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Is Fetal Anatomic Assessment on Follow-up Antepartum Sonograms Clinically Useful?

Department of Obstetrics and Gynecology, The Methodist Hospital, Houston, Texas USA (E.C.T., A.I.M., K.P.H., A.L.K.); Department of Obstetrics and Gynecology, St Joseph Medical Center, Houston, Texas USA (E.C.T., A.I.M., K.P.H.); and Department of Ultrasound, Southwest Community Health Clinic, Houston, Texas USA (E.C.T., L.P.F., K.P.H.).

Address correspondence to Eugene C. Toy, MD, Department of Obstetrics and Gynecology, The Methodist Hospital, 1819 Crawford St, Suite 1708, Houston, TX 77002 USA. E-mail: ectoy{at}tmhs.org

Objective. The purpose of this study was to evaluate the clinical usefulness of a fetal anatomic survey on follow-up antepartum sonograms. Methods. A retrospective follow-up study was conducted at a low-risk maternity clinic from July 1, 2005, to June 30, 2006. Eligible women had at least 1 prior sonographic examination beyond 18 weeks’ gestation with a complete and normal fetal anatomic assessment and at least 1 follow-up sonogram. Full fetal anatomic surveys were performed on all follow-up sonograms regardless of the indication. Neonatal charts were reviewed for those patients whose follow-up sonograms revealed unanticipated fetal anomalies. Neonatal intervention was defined as surgical or medical therapy or arranged subspecialty follow-up specifically for the suspected fetal anomaly. Results. Of a total of 4269 sonographic examinations performed, 437 (10.2%) were follow-up studies. Of these, 101 (23.1%) were excluded because the initial sonogram revealed a suspected fetal anomaly, and 42 (9.8%) were excluded for other reasons. Of the remaining 294 women, 21 (7.1%) had an unanticipated fetal anomaly, most often renal pyelectasis. Compared with follow-up sonography for other reasons, repeated sonography for fetal growth evaluation yielded a higher incidence of unexpected fetal anomalies: 15 (12.3%) of 122 versus 6 (3.5%) of 172 (P = .01). When compared with the neonates in the nongrowth indications group, those neonates whose mothers had sonographic examinations for fetal growth had a higher rate of neonatal interventions: 6 (40.0%) of 15 versus 0 (0%) of 6 (P = .04). Conclusions. A fetal anatomic survey on follow-up sonograms may identify unanticipated fetal anomalies, especially when the indication is for fetal growth.

Key Words: anomalies • antepartum • follow-up • sonography

Abbreviations: AIUM, American Institute of Ultrasound in Medicine • VSD, ventricular septal defect

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