Detailed Second Trimester Ultrasound Examination in Low Risk Pregnancies: A Tertiary Center Experience
Abstract
Aim: Congenital anomalies are abnormal deviations from the standard type during morphogenesis that include fetal structural and functional abnormalities. A major congenital anomaly affects 2-3% of newborn babies. Major congenital anomalies are second major causes of prenatal mortality and morbidity after preterm birth. The aim of this study is to evaluate the anomaly type, incidence and prognosis of pregnancies which were found to have congenital anomaly during prenatal period.Material and Methods: The detailed ultrasound results of 2640 pregnant women who were followed at our hospital and as well as pregnant women referred to high-risk pregnancy clinic for various indications such as minor marker presence, family history and advanced maternal age were evaluated retrospectively.Results: A total of 107 major congenital anomalies were detected in 93 3.5% patients. The most common abnormality was detected in central nervous system 34.6% and the most common abnormalities in this group were ventriculomegaly and hydrocephalus 15/37 . The second most common malformations were detected in cardiovascular system. In this group septal defects were the most frequent malformations 9/21 . 79.4% 85 of fetuses with major fetal anomalies’ were diagnosed in 18 to 23 weeks detailed ultrasound scan.Conclusion: A large proportion of major fetal structural anomalies can be identified with 18-23 week detailed ultrasound evaluation; however, in cases whom, adequate visualization cannot be provided at second trimester, with the re-evaluation in the 3rd trimester, more than 90% of patients can be diagnosed in prenatal period.
References
- Simpson JL, Otano L. Prenatal genetic diagnosis. Gabbe SG, Niebly JR, Simpson JL (Eds). Obstetrics: Normal and Problem Pregnancy Churchill Livingstone, Elsevier, 5. Baskı, 2007; Bölüm 7: 152-183
- RCOG Study Group. The antenatal diagnosis of fetal abnormalities. In: Drife JO, Donnai D, eds. Proceedings of the Eighteenth Study Group of the Royal College of Obstetricians and Gynecologists. London: Springer Verlag, 1991.
- American Institute of Ultrasound in Medicine. AIUM practice guideline for the performance of an antepartum obstetric ultrasound examination. J Ultrasound Med 2003;22: 1116.
- Grandjean H, Larroque D, Levi S. The performance of routine ultraso- nographic screening of pregnancies in the Eurofetus Study. Am J Obstet Gynecol. 1999;181:446-54.
- Garne E, Loane M, Dolk H, De Vigan C, Scarano G, Tucker D, et al. Pre- natal diagnosis of severe structural congenital malformations in Europe. Ultrasound Obstet Gynecol 2005;25: 6-11.
- Hadlock FP, Deter RL, Harrist RB, et al. Fetal biparietal diameter: a critical re-evaluation of the relation to menstrual age by means of real-time ult- rasound. J Ultrasound Med 1982;1:97.
- Hadlock FP, Harrist RB, Deter RL, et al. Fetal femur length as a predic- tor of menstrual age: sonographically measured. AJR Am J Roentgenol 1982;138:875.
- Hadlock FP, Deter RL, Harrist RB, et al. Fetal abdominal circumference as a predictor of menstrual age. AJR Am J Roentgenol 1982;139:367.
- Jeanty P, Kirkpatrick C, Dramaix-Wilmet M, et al. Ultrasonic evaluation of fetal limb growth. Radiology 1981;140:165.
- Salomon LJ, Alfirevic Z, Berghella C, Bilardo E, Hernandez-Andrade E, Johnsen SL, Kalache K, et al. Practice guidelines for performance of the routine mid-trimester fetal ultrasound scan. Ultrasound Obstet Gynecol 2011;37:116-26.
- Tomatir AG, Demirhan H, Sorkun HC, Köksal A, Ozerdem F, Cilengir N. Major congenital anomalies: a five-year retrospective regional study in Turkey. Genet Mol Res 2009;8:19-27.
- Kurdoğlu M, Kuroğlu Z, Küçükaydın Z, Kolusarı A, Adalı E, Yıldızhan R ve ark. Van yöresinde konjenital malformasyonların görülme sıklığı ve dağılımı. Van Tıp Dergisi 2009;16:95-8.
- Özler A, Başaranoğlu S, Karaçor T, Yaman Tunç S, Yaman Tunç N, Palancı Y, Evsen MS, Yalınkaya A. Tersiyer bir merkezde konjenital anomalili do- ğumların retrospektif analizi. Perinatoloji Dergisi 2014;22:13-17.
- EUROCAT Working Group. Surveillance of Congenital Anomalies in Europe 1980–1999: Report 8. EUROCAT Central Registry, University of Ulster, Northern Ireland BT370QB. http://www.eurocat.ulster.ac.uk [Ac- cessed 7 July 2003].
- Chen M, Lee CP, Lam YH, Tang RYK, Chan BCP, Wong SF, Tse LHY, Tang MHY. Comparison of nuchal and detailed morphology ultrasound exa- minations in early pregnancy for fetal structural abnormality screening: a randomized controlled trial. Ultrasound Obstet Gynecol 2008;31:136– 146.
- Iliescu D, Tudorache S, Comanescu A, Antsaklis P, Cotarcea S, Novac L, Cernea N, Antsaklis A. Improved detection rate of structural abnor- malities in the first trimester using an extended examination protocol. Ultrasound Obstet Gynecol. 2013;42:300-9.
- Gadow EC. Primary prevention of birth defects. In: Carrera JM, Cabero L, Baraibar R, editors. The Perinatal Medicine of the New Millenium. Bolog- na: Monduzzi Ed. 2001;319-25.
Abstract
Amaç: Konjenital anomaliler, morfogenez sırasında, anormal gelişim sonucu meydana gelen fetal yapısal ve işlevsel anomalileri içerir. Yeni doğanların %2-3’ünde majör konjenital anomali bulunmaktadır. Majör anomaliler, preterm doğumlardan sonra fetal mortalite ve morbiditenin en önemli ikinci sıklıktaki sebebidir. Çalışmamızın amacı, kliniğimizde prenatal dönemde saptanan fetal anomalilerin tiplerini, insidans ve prognozlarını değerlendirmektirMateryal ve Metod: Hastanemiz gebe polikliniğinde takipleri yapılan ve riskli gebelik polikliniğine minör marker varlığı, aile hikâyesi, ileri anne yaşı gibi çeşitli endikasyonlar ile refere edilmiş olan 2640 hastanın detaylı ultrason sonuçları retrospektif olarak değerlendirildi.Sonuçlar: 2640 Hastanın 93’ünde %3.5 toplam 107 major konjenital anomali tespit edildi. En sık anomali tespit edilen sistem merkezi sinir sistemi olup %34.6 , bu grupta en sık ventrikülomegali ve hidrosefali 15/37 saptandı. İkinci sıklıkta kardiyak anomaliler saptanır iken, bu grupta en sık karşılaşılan malformasyon ise septal defektler idi 9/21 . Majör fetal anomalisi bulunan fetusların %79.4’üne 85 18-23 hafta detaylı ultrason taramasında tanı konuldu.Tartışma: Majör fetal yapısal anomalilerin büyük bir bölümü 18-23 haftalar arasında yapılacak detaylı ultrason değerlendirmesi ile tanımlanabilmekte ise de, yeterli görüntülemenin sağlanamadığı olgularda 3. trimesterde yapılacak tekrar değerlendirmeler ile prenatal dönemde olguların %90’dan fazlasına tanı konulabilir.
References
- Simpson JL, Otano L. Prenatal genetic diagnosis. Gabbe SG, Niebly JR, Simpson JL (Eds). Obstetrics: Normal and Problem Pregnancy Churchill Livingstone, Elsevier, 5. Baskı, 2007; Bölüm 7: 152-183
- RCOG Study Group. The antenatal diagnosis of fetal abnormalities. In: Drife JO, Donnai D, eds. Proceedings of the Eighteenth Study Group of the Royal College of Obstetricians and Gynecologists. London: Springer Verlag, 1991.
- American Institute of Ultrasound in Medicine. AIUM practice guideline for the performance of an antepartum obstetric ultrasound examination. J Ultrasound Med 2003;22: 1116.
- Grandjean H, Larroque D, Levi S. The performance of routine ultraso- nographic screening of pregnancies in the Eurofetus Study. Am J Obstet Gynecol. 1999;181:446-54.
- Garne E, Loane M, Dolk H, De Vigan C, Scarano G, Tucker D, et al. Pre- natal diagnosis of severe structural congenital malformations in Europe. Ultrasound Obstet Gynecol 2005;25: 6-11.
- Hadlock FP, Deter RL, Harrist RB, et al. Fetal biparietal diameter: a critical re-evaluation of the relation to menstrual age by means of real-time ult- rasound. J Ultrasound Med 1982;1:97.
- Hadlock FP, Harrist RB, Deter RL, et al. Fetal femur length as a predic- tor of menstrual age: sonographically measured. AJR Am J Roentgenol 1982;138:875.
- Hadlock FP, Deter RL, Harrist RB, et al. Fetal abdominal circumference as a predictor of menstrual age. AJR Am J Roentgenol 1982;139:367.
- Jeanty P, Kirkpatrick C, Dramaix-Wilmet M, et al. Ultrasonic evaluation of fetal limb growth. Radiology 1981;140:165.
- Salomon LJ, Alfirevic Z, Berghella C, Bilardo E, Hernandez-Andrade E, Johnsen SL, Kalache K, et al. Practice guidelines for performance of the routine mid-trimester fetal ultrasound scan. Ultrasound Obstet Gynecol 2011;37:116-26.
- Tomatir AG, Demirhan H, Sorkun HC, Köksal A, Ozerdem F, Cilengir N. Major congenital anomalies: a five-year retrospective regional study in Turkey. Genet Mol Res 2009;8:19-27.
- Kurdoğlu M, Kuroğlu Z, Küçükaydın Z, Kolusarı A, Adalı E, Yıldızhan R ve ark. Van yöresinde konjenital malformasyonların görülme sıklığı ve dağılımı. Van Tıp Dergisi 2009;16:95-8.
- Özler A, Başaranoğlu S, Karaçor T, Yaman Tunç S, Yaman Tunç N, Palancı Y, Evsen MS, Yalınkaya A. Tersiyer bir merkezde konjenital anomalili do- ğumların retrospektif analizi. Perinatoloji Dergisi 2014;22:13-17.
- EUROCAT Working Group. Surveillance of Congenital Anomalies in Europe 1980–1999: Report 8. EUROCAT Central Registry, University of Ulster, Northern Ireland BT370QB. http://www.eurocat.ulster.ac.uk [Ac- cessed 7 July 2003].
- Chen M, Lee CP, Lam YH, Tang RYK, Chan BCP, Wong SF, Tse LHY, Tang MHY. Comparison of nuchal and detailed morphology ultrasound exa- minations in early pregnancy for fetal structural abnormality screening: a randomized controlled trial. Ultrasound Obstet Gynecol 2008;31:136– 146.
- Iliescu D, Tudorache S, Comanescu A, Antsaklis P, Cotarcea S, Novac L, Cernea N, Antsaklis A. Improved detection rate of structural abnor- malities in the first trimester using an extended examination protocol. Ultrasound Obstet Gynecol. 2013;42:300-9.
- Gadow EC. Primary prevention of birth defects. In: Carrera JM, Cabero L, Baraibar R, editors. The Perinatal Medicine of the New Millenium. Bolog- na: Monduzzi Ed. 2001;319-25.
Details
| Primary Language | Turkish |
|---|---|
| Journal Section | Research Article |
| Authors | |
| Publication Date | January 1, 2015 |
| Published in Issue | Year 2015 Volume: 12 Issue: 1 |