title: Cost Analysis of Following Up Incomplete Low-Risk Fetal Anatomy Ultrasounds.
abstract: To examine the clinical utility and cost of follow-up ultrasounds performed as a result of suboptimal views at the time of initial second-trimester ultrasound in a cohort of low-risk pregnant women.
  
  
  
  We conducted a retrospective cohort study of women at low risk for fetal structural anomalies who had second-trimester ultrasounds at 16 to less than 24 weeks of gestation from 2011 to 2013. We determined the probability of women having follow-up ultrasounds as a result of suboptimal views at the time of the initial second-trimester ultrasound, and calculated the probability of detecting an anomaly on follow-up ultrasound. These probabilities were used to estimate the national cost of our current ultrasound practice, and the cost to identify one fetal anomaly on follow-up ultrasound.
  
  
  
  During the study period, 1,752 women met inclusion criteria. Four fetuses (0.23% [95% CI 0.06-0.58]) were found to have anomalies at the initial ultrasound. Because of suboptimal views, 205 women (11.7%) returned for a follow-up ultrasound, and one (0.49% [95% CI 0.01-2.7]) anomaly was detected. Two women (0.11%) still had suboptimal views and returned for an additional follow-up ultrasound, with no anomalies detected. When the incidence of incomplete ultrasounds was applied to a similar low-risk national cohort, the annual cost of these follow-up scans was estimated at $85,457,160. In our cohort, the cost to detect an anomaly on follow-up ultrasound was approximately $55,000.
  
  
  
  The clinical yield of performing follow-up ultrasounds because of suboptimal views on low-risk second-trimester ultrasounds is low. Since so few fetal abnormalities were identified on follow-up scans, this added cost and patient burden may not be warranted.
authors.affiliation: Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Beth Israel Deaconess Medical Center, Boston, MA, USA.|Department of Obstetrics, Gynecology and Reproductive Biology, Harvard Medical School, Boston, MA, USA.
authors.forename: Karen
authors.initials: K
authors.lastname: O'Brien
authors.affiliation: Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Beth Israel Deaconess Medical Center, Boston, MA, USA.|Department of Obstetrics, Gynecology and Reproductive Biology, Harvard Medical School, Boston, MA, USA.
authors.forename: Scott A
authors.initials: SA
authors.lastname: Shainker
authors.affiliation: Department of Obstetrics and Gynecology, Beth Israel Deaconess Medical Center, Boston, MA, USA.
authors.forename: Anna M
authors.initials: AM
authors.lastname: Modest
authors.affiliation: Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Beth Israel Deaconess Medical Center, Boston, MA, USA.|Department of Obstetrics, Gynecology and Reproductive Biology, Harvard Medical School, Boston, MA, USA.
authors.forename: Melissa H
authors.initials: MH
authors.lastname: Spiel
authors.affiliation: Department of Obstetrics, Gynecology and Reproductive Biology, Harvard Medical School, Boston, MA, USA.|Division of Reproductive Endocrinology and Infertility, Department of Obstetrics and Gynecology, Beth Israel Deaconess Medical Center, Boston, MA, USA.|Boston IVF, Waltham, MA, USA.
authors.forename: Nina
authors.initials: N
authors.lastname: Resetkova
authors.affiliation: Department of Obstetrics, Gynecology and Reproductive Biology, Harvard Medical School, Boston, MA, USA.|Department of Obstetrics and Gynecology, Beth Israel Deaconess Medical Center, Boston, MA, USA.
authors.forename: Neel
authors.initials: N
authors.lastname: Shah
authors.affiliation: Department of Obstetrics, Gynecology and Reproductive Biology, Harvard Medical School, Boston, MA, USA.|Department of Obstetrics and Gynecology, Beth Israel Deaconess Medical Center, Boston, MA, USA.
authors.forename: Michele R
authors.initials: MR
authors.lastname: Hacker
mesh_terms: D000328:Adult; D001900:Boston; D000013:Congenital Abnormalities / Q000000981:diagnostic imaging* / Q000191:economics; D003365:Costs and Cost Analysis; D005260:Female; D005865:Gestational Age; D006801:Humans; D008403:Mass Screening / Q000191:economics / Q000379:methods; D011247:Pregnancy; D011262:Pregnancy Trimester, Second; D012189:Retrospective Studies; D016216:Ultrasonography, Prenatal / Q000191:economics*; D055815:Young Adult
keywords: fetal abnormalities; pregnancy; ultrasound