2018; 52 (4): 550. https://doi.org/10.1002/uog.17487.
Dulgheroff FF, Peixoto AB, Galvao Petrini C, Rodrigues da Cunha Caldas TC, Rocha Ramos D, Oliveira Magalhaes F, Araujo Júnior E. Fetal structural anomalies diagnosed during the first, second and third trimesters of pregnancy using ultrasonography: a retrospective cohort study. Sao Paulo Med J. 2019;137(5):391-400. http://dx.doi. org/10.1590/1516-3180.2019.026906082019.