Routine ultrasound examination at 41 weeks of gestation and risk of post‐term severe adverse fetal outcome: a retrospective evaluation of two units, within the same hospital, with different guidelines

Lindqvist, Pelle G.; Pettersson, Karin; Morén, Anton Forsberg; Kublickas, Marius; Nordström, Lennart

doi:10.1111/1471-0528.12654

Cited by 16 publications

(13 citation statements)

References 13 publications

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“…However, a 20-fold lower risk of stillbirth was shown in the screened group (0/1447 vs 9/1455, OR 0.05, 95 % CI 0.00À0.9 [30], although this was not a prespecified analysis. Further, in accordance with the above, post-term (as opposed to term) pregnancies without a routine week 41 ultrasound were at a 48 % increased risk of severe adverse outcomes (OR 1.48, 95 % CI 1.06 -2.1), while post-term pregnancies in those scheduled for a routine week 41 ultrasound were at an OR of 0.89, i.e., 60 % lower [13]. After economic assessment, a routine week 41 ultrasound was implemented throughout the Stockholm region in 2014.…”

Section: Management Options Of Lga Pregnanciessupporting

confidence: 71%

“…We can only speculate as to how antenatal awareness of LGA was communicated in the clinical context. After having conducted two studies in which antepartum awareness of SGA fetuses greatly improved fetal outcomes, we had expected antenatal awareness of LGA to do the same [11,13]. There was no decreased risk in general, but a three-fold lower risk among cases of estimated LGA at 41 weeks.…”

Section: Discussionmentioning

confidence: 99%

“…Ultrasonography in the third trimester was carried out on clinical indication in both units, as for example in cases of increased symphysis fundal height or maternal diabetes. Pregnant women at the Huddinge unit were also routinely scheduled for a late scan including fetometry and measurement of amniotic fluid index (AFI) at 41 +0 GW [13]. (For a day-to-day estimation of fetal weight and LGA according to the Marŝál algorithm, see Supplementary Table 1) In approximately 25 % of all cases, ultrasound data was missing, generally because the examinations had been performed at external units not linked to Obstetrix.…”

Section: Methodsmentioning

confidence: 99%

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Antenatal awareness and obstetric outcomes in large fetuses: A retrospective evaluation

Dodd

Lindqvist

2021

European Journal of Obstetrics & Gynecology and Reproductiv

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Section: Management Options Of Lga Pregnanciessupporting

confidence: 71%

Section: Discussionmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

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Antenatal awareness and obstetric outcomes in large fetuses: A retrospective evaluation

Dodd

Lindqvist

2021

European Journal of Obstetrics & Gynecology and Reproductiv

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“…However, there is currently insufficient evidence that routine surveillance with ultrasonographic assessment in late term in order to detect fetuses at risk reduces perinatal mortality [36][37][38][39]. In a Swedish retrospective study, a reduction in SGA but no reduction in rates of composite perinatal mortality and morbidity or stillbirth was found with routine ultrasound at 41 weeks compared with indicated ultrasound [38]. Thus, whether the use of routine ultrasonographic assessment at 41 weeks affected the outcome is difficult to determine.…”

Section: Strengths and Limitationsmentioning

confidence: 99%

Induction of labour at 41 weeks or expectant management until 42 weeks: A systematic review and an individual participant data meta-analysis of randomised trials

et al. 2020

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Background The risk of perinatal death and severe neonatal morbidity increases gradually after 41 weeks of pregnancy. Several randomised controlled trials (RCTs) have assessed if induction of labour (IOL) in uncomplicated pregnancies at 41 weeks will improve perinatal outcomes. We performed an individual participant data meta-analysis (IPD-MA) on this subject. Methods and findings We searched PubMed, Excerpta Medica dataBASE (Embase), The Cochrane Library, Cumulative Index of Nursing and Allied Health Literature (CINAHL), and PsycINFO on February 21, 2020 for RCTs comparing IOL at 41 weeks with expectant management until 42 weeks in women with uncomplicated pregnancies. Individual participant data (IPD) were sought from eligible RCTs. Primary outcome was a composite of severe adverse perinatal outcomes: mortality and severe neonatal morbidity. Additional outcomes included neonatal admission, mode of delivery, perineal lacerations, and postpartum haemorrhage. Prespecified subgroup analyses were conducted for parity (nulliparous/multiparous), maternal age (<35/≥35 years), and body mass index (BMI) (<30/≥30). Aggregate data meta-analysis (MA) was performed to include data from RCTs for which IPD was not available. From 89 full-text articles, we identified three eligible RCTs (n = 5,161), and two contributed with IPD (n = 4,561). Baseline characteristics were similar between the groups regarding age, parity, BMI, and higher level of education. IOL resulted overall in a decrease of severe adverse perinatal outcome (0.4% [10/2,281] versus 1.0% [23/2,280]; relative risk [RR] 0.43 [95% confidence interval [CI] 0.21 to 0.91], p-value 0.027, risk difference [RD] −57/10,000 [95% CI −106/10,000 to −8/10,000], I2 0%). The number needed to treat (NNT) was 175 (95% CI 94 to 1,267). Perinatal deaths occurred in one (<0.1%) versus eight (0.4%) pregnancies (Peto odds ratio [OR] 0.21 [95% CI 0.06 to 0.78], p-value 0.019, RD −31/10,000, [95% CI −56/10,000 to −5/10,000], I2 0%, NNT 326, [95% CI 177 to 2,014]) and admission to a neonatal care unit ≥4 days occurred in 1.1% (24/2,280) versus 1.9% (46/2,273), (RR 0.52 [95% CI 0.32 to 0.85], p-value 0.009, RD −97/10,000 [95% CI −169/10,000 to −26/10,000], I2 0%, NNT 103 [95% CI 59 to 385]). There was no difference in the rate of cesarean delivery (10.5% versus 10.7%; RR 0.98, [95% CI 0.83 to 1.16], p-value 0.81) nor in other important perinatal, delivery, and maternal outcomes. MA on aggregate data showed similar results. Prespecified subgroup analyses for the primary outcome showed a significant difference in the treatment effect (p = 0.01 for interaction) for parity, but not for maternal age or BMI. The risk of severe adverse perinatal outcome was decreased for nulliparous women in the IOL group (0.3% [4/1,219] versus 1.6% [20/1,264]; RR 0.20 [95% CI 0.07 to 0.60], p-value 0.004, RD −127/10,000, [95% CI −204/10,000 to −50/10,000], I2 0%, NNT 79 [95% CI 49 to 201]) but not for multiparous women (0.6% [6/1,219] versus 0.3% [3/1,264]; RR 1.59 [95% CI 0.15 to 17.30], p-value 0.35, RD 27/10,000, [95% CI −29/10,000 to 84/10,000], I2 55%). A limitation of this IPD-MA was the risk of overestimation of the effect on perinatal mortality due to early stopping of the largest included trial for safety reasons after the advice of the Data and Safety Monitoring Board. Furthermore, only two RCTs were eligible for the IPD-MA; thus, the possibility to assess severe adverse neonatal outcomes with few events was limited. Conclusions In this study, we found that, overall, IOL at 41 weeks improved perinatal outcome compared with expectant management until 42 weeks without increasing the cesarean delivery rate. This benefit is shown only in nulliparous women, whereas for multiparous women, the incidence of mortality and morbidity was too low to demonstrate any effect. The magnitude of risk reduction of perinatal mortality remains uncertain. Women with pregnancies approaching 41 weeks should be informed on the risk differences according to parity so that they are able to make an informed choice for IOL at 41 weeks or expectant management until 42 weeks. Study Registration: PROSPERO CRD42020163174

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“…After 280 days of pregnancy, the risk of intrauterine fetal death is greater, especially in cases of fetuses with previously undiagnosed growth restriction (SGA) [37]. According to the current recommendations, after delivery date, each patient should have an ultrasound examination, which primary goal is [38]: 1. Evaluation of the fetal position and presentation, 2.…”

Section: Fetal Ultrasound Examination After Delivery Datementioning

confidence: 99%

Practice guidelines of the Polish Society of Gynecologists and Obstetricians - Ultrasound Section for ultrasound screening in uncomplicated pregnancy - 2020

Borowski¹,

Pietryga²,

Basta³

et al. 2020

Ginekol Pol

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Routine ultrasound examination at 41 weeks of gestation and risk of post‐term severe adverse fetal outcome: a retrospective evaluation of two units, within the same hospital, with different guidelines

Abstract: Objective To study whether a routine with a routine ultrasound examination (routine scan) at 41 gestational weeks as compared with ultrasound on clinical indication (indicated scan), lowered the risk of severe adverse fetal outcome in post-term period.Design A retrospective cohort study.

Cited by 16 publications

References 13 publications

Antenatal awareness and obstetric outcomes in large fetuses: A retrospective evaluation

Antenatal awareness and obstetric outcomes in large fetuses: A retrospective evaluation

Induction of labour at 41 weeks or expectant management until 42 weeks: A systematic review and an individual participant data meta-analysis of randomised trials

Practice guidelines of the Polish Society of Gynecologists and Obstetricians - Ultrasound Section for ultrasound screening in uncomplicated pregnancy - 2020

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