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Cited by 437Prenatal Screening and DiagnosticsMaternal and Perinatal Health InterventionsClinical practice guidelines implementation

ISUOG Practice Guidelines (updated): performance of the routine mid‐trimester fetal ultrasound scan

Open access
Salomon, L. J., Alfirevic, Z., Berghella, V., Bilardo, C. M., Chalouhi, G. E., Da Silva Costa, F., Hernandez‐Andrade, E., Malinger, G. +6 more·2022·Ultrasound in Obstetrics & Gynecology
DOI 10.1002/uog.24888
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Abstract

The International Society of Ultrasound in Obstetrics and Gynecology (ISUOG) is a scientific organization that encourages sound clinical practice, and high-quality teaching and research related to diagnostic imaging in women's healthcare. The ISUOG Clinical Standards Committee (CSC) has a remit to develop Practice Guidelines and Consensus Statements as educational recommendations that provide healthcare practitioners with a consensus-based approach, from experts, for diagnostic imaging. They are intended to reflect what is considered by ISUOG to be the best practice at the time at which they are issued. Although ISUOG has made every effort to ensure that Guidelines are accurate when issued, neither the Society nor any of its employees or members accepts liability for the consequences of any inaccurate or misleading data, opinions or statements issued by the CSC. The ISUOG CSC documents are not intended to establish a legal standard of care, because interpretation of the evidence that underpins the Guidelines may be influenced by individual circumstances, local protocol and available resources. Approved Guidelines can be distributed freely with the permission of ISUOG (info@isuog.org).

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  • Premisecitation
    § Fetal biometry and wellbeing · p. 4

    Recent evidence from the INTERGROWTH-21st study indicates that HC alone or HC plus FL may be the most accurate predictor of gestational age after 14 weeks.

    “Although head measurements (BPD and HC) and FL have all been used in the past, recent evidence from the INTERGROWTH-21 st study indicates that HC alone or HC plus FL may be the most accurate predictor of gestational age after 14weeks 19 .”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [19] 19. Papageorghiou AT, Kemp B, Stones W, Ohuma EO, Kennedy SH, Purwar M, Salomon LJ, Altman DG, Noble JA, Bertino E, Gravett MG, Pang R, Cheikh Ismail L, Barros FC, Lambert A, Jaffer YA, Victora CG, Bhutta ZA, Villar J, for the International Fetal and Newborn Growth Consortium for the 21 st Century (INTERGROWTH-21st). Ultrasound-based gestational-age estimation in late pregnancy. Ultrasound Obstet Gynecol 2016; 48 : 719-726. source

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  • Interpretationcitation
    § Recommendation · p. 3

    It is likely that the policy of including a mid-trimester ultrasound scan has become even more effective since 2005, as the detection rate of congenital heart defects may have increased.

    “It is likely that this policy has become even more effective since then, as the detection rate of congenital heart defects may have increased 6 .”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [6] 6. Lytzen R, Vejlstrup N, Bjerre J, Petersen OB, Leenskjold S, Dodd JK, Jørgensen FS, Søndergaard L. Live-Born Major Congenital Heart Disease in Denmark: Incidence, Detection Rate, and Termination of Pregnancy Rate From 1996 to 2013. JAMA Cardiol 2018; 3 : 829-837. source

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  • Premisecitation
    § Recommendation · p. 4

    When an examination cannot be performed completely in accordance with adopted guidelines, abnormalities are eventually detected in 0.5-5% of such cases.

    “as abnormalities are eventually detected in 0.5-5% of such cases 11,12 .”
    Quote in the paperSubstantial claim0 of 2 sources checked
    • cites [11] 11. Silvestri MT, Pettker CM, Raney JH, Xu X, Ross JS. Frequency and Importance of Incomplete Screening Fetal Anatomic Sonography in Pregnancy. J Ultrasound Med 2016; 35 : 2665-2673. source

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    • cites [12] 12. Waller SA, O'Connell K, Carter A, Gravett MG, Dighe M, Richardson ML, Dubinsky TJ. Incidence of fetal anomalies after incomplete anatomic surveys between 16 and 22 weeks. Ultrasound Q 2013; 29 : 307-312. source

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  • Premisecitation
    § Fetal biometry and wellbeing · p. 5

    Recent evidence suggests that outer-to-outer placement of calipers eases standardization, reproducibility and quality control.

    “Recent evidence suggests that outer-to-outer placement of calipers eases standardization, reproducibility and quality control 22 .”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [22] 22. Napolitano R, Donadono V, Ohuma EO, Knight CL, Wanyonyi SZ, Kemp B, Norris T, Papageorghiou AT. Scientific basis for standardization of fetal head measurements by ultrasound: a reproducibility study. Ultrasound Obstet Gynecol 2016; 48 : 80-85. source

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  • Premisecitation
    § INTRODUCTION · p. 2

    In experts' hands, most clinically important structural anomalies can be detected.

    “In experts' hands, most clinically important structural anomalies can be detected 1 .”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [1] 1. Edwards L, Hui L. First and second trimester screening for fetal structural anomalies. Semin Fetal Neonatal Med 2018; 23 : 102-111. source

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  • Classified as probably not a substantial claim. 16
  • May combine two claims. 13

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    Interpretationnone given
    § Recommendation · p. 4

    Prenatal ultrasonography appears to be safe in clinical practice.

    “Prenatal ultrasonography appears to be safe in clinical practice. To date, there has been no independently confirmed study to suggest otherwise.”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Premisecitation
    § Fetal biometry and wellbeing · p. 5

    Abnormal head shape can lead to inaccurate estimates of fetal age when BPD is used; in these cases, HC measurements are more reliable.

    “This finding can also lead to inaccurate estimates of fetal age when the BPD is used; in these cases, HC measurements are even more reliable 20,21 .”
    Quote in the paperSubstantial claim0 of 2 sources checked
    • cites [20] 20. Malinger G, Paladini D, Haratz KK, Monteagudo A, Pilu GL, Timor-Tritsch IE. ISUOG Practice Guidelines (updated): sonographic examination of the fetal central nervous system. Part 1: performance of screening examination and indications for targeted neurosonography. Ultrasound Obstet Gynecol 2020; 56 : 476-484. source

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    • cites [21] 21. Hadlock FP, Deter RL, Carpenter RJ, Park SK. Estimating fetal age: effect of head shape on BPD. AJR Am J Roentgenol 1981; 137 : 83-85. source

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    Premisecitation
    § Recommendation · p. 3

    Strategies that include a mid-trimester ultrasound scan result in more abnormalities being detected and have lower costs per anomaly detected, according to a 2005 cost-effectiveness analysis.

    “A 2005 cost-effectiveness analysis concluded that strategies which include a mid-trimester ultrasound scan result in more abnormalities being detected and have lower costs per anomaly detected 5 .”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [5] 5. Ritchie K, Bradbury I, Slattery J, Wright D, Iqbal K, Penney G. Economic modelling of antenatal screening and ultrasound scanning programmes for identification of fetal abnormalities. BJOG 2005; 112 : 866-874. source

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  • May combine two claims.

    Premisecitation
    § Femur length (FL) · p. 6

    Technical improvements in modern ultrasound machines have reduced the beam width, which has affected fetal measurements in the lateral direction.

    “Technical improvements in modern ultrasound machines have reduced the beam width, which has affected fetal measurements in the lateral direction 23 .”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [23] 23. Økland I, Bj˚ astad TG, Johansen TF, Gjessing HK, Grøttum P, Eik-Nes SH. Narrowed beam width in newer ultrasound machines shortens measurements in the lateral direction: fetal measurement charts may be obsolete. Ultrasound Obstet Gynecol 2011; 38 : 82-87. source

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  • May combine two claims.

    Premisecitation
    § Recommendation · p. 6

    Observational evidence comparing ultrasound with dye-determination of amniotic fluid volume has shown that deepest vertical pocket may be superior for identifying oligohydramnios and amniotic fluid index superior for identifying polyhydramnios.

    “Observational evidence comparing ultrasound with dye-determination of amniotic fluid volume has shown that DVP may be superior for identifying oligohydramnios and the AFI superior for identifying polyhydramnios 39 .”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [39] 39. Hughes DS, Magann EF, Whittington JR, Wendel MP, Sandlin AT, Ounpraseuth ST. Accuracy of the Ultrasound Estimate of the Amniotic Fluid Volume (Amniotic Fluid Index and Single Deepest Pocket) to Identify Actual Low, Normal, and High Amniotic Fluid Volumes as Determined by Quantile Regression. J Ultrasound Med 2020; 39 : 373-378. source

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  • Classified as probably not a substantial claim.

    Premisecitation
    § Recommendations · p. 12

    A renal pelvis ≥ 7mm indicates a need for reassessment in the third trimester.

    “A renal pelvis ≥ 7mm indicates a need for reassessment in the third trimester 80,81 .”
    Quote in the paperSubstantial claim0 of 2 sources checked
    • cites [80] 80. Sairam S, Al-Habib A, Sasson S, Thilaganathan B. Natural history of fetal hydronephrosis diagnosed on mid-trimester ultrasound. Ultrasound Obstet Gynecol 2001; 17 : 191-196. source

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    • cites [81] 81. Nguyen HT, Benson CB, Bromley B, Campbell JB, Chow J, Coleman B, Cooper C, Crino J, Darge K, Herndon CDA, Odibo AO, Somers MJG, Stein DR. Multidisciplinary consensus on the classification of prenatal and postnatal urinary tract dilation (UTD classification system). J Pediatr Urol 2014; 10 : 982-998. source

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    Premisecitation
    § Recommendations · p. 8

    Chorionicity is better evaluated before 14-15 weeks, when the lambda sign or T-sign can be determined.

    “however, chorionicity is better evaluated before 14-15weeks, when the lambda sign or T-sign can be determined;”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [54] 54. ISUOG Practice Guidelines: role of ultrasound in twin pregnancy. Ultrasound Obstet Gynecol 2016; 47 : 247-263. source

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  • Classified as probably not a substantial claim.

    Premisecitation
    § Recommendations · p. 6

    Estimated fetal weight or abdominal circumference can be used as a baseline parameter for the detection of subsequent growth problems.

    “Estimated fetal weight (EFW) or AC can be used as a baseline parameter for the detection of subsequent growth problems 26 .”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [26] 26. McCowan LM, Figueras F, Anderson NH. Evidence-based national guidelines for the management of suspected fetal growth restriction: comparison, consensus, and controversy. Am J Obstet Gynecol 2018; 218 (2S): S855-S868. source

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  • May combine two claims.

    Premisecitation
    § Recommendation · p. 6

    Amniotic fluid index identifies more women as having oligohydramnios than does deepest vertical pocket, thereby increasing the rate of labor induction, but without improving clinical outcome.

    “However, it appears that AFI identifies more women as having oligohydramnios than does DVP, thereby increasing the rate of labor induction, but without improving the clinical outcome 37,38 .”
    Quote in the paperSubstantial claim0 of 2 sources checked
    • cites [37] 37. Magann EF, Chauhan SP, Doherty DA, Magann MI, Morrison JC. The evidence for abandoning the amniotic fluid index in favor of the single deepest pocket. Am J Perinatol 2007; 24 : 549-555. source

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    • cites [38] 38. Kehl S, Schelkle A, Thomas A, Puhl A, Meqdad K, Tuschy B, Berlit S, Weiss C, Bayer C, Heimrich J, Dammer U, Raabe E, Winkler M, Faschingbauer F, Beckmann MW, S¨ utterlin M. Single deepest vertical pocket or amniotic fluid index as evaluation test for predicting adverse pregnancy outcome (SAFE trial): a multicenter, open-label, randomized controlled trial. Ultrasound Obstet Gynecol 2016; 47 : 674-679. source

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  • May combine two claims.

    Premisecitation
    § Recommendation · p. 6

    Both amniotic fluid index and deepest vertical pocket correlate poorly with the actual dye-calculated volume of amniotic fluid, and neither appears significantly better than the other.

    “Both AFI and DVP correlate poorly with the actual dye-calculated volume of amniotic fluid, and neither of them appears significantly better than the other 37 .”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [37] 37. Magann EF, Chauhan SP, Doherty DA, Magann MI, Morrison JC. The evidence for abandoning the amniotic fluid index in favor of the single deepest pocket. Am J Perinatol 2007; 24 : 549-555. source

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    Premisecitation
    § Recommendations · p. 7

    Single umbilical artery is associated with congenital anomalies and fetal growth restriction, although it does not constitute an anomaly per se.

    “SUA is associated with congenital anomalies and FGR 49 , although it does not constitute an anomaly per se .”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [49] 49. Hasegawa J. Ultrasound screening of umbilical cord abnormalities and delivery management. Placenta 2018; 62 : 66-78. source

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    Premisecitation
    § Recommendations · p. 9

    Two axial planes, commonly referred to as the transventricular and transthalamic planes, permit visualization of the cerebral structures relevant to the anatomical integrity of the brain.

    “Two axial planes, commonly referred to as the transventricular and transthalamic planes, permit visualization of the cerebral structures relevant to the anatomical integrity of the brain (Figure 2).”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [20] 20. Malinger G, Paladini D, Haratz KK, Monteagudo A, Pilu GL, Timor-Tritsch IE. ISUOG Practice Guidelines (updated): sonographic examination of the fetal central nervous system. Part 1: performance of screening examination and indications for targeted neurosonography. Ultrasound Obstet Gynecol 2020; 56 : 476-484. source

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Premisecitation
    § Recommendations · p. 7

    Single umbilical artery is the result of obliteration or atrophy of one of the arteries, most commonly the left.

    “Single umbilical artery (SUA) is the result of obliteration or atrophy of one of the arteries, most commonly the left 48 .”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [48] 48. Santillan M, Santillan D, Fleener D, Stegmann B, Zamba G, Hunter S, Yankowitz J. Single umbilical artery: Does side matter? Fetal Diagn Ther 2012; 32 : 201-208. source

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  • Classified as probably not a substantial claim.

    Premisecitation
    § Recommendations · p. 8

    Reporting distinguishing features (gender, unique markers, position in uterus) is critical to label twins correctly.

    “reporting of distinguishing features (gender, unique markers, position in uterus), as it is critical to label twins correctly 55 .”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [55] 55. Dias T, Arcangeli T, Bhide A, Napolitano R, Mahsud-Dornan S, Thilaganathan B. First-trimester ultrasound determination of chorionicity in twin pregnancy. Ultrasound Obstet Gynecol 2011; 38 : 530-532. source

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    Interpretationcitation
    § Recommendation · p. 7

    There is insufficient evidence to support universal use of uterine or umbilical artery pulsed Doppler evaluation for the screening of low-risk pregnancies.

    “There is insufficient evidence to support universal use of uterine or umbilical artery pulsed Doppler evaluation for the screening of low-risk pregnancies 53 .”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [53] 53. Alfirevic Z, Stampalija T, Medley N. Fetal and umbilical Doppler ultrasound in normal pregnancy. Cochrane Database Syst Rev 2015; ( 4 ): CD001450. source

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  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Premisecitation
    § Recommendations · p. 7

    The insertion of the umbilical cord is central in about 80% of cases, paracentral in about 12%, marginal in 5-8%, and velamentous in approximately 1%.

    “The insertion of the umbilical cord is in the center of the placenta in about 80% of cases, paracentral in about 12% of cases and marginal (within 2 cm of the placental edge) in 5-8% of cases. Velamentous insertion occurs in approximately 1% of cases, and is defined as insertion of the umbilical vessels within the amniotic membranes instead of the placenta 46 .”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [46] 46. Padula F, Lagan` a AS, Vitale SG, Mangiafico L, D'Emidio L, Cignini P, Giorlandino M, Gulino FA, Capriglione S, Giorlandino C. Ultrasonographic evaluation of placental cord insertion at different gestational ages in low-risk singleton pregnancies: a predictive algorithm. Facts Views Vis ObGyn 2016; 8 : 3-7.

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    Premisecitation
    § Amniotic membranes · p. 7

    Amniotic sheets are benign findings, to be distinguished from amniotic bands which may cause fetal deformities.

    “Amniotic sheets are benign findings, to be distinguished from amniotic bands which may cause fetal deformities 40-42 .”
    Quote in the paperNot a substantial claim0 of 3 sources checked
    • cites [40] 40. Ples ¸ L, Sima RM, Moisei C, Moga MA, Dracea L. Abnormal ultrasound appearance of the amniotic membranes - diagnostic and significance: a pictorial essay. Med Ultrason 2017; 19 : 211-215. source

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    • cites [41] 41. Shetty P, Menezes LT, Tauro LF, Diddigi KA. Amniotic band syndrome. Indian J Surg 2013; 75 : 401-402. source

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    • cites [42] 42. Society for Maternal-Fetal Medicine,Gandhi M, Rac MWF, McKinney J. Amniotic Band Sequence. Am J Obstet Gynecol 2019; 221 : B5-B6. source

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  • Classified as probably not a substantial claim.

    Premisecitation
    § Recommendations · p. 10

    Fetal cardiac screening is performed for the detection of congenital heart disease during the mid-trimester scan.

    “Fetal cardiac screening is performed for the detection of congenital heart disease during the mid-trimester scan (Figure 4) 71 .”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [71] 71. International Society of Ultrasound in Obstetrics and Gynecology,Carvalho JS, Allan LD, Chaoui R, Copel JA, DeVore GR, Hecher K, Lee W, Munoz H, Paladini D, Tutschek B, Yagel S. ISUOG Practice Guidelines (updated): sonographic screening examination of the fetal heart. Ultrasound Obstet Gynecol 2013; 41 : 348-359. source

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    Premisecitation
    § Fetal movement · p. 7

    The biophysical profile is not considered part of the routine mid-trimester scan.

    “The biophysical profile is not considered part of the routine mid-trimester scan 45 .”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [45] 45. Manning FA. Fetal biophysical profile. Obstet Gynecol Clin North Am 1999; 26 : 557-577. source

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  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Premisecitation
    § Thorax · p. 10

    Both lungs should appear homogeneous and without evidence of mediastinal shift or masses.

    “Both lungs should appear homogeneous and without evidence of mediastinal shift or masses 68 .”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [68] 68. Delacourt C, Bertille N, Salomon LJ, Benachi A, Henry E, Massardier J, Mottet N, Rosenblatt J, Sartor A, Thong-Vanh C, Valat-Rigot AS, Winer N, Lelong N, Khoshnood B, for the Prenatal MALFPULM Study Group, Alanio E, Bory J -P., Aquilue LN, Choupeaux L, Hauw C, Banaszkiewicz N, Bertorello S, Lebouar G, Biquard F, Sentilhes L, Bonfiglioli V, Carbillon L, Bonnard A, Bremont F, Bultez T, Roth P, Stirnemann J, Ville Y, Castaigne V, Touboul C, Coatleven F, Mangione R, Darras A -M., Guilbaud L, Jouannic J-M., Dazel-Salonne C, Ducoin H, Dugue-Marechaud M, Goua V, Eszto-Cambon M-L., Fange C, Prieur source

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    Premisecitation
    § Recommendations · p. 14

    Prenatal knowledge of vasa previa significantly increases survival and decreases perinatal morbidity.

    “prenatal knowledge of vasa previa significantly increases survival and decreases perinatal morbidity 96 .”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [96] 96. Zhang W, Geris S, Al-Emara N, Ramadan G, Sotiriadis A, Akolekar R. Perinatal outcome of pregnancies with prenatal diagnosis of vasa previa: systematic review and meta-analysis. Ultrasound Obstet Gynecol 2021; 57 : 710-719. source

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    Premisereasoning
    § Recommendations · p. 14

    Transvaginal ultrasound CL measurement is commonly recommended in the general population.

    “For these reasons, transvaginal ultrasound CL measurement is commonly recommended in the general population 104-106 .”
    Quote in the paperSubstantial claim0 of 3 sources checked
    • cites [104] source

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    • cites [106]

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    Premisecitation
    § Recommendations · p. 14

    Several medical societies recommend serial transvaginal sonographic CL measurement at 16-23 weeks in women with singleton gestation, a short cervix and prior spontaneous preterm birth.

    “Several medical societies recommend serial transvaginal sonographic CL measurement at 16-23 weeks in this population 104,105,108,109 .”
    Quote in the paperNot a substantial claim0 of 4 sources checked
    • cites [104] source

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    • cites [105] source

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    • cites [108] source

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    • cites [109]

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  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Premisecitation
    § Thorax · p. 10

    The shape of the thorax should be regular, with a smooth transition to the abdomen.

    “The shape of the thorax should be regular, with a smooth transition to the abdomen 67 .”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [67] 67. Azouz EM, Teebi AS, Eydoux P, Chen MF, Fassier F. Bone dysplasias: an introduction. Can Assoc Radiol J 1998; 49 : 105-109.

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    Premisecitation
    § Recommendations · p. 14

    There is ongoing debate regarding whether routine screening for velamentous cord insertion and/or vasa previa should be performed at the mid-trimester scan; the evidence is of limited quality and fails to take into account the consequences of over-diagnosing such anomalies.

    “There is, however, ongoing debate regarding whether routine screening for velamentous cord insertion and/or vasa previa should be performed at the mid-trimester scan; the evidence is of limited quality and fails to take into account the consequences of over-diagnosing such anomalies 47,88 .”
    Quote in the paperSubstantial claim0 of 2 sources checked
    • cites [47] 47. Buchanan-Hughes A, Bobrowska A, Visintin C, Attilakos G, Marshall J. Velamentous cord insertion: results from a rapid review of incidence, risk factors, adverse outcomes and screening. Syst Rev 2020; 9 : 147. source

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    • cites [88] 88. Jauniaux E, Alfirevic Z, Bhide AG, Burton GJ, Collins SL, Silver R, Royal College of Obstetricians and Gynaecologists. Vasa Praevia: Diagnosis and Management: Green-top Guideline No. 27b. BJOG 2019; 126 : e49-e61. source

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    Premisecitation
    § Recommendations · p. 12

    Other views of the fetal spine may identify other spinal malformations, including vertebral anomalies and sacral agenesis.

    “Other views of the fetal spine may identify other spinal malformations, including vertebral anomalies and sacral agenesis 20 .”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [20] 20. Malinger G, Paladini D, Haratz KK, Monteagudo A, Pilu GL, Timor-Tritsch IE. ISUOG Practice Guidelines (updated): sonographic examination of the fetal central nervous system. Part 1: performance of screening examination and indications for targeted neurosonography. Ultrasound Obstet Gynecol 2020; 56 : 476-484. source

      Not checked in the free run.

26 of 26

  • The paper relies on this without support.

    There are significant differences in detection rates between centers and between operators.

    “However, there are significant differences in detection rates between centers and between operators.”

  • The paper relies on this without support.

    The mid-trimester fetal ultrasound scan serves as a baseline against which later scans can be compared for the evaluation of fetal growth.

    “The mid-trimester fetal ultrasound scan also serves as a baseline against which later scans can be compared for the evaluation of fetal growth.”

  • The paper relies on this without support.

    Most countries offer one mid-trimester scan as part of routine prenatal care.

    “Most countries offer one mid-trimester scan as part of routine prenatal care.”

  • The paper relies on this without support.

    Abnormal head shape can be associated with syndromes or be the result of oligohydramnios or breech presentation.

    “Abnormal head shape (e.g. brachycephaly or dolichocephaly) can be associated with syndromes or be the result of oligohydramnios or breech presentation.”

  • The paper relies on this without support.

    The degree of deviation from normal at mid-trimester that would justify action has not been established.

    “However, the degree of deviation from normal at this early stage of pregnancy that would justify action (e.g. follow-up scan to assess fetal growth or fetal chromosomal analysis) has not been established.”

  • The paper relies on this without support.

    From 16 weeks onwards, the amnion and chorion are usually fused.

    “From 16weeks onwards, the amnion and chorion are usually fused.”

  • The paper relies on this without support.

    Normal fetuses typically have a neutral position and show regular movements.

    “Normal fetuses typically have a neutral position and show regular movements.”

  • The paper relies on this without support.

    A velamentous cord insertion may be associated with vasa previa and fetal growth restriction.

    “A velamentous cord insertion may be associated with vasa previa and FGR.”

  • The paper relies on this without support.

    Single umbilical artery is more frequent in twin pregnancy.

    “It is more frequent in twin pregnancy.”

  • The paper relies on this without support.

    Rarely, brain tissue can extrude through defects, for example, of the frontal or occipital bones.

    “Rarely, brain tissue can extrude through defects, for example, of the frontal or occipital bones.”

  • The paper relies on this without support.

    Normally, high skull density manifests as a continuous echogenic structure that is interrupted only by cranial sutures in specific anatomical locations.

    “normally, high skull density manifests as a continuous echogenic structure that is interrupted only by cranial sutures in specific anatomical locations.”

  • The paper relies on this without support.

    Vasa previa is found in approximately 0.5 per 1000 pregnancies in the general population.

    “Vasa previa, defined as unprotected fetal vessels running through the fetal membranes, over or within 2 cm of the internal cervical os, is found in approximately 0.5 per 1000 pregnancies in the general population.”

  • The paper relies on this without support.

    The neck normally appears as cylindrical, with no protuberances, masses or fluid collections.

    “The neck normally appears as cylindrical, with no protuberances, masses or fluid collections.”

  • The paper relies on this without support.

    A normal, regular heart rate typically ranges from 120 to 160 bpm.

    “A normal, regular heart rate typically ranges from 120 to 160 bpm.”

  • The paper relies on this without support.

    The heart is positioned in the left chest (as is the fetal stomach) if the situs is normal.

    “The heart is positioned in the left chest (as is the fetal stomach) if the situs is normal.”

  • The paper relies on this without support.

    A normal heart is usually no larger than one-third of the area of the chest and is without pericardial effusion.

    “A normal heart is usually no larger than one-third of the area of the chest and is without pericardial effusion.”

  • The paper relies on this without support.

    Normal-appearing great vessels are approximately equal in size and should cross each other as they exit their respective ventricular chambers.

    “Normal-appearing great vessels are approximately equal in size and should cross each other as they exit their respective ventricular chambers (Figure 4b,c).”

  • The paper relies on this without support.

    Routine assessment of the cardiac outflow tracts in addition to the four-chamber view increases the screening performance for identifying conotruncal anomalies, such as tetralogy of Fallot, transposition of the great arteries, double-outlet right ventricle and truncus arteriosus communis.

    “Routine assessment of the cardiac outflow tracts in addition to the four-chamber view increases the screening performance for identifying conotruncal anomalies, such as tetralogy of Fallot, transposition of the great arteries, double-outlet right ventricle and truncus arteriosus communis.”

  • The paper relies on this without support.

    The fetal stomach should be clearly visible in its normal position on the left side and should occupy about one-third of the left half of the transverse section of the fetal abdomen used for AC measurement.

    “The fetal stomach should be clearly visible in its normal position on the left side and should occupy about one-third of the left half of the transverse section of the fetal abdomen used for AC measurement.”

  • The paper relies on this without support.

    An abnormal location of any of the stomach, umbilical vein and gallbladder may be associated with a congenital anomaly (e.g. persistent right umbilical vein, heterotaxy, portohepatic shunt).

    “An abnormal location of any of these structures may be associated with a congenital anomaly (e.g. persistent right umbilical vein, heterotaxy, portohepatic shunt).”

  • The paper relies on this without support.

    The bowel should be contained within the abdomen.

    “The bowel should be contained within the abdomen.”

  • The paper relies on this without support.

    The fetal bladder should not reach the level of the umbilical cord insertion.

    “The fetal bladder should not reach the level of the umbilical cord insertion.”

  • The paper relies on this without support.

    A satisfactory examination of the fetal spine requires expertise and meticulous scanning, and the results are very dependent upon fetal position.

    “A satisfactory examination of the fetal spine requires expertise and meticulous scanning, and the results are very dependent upon fetal position.”

  • The paper relies on this without support.

    In most cases, in the routine mid-trimester examination, transabdominal ultrasonography permits clear definition of the relationship between the placenta and the internal cervical os.

    “In most cases, in the routine mid-trimester examination, transabdominal ultrasonography permits clear definition of the relationship between the placenta and the internal cervical os.”

  • The paper relies on this without support.

    Women with a history of uterine surgery and low anterior placenta or placenta previa are at risk for placenta accreta spectrum disorders.

    “Women with a history of uterine surgery and low anterior placenta or placenta previa are at risk for placenta accreta spectrum disorders.”

  • The paper relies on this without support.

    Not all medical practices may have sufficient experience in transvaginal sonography or the resources for proper disinfection procedures.

    “Furthermore, not all medical practices may have sufficient experience in transvaginal sonography or the resources for proper disinfection procedures.”

  • The paper relies on this without support.

    Examples of abnormal placental findings include the presence of hemorrhage, multiple anechoic cysts (distinct from normal lacunae) in triploidy, and placental masses, such as chorioangioma.

    “Examples of abnormal placental findings include the presence of hemorrhage, multiple anechoic cysts (distinct from normal lacunae) in triploidy, and placental masses, such as chorioangioma.”

  • The paper relies on this without support.

    The ribs should have normal curvature, without deformity.

    “The ribs should have normal curvature, without deformity.”
28 of 28

Claims other papers make about this one

Each is checked against this paper’s own text: does it say what the citing paper says it does?

  • Systematic evaluation of fetal anatomy during the first trimester allows for the identification of major structural anomalies.

    “Systematic evaluation of fetal anatomy during this period allows for the identification of major structural anomalies, although until recently basic fetal anatomical assessments were primarily performed during the second trimester, which served as the gold standard [4].”

    From First-Trimester Ultrasound: A Comparative Review of Guidelines (2026) · cites this paper as [4]

    The Recommendation (p. 3) says anomalies may be seen or suspected at a first-trimester scan, and the Introduction (p. 2) describes the mid-trimester scan as the main anatomical evaluation. The source does not establish that systematic first-trimester anatomical evaluation identifies major structural anomalies, or call the second-trimester assessment the gold standard. (LLM, conf=0.83)

    Experimental — accuracy not yet measured

  • Until recently, basic fetal anatomical assessments were primarily performed during the second trimester, which served as the gold standard.

    “Systematic evaluation of fetal anatomy during this period allows for the identification of major structural anomalies, although until recently basic fetal anatomical assessments were primarily performed during the second trimester, which served as the gold standard [4].”

    From First-Trimester Ultrasound: A Comparative Review of Guidelines (2026) · cites this paper as [4]

    The Introduction (p. 2) says the mid-trimester scan is performed mainly to evaluate fetal anatomy, and General Considerations (p. 2) lists basic fetal anatomy as part of that scan. The paper does not establish that this practice prevailed only until recently or describe the second-trimester assessment as the gold standard. (LLM, conf=0.86)

    Experimental — accuracy not yet measured

  • Scanning guidelines comprise a checklist of standard planes, structures and anatomies to be surveyed, but do not dictate the order in which the checklist should be populated.

    “Such scanning guidelines comprise typically a checklist of standard planes, structures and anatomies to be surveyed, but do not dictate the order in which the checklist should be populated.”

    From Clinical workflow of sonographers performing fetal anomaly ultrasound scans: Deep-learning-based analysis (2022) · cites this paper as [9]

Cites

Flagged first, then by citations

3 of the 115 references couldn’t be matched to a known paper.

Research works printed but not linked: 1

  1. 10.1597/1545-1569_2002_039_0073_udoc_2.0.co_2 · DOI

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Related

Authors
Salomon, L. J., Alfirevic, Z., Berghella, V., Bilardo, C. M., Chalouhi, G. E., Da Silva Costa, F., Hernandez‐Andrade, E., Malinger, G., Munoz, H., Paladini, D., Prefumo, F., Sotiriadis, A., Toi, A., & Lee, W.
Affiliations
  • Hôpital Necker-Enfants Malades (FR)
  • Department of Women's and Children's Health, University of Liverpool Liverpool UK
  • Thomas Jefferson University (US)
  • University Medical Center Groningen (NL)
  • Maternal Fetal Medicine Unit, Gold Coast University Hospital and School of Medicine, Griffith University, Gold Coast Queensland Australia
  • The University of Texas Health Science Center at Houston (US)
  • Tel Aviv University (IL)
  • University of Chile Hospital, Fetal Medicine Unit, Obstetrics & Gynecology Santiago Chile
  • Istituto Giannina Gaslini (IT)
  • University of Brescia (IT)
  • Aristotle University of Thessaloniki (GR)
  • Mount Sinai Hospital (CA)
  • Baylor College of Medicine (US)
ORCID
Venue
Ultrasound in Obstetrics & Gynecology
Publisher
Wiley
Published
2022-05-20
Volume
59
Issue
6
Pages
840-856
ISSN
  • 0960-7692 (ISSN-L)
  • 1469-0705
DOI
10.1002/uog.24888
OpenAlex
W4280616996
Semantic Scholar
3c0a6efe5b25ce7ec618babcfe77b2b4dea02d19
Cited by
436
References
115
Citations by year
2026: 113 · 2025: 131 · 2024: 106 · 2023: 70 · 2022: 14 · 2013: 1
FWCI
88.01
Type
journal article
Language
en
Update notices
erratum (2022-10-02)
Open access
Licence
onlinelibrary.wiley.com/termsAndConditions#vor (vor)
Locations
  • Ultrasound in Obstetrics and Gynecology (publishedVersion)
  • PubMed (publishedVersion)
  • Institutional Research Information System (Università degli Studi di Brescia) (submittedVersion, other-oa)
  • University of Groningen research database (University of Groningen / Centre for Information Technology) (submittedVersion, other-oa)
  • Griffith Research Online (submittedVersion, other-oa)
Funders
International Society of Ultrasound in Obstetrics and Gynecology
Topics
  • Health Sciences › Medicine › Pediatrics, Perinatology and Child Health › Prenatal Screening and Diagnostics
  • Health Sciences › Medicine › Obstetrics and Gynecology › Maternal and Perinatal Health Interventions
  • Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Clinical practice guidelines implementation
Keywords
second-trimester ultrasound, prenatal ultrasound, best practice recommendations
MeSH terms
Female, Gestational Age, Humans, Pregnancy, Pregnancy Trimester, Second, Ultrasonography, Prenatal

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