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Saturday, November 16, 2013

Trailers (65): Accuracy of first trimester ultrasound for fetal anomalies

Rossi and Prefumo. Accuracy at 11-14 weeks of gestation for detection of fetal structural anomalies: a systematic review

Why should you read about this topic?

Because the earlier the fetal anomaly is detected, the more options the mother has for intervention.

What were the authors trying to do?

Estimate the diagnostic accuracy of ultrasonography at 11-14 weeks for fetal anomalies

Who participated and in what setting?

Papers (N=19) published between 2000-2012 on ultrasound detection of fetal anomalies (996 anomalous fetuses out of 78,002 pregnancies) at 11-14 weeks

What was the study design?

Systematic review with pooled analysis of published studies

What were the main outcome measures?

Fetal malformations on postnatal or postmortem examination

What were the results?

Overall detection rate was 51%, highest for neck anomalies and lowest for limbs, face, and genitourinary anomalies.  The detection rate was higher for women at high-risk, compared with an unselected sample.

What is the most interesting image in the paper?

Figure 3

What were the study strengths and weaknesses?

Strengths: systematic search for publications; thoughtful selection of covariates. Weaknesses:  study heterogeneity; no description of false positive rates

What does the study contribute for your practice?

Some anomalies, particularly neck anomalies, can be detected by sonography at 11-14 weeks, but many are missed.