Related Experiment Videos
Routine ultrasound for detection and management of the small-for-gestational-age fetus
Serial ultrasound scanning was used routinely in 1687 private patients to detect small-for-gestational-age infants, twins, congenital anomalies, placenta previa, and errors in gestational age estimates. A control population of 8350 private patients was scanned only when indicated. Twenty-three percent of the small-for-gestational-age infants were detected in the control subjects, while routine scanning increased the detection rate to 57% (P = .0007). A high rate of false positive results were found. Seventeen percent of the routinely scanned population were found to be at risk for small-for-gestational age, but only 6% of those actually were small. Despite the increased detection of small-for-gestational-age infants in the routinely scanned population, no significant difference between the routinely scanned and the selectively scanned small-for-gestational-age patients could be shown in the areas of stillborns (6%), neonatal deaths (4%), perinatal mortality (10%), low one-minute (27%) or five-minute (7%) Apgar scores, cesarean section rate (22%), mean gestational age at birth (38.8 weeks), or weight (257 g below the tenth percentile). This occurred despite the aggressive use of maternal bedrest, correction of risk factors, serial scans, nonstress testing, and early delivery when indicated.
Serial ultrasound scanning was used routinely in 1687 private patients to detect small-for-gestational-age infants, twins, congenital anomalies, placenta previa, and errors in gestational age estimates. A control population of 8350 private patients was scanned only when indicated. Twenty-three percent of the small-for-gestational-age infants were detected in the control subjects, while routine scanning increased the detection rate to 57% (P = .0007). A high rate of false positive results were found. Seventeen percent of the routinely scanned population were found to be at risk for small-for-gestational age, but only 6% of those actually were small. Despite the increased detection of small-for-gestational-age infants in the routinely scanned population, no significant difference between the routinely scanned and the selectively scanned small-for-gestational-age patients could be shown in the areas of stillborns (6%), neonatal deaths (4%), perinatal mortality (10%), low one-minute (27%) or five-minute (7%) Apgar scores, cesarean section rate (22%), mean gestational age at birth (38.8 weeks), or weight (257 g below the tenth percentile). This occurred despite the aggressive use of maternal bedrest, correction of risk factors, serial scans, nonstress testing, and early delivery when indicated.