title: Improved detection rate of structural abnormalities in the first trimester using an extended examination protocol.
abstract: OBJECTIVE
  To assess the potential of first-trimester sonography in the detection of fetal abnormalities using an extended protocol that is achievable with reasonable resources of time, personnel and ultrasound equipment.
  
  
  METHODS
  This was a prospective two-center 2-year study of 5472 consecutive unselected pregnant women examined at 12 to 13 + 6 gestational weeks. Women were examined using an extended morphogenetic ultrasound protocol that, in addition to the basic evaluation, involved a color Doppler cardiac sweep and identification of early contingent markers for major abnormalities.
  
  
  RESULTS
  The prevalence of lethal and severe malformations was 1.39%. The first-trimester scan identified 40.6% of the cases detected overall and 76.3% of major structural defects. The first-trimester detection rate (DR) for major congenital heart disease (either isolated or associated with extracardiac abnormalities) was 90% and that for major central nervous system anomalies was 69.5%. In fetuses with increased nuchal translucency (NT), the first-trimester DR for major anomalies was 96%, and in fetuses with normal NT it was 66.7%. Most (67.1%) cases with major abnormalities presented with normal NT.
  
  
  CONCLUSIONS
  A detailed first-trimester anomaly scan using an extended protocol is an efficient screening method to detect major fetal structural abnormalities in low-risk pregnancies. It is feasible at 12 to 13 + 6 weeks with ultrasound equipment and personnel already used for routine first-trimester screening. Rate of detection of severe malformations is greater in early- than in mid-pregnancy and on postnatal evaluation. Early heart investigation could be improved by an extended protocol involving use of color Doppler.
authors.affiliation: Department of Obstetrics and Gynecology, University of Medicine and Pharmacy of Craiova, Craiova, Romania. dominic.iliescu@yahoo.com
authors.forename: D
authors.initials: D
authors.lastname: Iliescu
authors.forename: S
authors.initials: S
authors.lastname: Tudorache
authors.forename: A
authors.initials: A
authors.lastname: Comanescu
authors.forename: P
authors.initials: P
authors.lastname: Antsaklis
authors.forename: S
authors.initials: S
authors.lastname: Cotarcea
authors.forename: L
authors.initials: L
authors.lastname: Novac
authors.forename: N
authors.initials: N
authors.lastname: Cernea
authors.forename: A
authors.initials: A
authors.lastname: Antsaklis
mesh_terms: D000328:Adult; D002490:Central Nervous System / Q000002:abnormalities / Q000000981:diagnostic imaging; D018618:Echocardiography, Doppler, Color / Q000379:methods*; D005240:Feasibility Studies; D005260:Female; D006330:Heart Defects, Congenital / Q000000981:diagnostic imaging*; D006801:Humans; D011247:Pregnancy; D011261:Pregnancy Trimester, First; D011446:Prospective Studies; D016216:Ultrasonography, Prenatal / Q000379:methods*
keywords: color Doppler; congenital abnormalities; first trimester; prenatal diagnosis; screening; ultrasound