Objective To determine the value of early pregnancy sonography in detecting fetal abnormalities in an unselected obstetric population.Design Prospective cross-sectional study. All women initially underwent transabdominal sonography and when the anatomical survey was considered to be incomplete, transvaginal sonography was also performed (20.1 %). Nuchal translucency was measured and karyotyping was performed as appropriate.Setting University Department of Obstetrics and Gynaecology.Participants 6634 sequential unselected women (mean maternal age 29-9 years, range 13-50; mean gestational age 12& weeks, range 11+0-14+6), carrying 6443 live fetuses participated in this study.Main outcome measure Detection rate of fetal anomalies and the associated cost per case detected in early pregnancy. ResultsThe incidence of anomalous fetuses was 1.4% (926443) including 43 chromosomal abnormalities. The detection rate for structural abnormalities was 59.0% (37/63, 95% CI 46.5-72.4) and the specificity was 99.9% in early pregnancy. When the first and second trimester scans were combined, the detection for structural abnormalities was 8 1.0% (5 1/63, 95% CI 67.7-89.2). Seventy-eight percent (31/40) of chromosomal abnormalities (excluding three cases of XXY) were diagnosed at 11-14 weeks, either because of a nuchal translucency greater than or equal to the 99th centile for gestational age (43%; 17/40,95% CI 27-4-60.4), or due to the presence of structural abnormalities (35%; 14/40, 95% CI 21-2-52.8). Sixty-five percent (15/23) of cases of trisomy 21 were also diagnosed either because of having a nuchal translucency greater than or equal to the 99th centile (57.0%; 13/23) or due to the presence of a structural abnormality (9.0%; 2/23). Overall, the detection rate of structurally abnormal fetuses was 59% (37/63) in early pregnancy and 81% in combination with the second trimester scan. The cost per abnormality diagnosed in early pregnancy is estimated to be f6258 per structurally abnormal fetus, f7470 per chromosomal abnormality and f4453 per anomalous fetus. ConclusionThe majority of fetal structural and chromosomal abnormalities can be detected by sonographic screening at 11-14 weeks, but the second trimester scan should not be abandoned.

Whilst the accuracy of sonographic determination of fetal gender at 11-14 weeks is good, it still falls significantly short of invasive karyotyping tests.

Objective (14/16 vs. 6/14; odds ratio = 9.3; 95% CI,.Conclusions Psychological morbidity following termination of pregnancy for fetal anomaly is prevalent and persistent. Our data suggest that in the short term (as assessed at a 6-week follow-up), second-trimester termination may be more stressful compared with first-trimester termination.

The objective of this study was to determine the optimal gestational age for examining fetal anatomy and nuchal translucency in the first trimester. In a prospective cross-sectional study, 1288 women from an unselected population underwent a detailed assessment of fetal anatomy at 10-14 weeks of gestation (confirmed by crown-rump length) with the use of transabdominal sonography and transvaginal sonography, when necessary. Visualization of fetal anatomy improved with increasing gestational age: 6, 75, 96, and 98% of cases could be visualized at 10, 11, 12 and 13 weeks of gestation, respectively, and was similarly high (98%) at 14 weeks. The ability to measure nuchal translucency was similar from weeks 10 to 13 (100, 98, 98 and 98% success rate), but fell to 90% at 14 weeks. The need for transvaginal sonography steadily decreased with increasing gestational age, being 100, 42, 21, 15 and 11% at 10, 11, 12, 13 and 14 weeks, respectively. From these data it appears that the optimal gestational age to examine fetal anatomy and measure nuchal translucency in the first trimester is 13 weeks.

MISC showed similar anatomic results to OSC with a lower transfusion rate, shorter length of hospital stay and less blood loss. The rate of other complications was similar between the approaches. Cautious interpretation of results is advised due to risk of bias caused by the inclusion of nonrandomized studies.