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INTRAUTERINE GROWTH RESTRICTION |
Cochrane Database Syst Rev. 2007 Jul 18;(2):CD001451.
WITHDRAWN: Routine ultrasound in late pregnancy (after 24 weeks' gestation).
Bricker L, Neilson JP.
Liverpool Women's NHS Foundation Trust, Crown Street, Liverpool, UK, L8 7SS.
leanne.bricker@lwh.nhs.uk
Background:
Diagnostic ultrasound is used selectively in late pregnancy
where there are specific clinical indications. However, the value of routine
late pregnancy ultrasound screening in unselected populations is
controversial. The rationale for such screening would be the detection of
clinical conditions which place the fetus or mother at high risk, which
would not necessarily have been detected by other means such as clinical
examination, and for which subsequent management would improve perinatal
outcome.
Objectives:
To assess the effects on obstetric practice and
pregnancy outcome of routine late pregnancy ultrasound, defined as greater
than 24 weeks gestation, in women with either unselected or low risk
pregnancies.
Search Strategy:
The Cochrane Pregnancy and Childbirth Group
Specialised Register of Controlled Trials and the Cochrane Controlled Trials
Register were searched.
Selection Criteria:
All acceptably controlled trials
of routine ultrasound in late pregnancy (defined as after 24 weeks). DATA
COLLECTION AND ANALYSIS: The principal reviewer assessed trial quality and
extracted data, under supervision of the co-reviewer. Main Results:
Seven
trials recruiting 25,036 women were included. The quality of trials overall
was satisfactory. There was no difference in antenatal, obstetric and
neonatal intervention or morbidity in screened versus control groups.
Routine late pregnancy ultrasound was not associated with improvements in
overall perinatal mortality. Placental grading as an adjunct to third
trimester examination scan was associated with a significant reduction in
the stillbirth rate in the one trial that assessed it. There is a lack of
data with regard to long term substantive outcomes such as neurodevelopment.
There is a lack of data on maternal psychological effects. AUTHORS'
Conclusions:
Based on existing evidence, routine late pregnancy ultrasound
in low risk or unselected populations does not confer benefit on mother or
baby. There is a lack of data about the potential psychological effects of
routine ultrasound in late pregnancy, and the effects on both short and long
term neonatal and childhood outcome. Placental grading in the third
trimester may be valuable, but whether reported results are reproducible
remains to be seen, and future research of late pregnancy ultrasound should
include evaluation of placental textural assessment.
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