A randomized trial of routine prenatal ultrasound

Article Abstract:

Ultrasound is an important tool in the management of some pregnancies. The Royal College of Obstetricians and Gynecologists in Great Britain has recommended the routine use of prenatal ultrasound; however, additional studies are needed before the same recommendation is made by physicians in the United States. A randomized trial was conducted to determine if a single routine ultrasound performed early in pregnancy would result in a decrease in the need for induced labor for pregnancies that went beyond the expected delivery date. The trial also studied whether such routine ultrasound could detect multiple gestations earlier in pregnancy than selective ultrasound use. There were a total of 402 pregnancies in the ultrasound group and 413 pregnancies in the usual care group that were able to be analyzed. Of the patients in the ultrasound group, 84 percent received routine ultrasound, while in the usual care group, only 23.9 percent of patients received ultrasound between 10 and 18 weeks' gestation. A total of 31 (7.7 percent) of the routine ultrasound and 20 (4.8 percent) of the usual care patients had gestational age errors. The estimated date of confinement (delivery) was altered in 93 (23.1 percent) of routine ultrasound patients and in 45 (10.9 percent) of usual care patients. There is an increased accuracy of gestational age assessment and detection of twin pregnancies with the use of routine ultrasound. The patients in this study had low-risk pregnancies. Routine ultrasound would require more experienced practitioners, more sophisticated equipment and more time; it would therefore be more expensive. Clinical benefit from routine ultrasound must be demonstrated before it can be recommended. There was no benefit to routine office ultrasound screening found in this study, since most important errors of gestational age and most twin pregnancies were suspected clinically and then confirmed by an indicated ultrasound. (Consumer Summary produced by Reliance Medical Information, Inc.)

Medical screening, Health screening

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Size of the fetal adrenal in bilateral renal agenesis

Article Abstract:

A fetal malformation called bilateral renal agenesis refers to failure of the kidneys to develop, a condition that is incompatible with life outside the uterus, and resulting in 100 percent mortality for fetuses that are alive at birth. Bilateral renal agenesis is diagnosed when prenatal ultrasound examination fails to reveal the fetal bladder and kidneys. However, ultrasonographic misdiagnosis can occur because the technique occasionally falsely indicates the presence of kidneys, which are in fact enlarged adrenal glands. There have been previous reports of increased size of fetal adrenal glands associated with bilateral renal agenesis. Autopsy records were analyzed from 11 fetuses diagnosed with bilateral renal agenesis. The adrenal glands of all 11 fetuses were examined to determine if adrenal hypertrophy (increased organ size) existed in fetuses with this condition and if there was a direct relationship between the two. Normal adrenal weight was determined from 240 normal fetuses and compared with the weight of adrenal glands from the 11 fetuses with bilateral renal agenesis. The adrenal weights were well within the normal range and adrenal hypertrophy was not found in the fetuses with bilateral fetal agenesis. In four of the 11 fetuses, the adrenal glands were flattened and had a disc-like appearance. There does not seem to be increased adrenal size in fetuses with bilateral renal agenesis; rather, it appears that false-positive ultrasound images may have been the consequence of the particular shape, rather than the size, of the adrenals. (Consumer Summary produced by Reliance Medical Information, Inc.)

Abnormalities, Birth defects, Kidneys, Kidney, Adrenal glands

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Long-bone growth in fetuses with Down's syndrome

Article Abstract:

Down's syndrome is a genetic birth defect characterized by mental retardation and other physical abnormalities. Growth deficiencies in Down's syndrome children are evident after birth, but it is not known whether they occur during fetal development. In early childhood, short stature (associated with Down's syndrome) is the result of shorter leg bones compared with the length of the trunk. Ultrasonography, the use of high frequency sound waves to visualize internal structures, can be employed to assess the leg length of fetuses. To determine whether fetal leg length is indicative of Down's syndrome, 37 fetuses who died from trisomy 21, Down's syndrome, were compared with normal fetuses by measuring all arm and leg bone lengths either by X-ray or actual bone length. Although all bone lengths were shorter in the affected fetuses, the differences were relatively small. Bone length was a less effective predictor of Down's syndrome than the use of two well-known predictors, maternal age and alpha-fetoprotein tests.

Bones, Growth, Arm, Leg, Down syndrome, Trisomy, Fetal development, Extremities, Lower, Extremities, Upper

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