Ultrasound screening for fetal structural abnormalities performed by trained midwives in the second trimester in a low-risk population--an appraisal.
OBJECTIVE
To determine the performance of trained midwives in second trimester ultrasound screening for fetal structural abnormalities in a low-risk population.


METHODS
Retrospective study.


METHODS
University Department of Obstetrics and Gynecology.


METHODS
About 13,882 women with singleton pregnancies.


METHODS
The findings of routine second trimester anomaly scan performed by midwives were reviewed. Reasons for referral to maternal fetal medicine (MFM) specialists for further assessment were analyzed.


METHODS
The detection, false positive and false alarm rates for fetal anomalies.


RESULTS
One hundred and eighty-nine pregnancies with unknown outcome were excluded from the final analysis. Overall, 617 (4.51%) women were referred to MFM specialists for further assessment, of which 470 (70.2%) were for soft markers alone and 147 (23.8%) for suspected fetal structural abnormalities. In these 13,693 fetuses with known outcome, malformed fetuses were present in 185, a prevalence of 1.35%. Of these, 115 were detected during the second trimester scan and two were detected in the third trimester. The remaining 68 malformed fetuses, most of which had minor anomalies, were identified after birth. The detection rate for a malformed fetus in second trimester scan was 62.2% (115/185) (95% CI 55.2-69.2). There were four cases of false positives and 33 cases of false alarm.


CONCLUSIONS
Experienced midwives with proper training can detect the majority of major structural abnormalities. Continuous audit and quality control plays a significant role in optimizing the fetal structural examination.
Department of Obstetrics and Gynaecology, Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong, China. chenm@cuhk.edu.hk
Min
M
Chen
Tak Yeung
TY
Leung
Daljit Singh
DS
Sahota
Tak Yuen
TY
Fung
Lin Wai
LW
Chan
Lai Wa
LW
Law
Mo Ching
MC
Chau
Tzu-Hsi Terence
TH
Lao
Tze Kin
TK
Lau
D000013:Congenital Abnormalities / Q000000981:diagnostic imaging*; D005260:Female; D005333:Fetus / Q000002:abnormalities; D006801:Humans; D008403:Mass Screening; D008880:Midwifery; D011247:Pregnancy; D011248:Pregnancy Complications / Q000000981:diagnostic imaging*; D011262:Pregnancy Trimester, Second; D012189:Retrospective Studies; D016216:Ultrasonography, Prenatal