Routine Anomaly Scan Ilse Erasmus. Routine Anomaly Scan Timing: – 18 – 23 weeks Costs – about...
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Transcript of Routine Anomaly Scan Ilse Erasmus. Routine Anomaly Scan Timing: – 18 – 23 weeks Costs – about...
Routine Anomaly ScanRoutine Anomaly Scan
Ilse Erasmus
Routine Anomaly ScanRoutine Anomaly Scan
Timing:– 18 – 23 weeks
Costs – about R 230 – 00
RCOG Guidelines October 1997RCOG Guidelines October 1997Timing of sonarsTiming of sonars
Best Acceptable Less Accept
Dating 8-10 10-20 24
Viability >7
Twins Anytime
Chorionicity 8-12 13-15
Fetal anomaly 18-20
NT 8-15* 15-16* 18-20*
Routine Anomaly ScanRoutine Anomaly Scan
Waste of resource to request routine anomaly scan in the late second or 3rd trimester
Waste of resource to request growth scan in 3rd trimester in the absence of an early sonar
Routine Anomaly ScanRoutine Anomaly Scan
Indication in SA cost considerations??? Routine late bookers High risk
– Previous fetal/ neonatal anomalies– Previous IUD– AMA– Maternal:– disease index pregnancy / history of– Medication– Congenital anomalies
Routine Anomaly ScanRoutine Anomaly Scan
Cochrane Database
– Reduction in post term inductions– Twin Pregnancies
Radius?!?
Routine Anomaly ScanRoutine Anomaly Scan
Screening?
1/55 babies born with major anomalyStructural anomalies > single gene
defectsUK Fetal anomalies = 15% of perinatal
deaths and 15% of deaths in first year of life
Routine Anomaly ScanRoutine Anomaly Scan
Screening? Six objectives Reassurance that baby is apparently normal Or the identification of: Non –viable anomalies Anomalies associated with high morbidity and long term
handicap Fetal conditions with the potential for intrauterine therapy Fetal conditions requiring postnatal investigation and/ or therapy Parental preparation
Routine Anomaly ScanRoutine Anomaly Scan
Screening? Lethal anomalies – anencheph, BRA, thanatophoric
dwarfs High morbidity and long term handicap – NTD,
cardiac,aneuploidy Potential intrauterine therapy – RH, Parvo,TTS Fetal conditions requiring postnatal investigation and/
or therapy – renal, facial cleft Parental preparation
RCOGRCOG Guidelines October 1997Guidelines October 1997
Detection Rates for Specific anomaliesDetection Rates for Specific anomalies
Anomaly <24w Sensitivity Specificity
Anencheph/Enc 87 – 100% (>95%) 99 – 100%
Intracranial Path 27 – 100% (70%) 99 – 100%
Renal Agenesis 75 - 100% (85%) 99 – 100%
Cystic Lung 0- 100% (100%) 99 – 100%
Cardiac Major 4 – 77% (47%) 98 – 99%
CD hernia 0 – 100% (40%) 99 – 100%
Exomphalos 0 – 100% (>95%) 99 – 100%
Gastroschisis 0 –100% (66%) 0 - 100%
Muscuoloskeletal 0 –100% (50%) 0 - 100%
RCOGRCOG Guidelines October 1997Guidelines October 1997
Detection Rates for Specific anomaliesDetection Rates for Specific anomalies
Anomaly < 24 Sensitivity Specificity
Spina Bifida 69 – 100% (78%) 99 – 100%
Major Renal 26 – 100% (60%) 99 – 100%
RCOG Routine sonar in PregnancyRCOG Routine sonar in PregnancyJuly 2000July 2000
6 year Scottish Study
Booking scan only % Minimum standard scan %
Anencheph 97 100 ( better)
Spina Bifida 61 92 (better)
Major cardiac
(hypoplastic LV)
14 61 (better)
CD Hernia 30 62 (better)
Gastroshcisis 86 100 (better)
Exomphalos 45 92 (same)
Major renal
Renal agenesis
76 85 (better)
RCOG 2000 JulyRCOG 2000 JulyMinimum standard for a 20 week anomaly scanMinimum standard for a 20 week anomaly scan
Gestational age– BPD, HC, FL, AC
MeasurmentsMeasurments
RCOG 2000 JulyRCOG 2000 JulyMinimum standard for a 20 week anomaly scanMinimum standard for a 20 week anomaly scan
Gestational age– BPD, HC, FL, AC
Fetal Normality– Head shape and internal structures
CSP, Cerebellum, Ventricular size at atrium (<10mm)
– Spine longitudinal and transverse– Abdominal shape and content at the level
of the stomach
RCOG 2000 JulyRCOG 2000 JulyMinimum standard for a 20 week anomaly scanMinimum standard for a 20 week anomaly scan
– Renal Pelvis (<5mm AP)– Longitudinal axis – abdominal thoracic
appearance (diaphragm/bladder)– Thorax at level of 4ch cardiac view– Arms – 2 x 3 long bones + hands (not
counting fingers)– Legs - 2 x 3 long bones + feet (not
counting toes)
RCOG 2000 JulyRCOG 2000 JulyMinimum standard for a 20 week anomaly scanMinimum standard for a 20 week anomaly scan
RCOG 2000 JulyRCOG 2000 JulyOptimal standard for a 20 week anomaly scanOptimal standard for a 20 week anomaly scan
– The above plus:– Cardiac outflow tracts– Face and lips
RCOG 2000 JulyRCOG 2000 JulyMarker scansMarker scans
– Not considered “routine”– Isolated markers of dubious value– Increased overall detection rate increase from
51% - 55% but FPR from 1/2332 to 1/188!!!!! (Boyd PA Lancet 1998)
– Two or more markers significant– Screening using maternal age, age + NT, age+
serum will identify 50 – 80%– So marker scan as screening in unscreened
population unlikely to be of use
RCOG 2000 JulyRCOG 2000 JulyMarker scansMarker scans
– “Markers”– CPC– Ventriculomegaly(>10mm at atrium)– Echogenic bowel(equivalent to bone density)– Head shape– Nuchal skinfold thickness(>5mm at 20 weeks)– CM– Cleft lip– Echogenic intracardiac focus
RCOG 2000 JulyRCOG 2000 JulyMarker scansMarker scans
– Dilated renal pelvis(>5mmAP)– Short Femur/Humerus– Talipes– Sandal gap– Clinodactyly– Clenched hand– Two vessel cord
RCOG 2000 JulyRCOG 2000 JulyMarker scansMarker scans
– Other risk factors
– Maternal age > 35– Serum screening results– Nuchal translucency at 11 – 14 weeks
Standard viewsStandard views
Pilu, Nicolaides CD - ROM
ISUOG Standards
Standard viewsStandard views
IntrauterineAmount of fetuses Cardiac activityPlacental Position, AppearanceCord vesselsLiquor
Standard viewsStandard viewsHead and BrainHead and Brain
Standard viewsStandard viewsFaceFace
Standard viewsStandard viewsFaceFace
Standard viewsStandard viewsSpineSpine
Standard viewsStandard viewsHeartHeart
Standard viewsStandard viewsGITGIT
Standard viewsStandard viewsLimbsLimbs
Anomaly scanAnomaly scan
Skull & BrainNormal and abnormal
Anomaly scanAnomaly scan
FaceNormal and abnormal
Anomaly scanAnomaly scan
SpineNormal and abnormal
NormalNormalSpineSpine
Abnormal SpineAbnormal Spine
Anomaly scanAnomaly scan
GITNormal and abnormal
Anomaly scanAnomaly scan
HeartNormal and abnormal
Anomaly scanAnomaly scan
KidneysNormal and abnormal
Anomaly scanAnomaly scan
LimbsNormal and abnormal