Current practice of first‐trimester ultrasound screening for structural fetal anomalies in developed countries

Abstract

Objectives: First-trimester ultrasound screening is increasingly performed to detect fetal anomalies early in pregnancy, aiming to enhance reproductive autonomy for future parents. This study aims to display the current practice of first-trimester ultrasound screening in developed countries.Method: An online survey among 47 prenatal screening experts in developed countries.Results: First-trimester structural anomaly screening is available in 30 of the 33 countries and is mostly offered to all women with generally high uptakes. National protocols are available in 23/30 (76.7%) countries, but the extent of anatomy assessment varies. Monitoring of scan quality occurs in 43.3% of the countries. 23/ 43 (53.5%) of the respondents considered the quality of first-trimester ultrasound screening unequal in different regions of their country.Conclusions: First-trimester screening for structural fetal anomalies is widely offered in developed countries, but large differences are reported in availability and use of screening protocols, the extent of anatomy assessment, training and experience of sonographers and quality monitoring systems. Consequently, this results in an unequal offer to parents in developed countries, sometimes even within the same country. Furthermore, as offer and execution differ widely, this has to be taken into account when results of screening policies are scientifically published or compared. Key pointsWhat is already known about this topic? � First-trimester ultrasound screening is increasingly performed to detect fetal anomalies early in pregnancy. What does this study add?� Large differences in developed countries are reported in the availability and use of screening protocols, extent of anatomy assessment, training and experience of sonographers and monitoring systems.

Informed choice and routinization of the second-trimester anomaly scan: a national cohort study in the Netherlands

“…Furthermore, since September 2021, the first-trimester anomaly scan is offered in context of the IMITAS study. The combined test is not performed anymore [ 23 , 24 ]. Prenatal counseling is performed by certified obstetric healthcare professionals.…”

First-Trimester Ultrasound Screening in Routine Obstetric Practice

“…37 Although imaging protocols vary by international, national, and societal recommendations, even a standard (minimum) fetal anatomic evaluation will identify a significant proportion of major fetal malformations. [38][39][40][41][42][43][44][45] With the use of a standardized detailed anatomic template in the first trimester, approximately half of structural anomalies can be identified in singleton pregnancies. [46][47][48][49][50] In a population of more than 100,000 pregnancies, Karim et al 48 demonstrated that the pooled detection rate of all fetal anomalies was 32.4% in a low-risk or unselected population (46.1% major anomalies) and 61.2% in a high-risk population.…”

“…40 Regardless of the differing anatomic protocols, widespread implementation within most countries is inconsistent and suboptimal. 45 The Standard First-Trimester Anatomic Scan (Minimum)…”

“…In our opinion, implementation of the standard first-trimester screening examination is an absolute minimum threshold that we must strive to achieve while encouraging ourselves to look at the fetus more comprehensively. [38][39][40][41]45 The expertise gained by the ultrasonographer or ultrasonologist while attempting to obtain more detailed additional views of the fetus during an ultrasonographic examination will ultimately lead to enhanced imaging skills and improved detection of structural malformations. Similar to our enriched observations while performing the basic nuchal translucency scan, the improved detection of structural anomalies is anticipated to result in a shift in the paradigm of prenatal screening algorithms.…”

The first trimester: The new focal point for prenatal screening and diagnosis

“…7 It is notable that the rapid diffusion of NIPT, stimulated by important financial interests, has not been emulated by first trimester ultrasound screening. A decade after the publication of the seminal article by Syngelaki on the early diagnosis of structural anomalies, 8 many challenges persist in this area, as illustrated by the multinational overview by Bronsgeest et al 9 A systematic protocol for first structural anomaly ultrasound has not achieved widespread implementation, and robust datasets on early detection of fetal defects are still emerging. The practice of first trimester ultrasound reveals great disparities not only among countries but even within the same country.…”