Fetal anomaly detection by second-trimester ultrasonography in a tertiary center.
OBJECTIVE
Our purpose was to determine the relative accuracy of indicated versus screening second-trimester ultrasonography for detection of fetal anomalies and to assess the cost effectiveness of anomaly screening.


METHODS
The study population consisted of 2031 pregnant women with singleton gestations who prospectively underwent ultrasonographic scanning between 15 and 22 weeks and received complete obstetric care at the Medical University of South Carolina between July 1, 1993, and June 30, 1996. Patients were divided into two groups: (1) indicated and (2) screening. The cost of screening ultrasonography was compared with the cost of newborn care for selected anomalous fetuses.


RESULTS
Forty-seven fetuses (2.3%) were diagnosed by ultrasonography as having a major anomaly: 8.6% in the indicated group and 0.68% in the screening group (p=0.001). The sensitivity for detecting the anomalous fetus was 75.0% overall: 89.7% in the indicated group and 47.6% in the screening group (p=0.001). Of the 47 patients diagnosed with fetal anomalies, 11 (23.4%) chose pregnancy termination; of the 35 (74.5%) live-born anomalous infants, 29 (82.9%) were discharged alive. Projected newborn cost savings offset the cost of routine midtrimester screening.


CONCLUSIONS
Detection of anomalous fetuses was significantly better in the indicated compared with the screening group. Nevertheless, routine ultrasonographic screening appeared cost-effective in our population.
VanDorsten
J P
JP
Prenatal Wellness Center, Department of Obstetrics and Gynecology, Medical University of South Carolina, Charleston, USA.
Hulsey
T C
TC
Newman
R B
RB
Menard
M K
MK
D000013:Congenital Abnormalities / Q000000981:diagnostic imaging*; D005188:False Negative Reactions; D005189:False Positive Reactions; D005260:Female; D005315:Fetal Diseases / Q000000981:diagnostic imaging*; D005865:Gestational Age; D017048:Health Care Costs; D006554:Hernia, Umbilical / Q000000981:diagnostic imaging / Q000191:economics; D006801:Humans; D006849:Hydrocephalus / Q000000981:diagnostic imaging / Q000191:economics; D011247:Pregnancy; D011248:Pregnancy Complications; D011262:Pregnancy Trimester, Second; D011446:Prospective Studies; D012307:Risk Factors; D012680:Sensitivity and Specificity; D016135:Spinal Dysraphism / Q000000981:diagnostic imaging / Q000191:economics; D016216:Ultrasonography, Prenatal