Background Many clinicians advocate routine ultrasound screeningduring pregnancy to detect congenital anomalies, multiple-gestationpregnancies, fetal growth disorders, placental abnormalities,and errors in the estimation of gestational age. However, itis not known whether the detection of these conditions throughscreening leads to interventions that improve perinatal outcome.
Methods We conducted a randomized trial involving 15,151 pregnantwomen at low risk for perinatal problems to determine whetherultrasound screening decreased the frequency of adverse perinataloutcomes. The women randomly assigned to the ultrasound-screeninggroup underwent one sonographic examination at 15 to 22 weeksof gestation and another at 31 to 35 weeks. The women in thecontrol group underwent ultrasonography only for medical indications,as identified by their physicians. Adverse perinatal outcomewas defined as fetal death, neonatal death, or neonatal morbiditysuch as intraventricular hemorrhage.
Results The mean numbers of sonograms obtained per woman inthe ultrasound-screening and control groups were 2.2 and 0.6,respectively. The rate of adverse perinatal outcome was 5.0percent among the infants of the women in the ultrasound-screeninggroup and 4.9 percent among the infants of the women in thecontrol group (relative risk, 1.0; 95 percent confidence interval,0.9 to 1.2; P = 0.85). The rates of preterm delivery and thedistribution of birth weights were nearly identical in the twogroups. The ultrasonographic detection of congenital anomalieshad no effect on perinatal outcome. There were no significantdifferences between the groups in perinatal outcome in the subgroupsof women with post-date pregnancies, multiple-gestation pregnancies,or infants who were small for gestational age.
Conclusions Screening ultrasonography did not improve perinataloutcome as compared with the selective use of ultrasonographyon the basis of clinician judgment.
Source Information
From the Department of Family and Community Medicine, University of Missouri School of Medicine, Columbia (B.G.E., M.L.L.); the Department of Obstetrics and Gynecology, Washington University School of Medicine, St. Louis (J.P.C.); the Department of Obstetrics and Gynecology, Brigham and Women's Hospital, Harvard Medical School, Boston (F.D.F.); the Biostatistics Center, George Washington University, Rockville, Md. (R.P.B.); and the National Institute of Child Health and Human Development, Bethesda, Md. (D.M.). The investigators and institutions that participated in the Routine Antenatal Diagnostic Imaging with Ultrasound (RADIUS) trial are listed in the Appendix.
Address reprint requests to Dr. Ewigman at MA303 Health Sciences Center, Department of Family and Community Medicine, University of Missouri Health Sciences Center, 1 Hospital Dr., Columbia, MO 65212.
Prenatal Ultrasound Screening and Perinatal Outcome
Golde S. H., Hegge F. N., Copel J. A., Platt L. D., Campbell S., Haddow J. E., Knight G. J., Palomaki G. E., Ewigman B., Crane J. P., Frigoletto F.
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N Engl J Med 1994;
330:570-572, Feb 24, 1994.
Correspondence
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