Routine or selective ultrasound scanning

Routine prenatal care in Europe: the comparative experience of nine departments of gynaecology and obstetrics in eight different countries

OBJECTIVE

The aim of this study was to compare routine prenatal care in nine European obstetrics and gynaecology departments.

STUDY DESIGN

A survey was performed between October 1992 and November 1993 by means of a questionnaire. The questionnaire comprised 118 questions covering clinical examinations and investigations systematically performed during the pregnancy.

RESULTS

The survey revealed a certain number of differences between the types of prenatal care performed by each department. Thus, one notices differences to do the serological testing (toxoplasmosis, AIDS and hepatitis B) at the first visit and in the practice of vaginal examination, systematic ultrasound examination or cardiotocography.

CONCLUSION

The differences observed in the prenatal care furnished are only a reflection of our uncertainties concerning the validity of the various tests used to monitor pregnancies. At a time when financial restrictions impose choices, we consider an evaluation of the efficacy and cost of prenatal care to be essential.

Ultrasound examinations in pregnancy: some suggestions for debate

OBJECTIVE

to ascertain the number of ultrasound examinations a sample of women received in pregnancy.

DESIGN

a retrospective review of 50 sets of case notes of women delivering consecutively in one maternity unit.

SETTING

a large maternity unit in Northern England (approximately 5000 deliveries per year).

FINDINGS

the mean number of scans received was 2.6 indicating that many women receive an early 'dating' scan as well as a second trimester 'routine' scan.

CONCLUSIONS AND IMPLICATIONS FOR PRACTICE

first trimester and early mid-trimester scans may be clinically indicated, but we are concerned that they are becoming routine without fundamental questions of safety and efficacy being answered by large controlled trials. In addition, little is known about the possible positive or negative psychological effects of early scans and there is no evidence that they are cost effective.

Testing for fetal abnormality in routine antenatal care

The detection of fetal abnormality is a major component of routine antenatal care. A variety of techniques are now in use, although these are constantly being modified in the pursuit of more accurate and earlier detection. In this paper we draw attention to the distinction between screening and diagnostic tests, and describe the techniques which have been most commonly used in the UK: serum-screening for neural tube defects; screening for Down's syndrome; ultrasound scanning; amniocentesis and chorionic villus sampling.