The Performance of First-Trimester Anatomy Scan: A Decision Analysis.
Introduction First-trimester ultrasound (US) for anatomy assessment may improve anomaly detection, but it may also increase overall US utilization. We sought to assess the utility of first-trimester US for evaluation of fetal anatomy. Materials and Methods A decision analytic model was created to compare first- plus second-trimester anatomy scans to second-trimester scan alone in four populations: general, normal weight women, obese women, and diabetics. Probability estimates were obtained from the literature. Outcomes considered were number of: major structural anomalies detected, US performed, and false-positive US. Multivariable sensitivity analyses were performed to evaluate the consistency of the model with varying assumptions. Results A strategy of first- plus second-trimester US detected the highest number of anomalies but required more US examinations per anomaly detected. The addition of a first-trimester anatomy US was associated with a small increase in the false-positive US (< 10/10,000). In populations with higher anomaly prevalence and lower second-trimester US sensitivity (i.e., diabetes, obesity), the number of additional US performed per anomaly detected with the first-trimester US was < 60. Discussion In high-risk populations, a first-trimester US in addition to a second-trimester US may be a beneficial approach to detecting anomalies.
Department of Obstetrics and Gynecology, The University of Alabama at Birmingham, Center for Women's Reproductive Health, Birmingham, Alabama.
Lorie M
LM
Harper
Department of Obstetrics and Gynecology, The University of Alabama at Birmingham, Center for Women's Reproductive Health, Birmingham, Alabama.
S Lindsay
SL
Wood
Department of Obstetrics and Gynecology, The University of Alabama at Birmingham, Center for Women's Reproductive Health, Birmingham, Alabama.
Sheri M
SM
Jenkins
Department of Obstetrics and Gynecology, The University of Alabama at Birmingham, Center for Women's Reproductive Health, Birmingham, Alabama.
John
J
Owen
Department of Obstetrics and Gynecology, The University of Alabama at Birmingham, Center for Women's Reproductive Health, Birmingham, Alabama.
Joseph R
JR
Biggio
D000328:Adult; D003661:Decision Support Techniques; D005260:Female; D005333:Fetus / Q000002:abnormalities / Q000000981:diagnostic imaging*; D005865:Gestational Age; D006801:Humans; D015999:Multivariate Analysis; D011247:Pregnancy; D011261:Pregnancy Trimester, First; D011262:Pregnancy Trimester, Second; D012196:Review Literature as Topic; D012680:Sensitivity and Specificity; D016216:Ultrasonography, Prenatal / Q000706:statistics & numerical data*