> Ecografìin pregnancy: guidelines

the Ultrasound in pregnancy. The evidences have been extracted from the analysis of the 4 guidelines, 4 the reports of the technology assessment and 2 Cochrane reviews published from 1996 to today by various international bodies.

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  • Introduction
  • the

  • First quarter
  • Second quarter
  • the

  • Third quarter
  • the

  • Doppler
  • the Table

Introduction

ultrasound in obstetrics è was introduced almost 30 years ago, with signs restricted to confirmation of disease and/or malformations of the suspect.

Thanks to advances in ultrasound technology, the indications have expanded, and, with considerable differences, almost allà of the women in Europe make at least a routine ultrasound examination in pregnancy.

In the United States, Canada, Australia and all European countries, except for Sweden and Denmark, the ultrasound for the study of the morphology of the fetus is standard procedure during the ultrasound scans and prenatal. From a close examination of the documents showed the following evidence:

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  • obstetric ultrasound routine, in the light of the available evidence, it represents a biological risk né to the mother no" to the fetus

  • the

  • obstetric ultrasound in the absence of risk factors, can notò be recommended with the aim of reducing the mortalityà and the morbosità the perinatal and maternal

  • the

  • the consequences of The use of the resources available and the psycho-social consequences in the short and long term for the individual and for the company; have been overlooked

An obstetric procedure in the first quarter (=13 weeks. + 6 days):

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  1. does not determine differences in the load of clinical outcomes such as the mortalityà perinatal
  2. allows the visualization of the system of the chamber ovulate or of the presence of the embryo/fetus, their number and activitiesà heart
  3. allows the dating of the pregnancy
  4. the

  5. confirm the suspicion of an ectopic pregnancy, hydatidiform mole, or pelvic mass.
  6. there are insufficient data to demonstrate the efficacy as the method of screening of malformations, embryo/fetal

An obstetric ultrasound routine of the second quarter (14°-26° full week)

  1. allows the determination of the number of fetuses and the dating of the pregnancy
  2. allows the evaluation of the anatomy of the fetal, but requires a good level of accreditation of sonographers and equipment
  3. the

  4. sensitivityà of the ultrasound varies according to the type of the abnormality, on the basis of the gestational age, the abilityà of the sonographer, to the resolution of the device and to the possibilityà to ascertain the suspected anomalies after birth
  5. the

  6. in the case of diagnosis of fetal anomalies, or a result of abnormal of the examination it is important to inform and support the couple in an appropriate manner.

An ultrasound scan of the routines in the third trimester of pregnancy (>26° week)

Allows the assessment of fetal growth, the quantityà of the amniotic fluid and the insertion placental 2. on the basis of the levels of evidence available so far, in the absence of clinical suspicion, not può be né registered né excluded.

An examination echo-Doppler routine:

In the absence of risk factors there is no evidence of the benefits of this diagnostic test.

The opinion of the women:

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  • ultrasound is very attractive to women and their partners
  • the

  • results of clinical significance uncertain have important psychological consequences and social
  • the reduction in anxiety detected after the execution of the ultrasound, reflects only the increase of anxiety that is recorded before the exam
  • there is no evidence of the positive consequences of the examination (e.g. reduction of the cigarette smoke)

Costs and cost-effectiveness:

  • there are few studies of good quality; methodological
  • the abilityà of a professional sonographer, and the duration of the examination will have a significant effect on the cost-effectiveness
  • the

  • based on the available evidence a single obstetric ultrasound in 2° quarter represents the best option in terms of cost-effectiveness
  • the

  • it is important to include the costs to the woman in the economic evaluation becauseé the change in policies is often desirable to shift the costs from the services to the families.

Benché in the various documents reviewed there is wide agreement on the evidence, the analysis of the recommendations is the emergence of differences which reflect the different choices and welfare of individual countries and that are closely related to the health policies, but also to the availabilityà of the therapeutic abortion and the chronological limits for its execution.

The following table presents a summary of the recommended practices. The recommendations of the Italian reference to the Protocol of access to laboratory tests and diagnostic instruments for women in state of pregnancy and to the protection of maternityà of the Ministry of Health. (Ministerial decree 10/09/1998).

recommended Practices with respect to the ultrasound scans, routine pregnancy years 1996-2003

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  FRANCE SVEZIA CANADA REGNO UNITO ITALY
Ecografia And second quarter Si (11-13 weeks) No No Si (intorno 12 settimane) Si (entro primo second quarter)
Ecografia II second quarter Si (22-24 settimane) Si (entro 18 settimane) Si (18-19 weeks) Si (20 settimane) Si (19-21 weeks)
Ecografia III second quarter No No No No Si (32-35 weeks)
Eco-doppler No No No No No
n Medio ecografie in gravidanza 2 1 1 2 5-6

Despite the high average number of ultrasound scans carried out in pregnancy by Italian women the National Health Service offers three ultrasound free ticket in pregnancy the physiological and, although the second quarter is mainly focused on the study of malformations, structural, a screening programme organised at central or regional level, is absent in Italy.

in a study of economic evaluation of screening ultrasound of fetal malformations conducted in Italy indicated that as a program based on an ultrasound scan offered at 19-21 weeks with an additional diagnostic ultrasound for cases with a positive screening test would allow you to obtain a greater number of diagnosis ultrasound of the malformation and at a cost, for the fetus is malformed diagnosed, a reduction of almost a third lower than it is today.

(Source: Istituto Superiore di Sanità – National Centre of Epidemiology, Surveillance and Health Promotion)

Può affect:

Pregnancy, better to wait for the first ultrasound

Calendar of pregnancy online

Test on fetal dna in maternal blood NIPT, as it should be used

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Page updated on 22/7/2005

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