First-Trimester Ultrasound: A Comparative Review of Guidelines

May combine two claims.

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].”

• cites [4] Salomon, 2022, ISUOG Practice Guidelines (updated): Performance of the routine mid-trimester fetal ultrasound scan, Ultrasound Obstet. Gynecol. sourcePartly supported

  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

May combine two claims.

The prevalence of megacystis was 1 in 1632, with a chromosomal abnormality detected in 31.4% of affected cases.

“Moreover, results from a prospective study involving nearly 60,000 women showed that the prevalence of megacystis was 1 in 1632, with a chromosomal abnormality detected in 31.4% of affected cases [52].”

• cites [52] Kagan, 2010, The 11–13-week scan: Diagnosis and outcome of holoprosencephaly, exomphalos and megacystis, Ultrasound Obstet. Gynecol. sourceSupported

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

The AWMF recommends invasive testing in cases with fetal malformations, an NT ≥ 3.0 mm and especially if ≥3.5 mm, abnormal maternal biochemistry or abnormal cfDNA results.

“whereas the AWMF recommends it in cases with fetal malformations, an NT ≥ 3.0 mm and especially if ≥3.5 mm, abnormal maternal biochemistry or abnormal cfDNA results [84].”

• cites [84] Giovannopoulou, E., Tsakiridis, I., Mamopoulos, A., Kalogiannidis, I., Papoulidis, I., Athanasiadis, A., and Dagklis, T. (2022). Invasive Prenatal Diagnostic Testing for Aneuploidies in Singleton Pregnancies: A Comparative Review of Major Guidelines. Medicina, 58. sourceCould not verify

  The Evidence Acquisition section lists the guidelines reviewed but does not include AWMF. Sections 3.1 and 3.6 report recommendations concerning NT ≥3 mm and positive cfDNA results from other societies; they do not establish AWMF’s recommendations. A search of our copy for AWMF, NT ≥3.5 mm, and abnormal maternal biochemistry did not verify the attributed statement. (LLM, conf=0.78)

  Experimental — accuracy not yet measured

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

The AWMF, ISUOG, SOGC and WAPM consider the first-trimester ultrasound a fundamental part of routine antenatal care and recommend it for all pregnant women.

“The AWMF, ISUOG, SOGC and WAPM agree regarding the indications for performing this examination. In detail, these medical societies consider the first-trimester ultrasound as a fundamental part of routine antenatal care, recommending it for all pregnant women [1].”

• cites [1] Boureka, 2024, Antenatal Care: A Comparative Review of Guidelines, Obstet. Gynecol. Surv. sourceNot checked — no full text of the source

May combine two claims.

Cell-free DNA testing is addressed only by a few reviewed guidelines, with similar indications.

“The use of combined first-trimester examination is encouraged by all the reviewed medical societies, although cell-free DNA testing is addressed only by a few, with similar indications.”

Probably not a substantial claim: may not pass S4 (based). May combine two claims.

First-trimester sonographic examination is essential for assessing fetal viability, establishing accurate pregnancy dating, evaluating fetal and maternal anatomy, and calculating the risk of various fetal and maternal conditions.

“First-trimester sonographic examination is essential for assessing fetal viability, establishing accurate pregnancy dating, evaluating fetal and maternal anatomy and calculating the risk of various fetal and maternal conditions.”

Probably not a substantial claim: may not pass S4 (based). May combine two claims.

Controversy exists regarding the indications and appropriate gestational age at which the first-trimester scan should be performed, as well as the proper establishment of pregnancy dating.

“Controversy exists regarding the indications and appropriate gestational age at which the first-trimester scan should be performed, as well as the proper establishment of pregnancy dating.”

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

Invasive diagnostic testing is discussed by the AIUM, AWMF and SOGC, with differentiations among them regarding the indications for pursuing such procedures.

“Furthermore, invasive diagnostic testing is discussed by the AIUM, AWMF and SOGC, with differentiations among them regarding the indications for pursuing such procedures.”

May combine two claims.

There is consensus among the reviewed guidelines regarding the main parameters that should be evaluated, the qualifications of the examiner, specifications of the ultrasound machine, and the importance of informed consent.

“There is a consensus regarding the main parameters that should be evaluated, the qualifications of the examiner and specifications of the ultrasound machine, as well as the importance of informed consent.”

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

The first-trimester scan is used to evaluate fetal viability, fetal number, pregnancy dating, fetal anatomy, location of the gestational sac, and, in multiple pregnancy, amnionicity and chorionicity.

“The first-trimester scan is used to evaluate several parameters of an ongoing pregnancy: the fetal viability (AIUM, ASUM, ISUOG, and SOGC), fetal number (AIUM, ASUM, ISUOG, and SOGC), pregnancy dating (AIUM, ASUM, AWMF, ISUOG, SOGC, and WAPM), fetal anatomy (AIUM, ASUM, AWMF, ISUOG, SOGC, and WAPM), location of the gestational sac (ASUM, ISUOG) and, in case of multiple pregnancy, evaluation of the”

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

The ASUM mentions that first-trimester ultrasound can be performed upon request.

“In contrast, the AIUM suggests that it should be reserved only for groups at high risk for skeletal anomalies, while the ASUM mentions that it can be performed upon request.”

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

Evaluation of the fetal anatomy is one of the most important parts of the first-trimester sonographic examination and is discussed by all the reviewed medical societies.

“One of the most important parts of the first-trimester sonographic examination is the evaluation of the fetal anatomy, a subject discussed by all the reviewed medical societies.”

Classified as probably not a substantial claim.

The AIUM recommends a stricter window from 12+0 to 13+6 weeks for first-trimester ultrasound.

“However, other guidelines suggest narrower or broader timeframes; the AIUM recommends a stricter window from 12+0 to 13+6 weeks, while the ASUM mentions a much wider range, allowing for the examination to be performed anytime between 5 and 14 weeks of gestation.”

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

The SOGC classifies often detectable conditions as spina bifida, complex heart defect, lower urinary tract obstruction, absence of extremities and fatal skeletal dysplasia.

“These are classified as always detectable, including acrania, holoprosencephaly, encephalocele, pentalogy of Cantrell, ectopia cordis, exomphalos, gastroschisis and body stalk anomaly; and often detectable, including spina bifida, complex heart defect, lower urinary tract obstruction, absence of extremities and fatal skeletal dysplasia.”

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

The reviewed guidelines suggest evaluation of fetal biometry with the measurement of several parameters.

“In addition to the measurement of CRL for pregnancy dating, the reviewed guidelines suggest evaluation of fetal biometry with the measurement of several parameters.”

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

Crown-rump length measurement following a standardized technique is recommended by all medical societies.

“Notably, the CRL measurement, following a standardized technique, is recommended by all medical societies [25,26].”

• cites [25] Ioannou, 2013, Standardisation of crown-rump length measurement, Bjog sourceNot checked — no full text of the source
• cites [26] Wanyonyi, 2014, Image-scoring system for crown-rump length measurement, Ultrasound Obstet. Gynecol. sourceNot checked — no full text of the source

Classified as probably not a substantial claim.

For multiple pregnancies resulting from spontaneous conception, the AIUM, ASUM and SOGC recommend using the crown-rump length of the larger fetus to determine gestational age.

“As for multiple pregnancies resulting from spontaneous conception, the AIUM, ASUM and SOGC recommend using the CRL of the larger fetus to determine the gestational age.”

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

The WAPM guidelines state that a detailed fetal anatomical assessment protocol should be undertaken only in high-risk cases, although a brief anatomical evaluation is recommended in all pregnancies.

“Furthermore, the WAPM guidelines specifically mention that a detailed fetal anatomical assessment protocol should be undertaken only in high-risk cases, although a brief anatomical evaluation is recommended in all pregnancies.”

Classified as probably not a substantial claim.

The SOGC classifies always detectable conditions as acrania, holoprosencephaly, encephalocele, pentalogy of Cantrell, ectopia cordis, exomphalos, gastroschisis and body stalk anomaly.

“These are classified as always detectable, including acrania, holoprosencephaly, encephalocele, pentalogy of Cantrell, ectopia cordis, exomphalos, gastroschisis and body stalk anomaly; and often detectable, including spina bifida, complex heart defect, lower urinary tract obstruction, absence of extremities and fatal skeletal dysplasia.”

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

Measurement of biparietal diameter, head circumference, abdominal circumference and femoral length are considered components of a full biometry evaluation.

“Moreover, measurement of BPD, head circumference (HC), abdominal circumference (AC) and femoral length (FL) are considered components of a full biometry evaluation.”

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

The SOGC does not specifically describe the anatomical structures that should be examined; instead, it outlines the conditions that are always or often detectable and should therefore be actively assessed.

“The SOGC, on the other hand, does not specifically describe the anatomical structures that should be examined. Instead, this medical society outlines the conditions that are always or often detectable and should therefore be actively assessed.”

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

Abdominal circumference is part of routine fetal biometry according to the AIUM, ISUOG, SOGC and WAPM, either as an eclipse or with measurement of the antero-posterior abdominal diameter and transverse abdominal diameter as proposed alternatively by the ISUOG, while the AWMF mentions that it can be measured optionally.

“Additionally, the AC is a part of routine fetal biometry according to the AIUM, ISUOG, SOGC, and WAPM, either as an eclipse or with the measurement of the antero-posterior abdominal diameter (APAD) and transverse abdominal diameter (TAD), as proposed alternatively by the ISUOG, while the AWMF mentions that it can be measured optionally.”

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

Femoral length is recommended by the AIUM, ISUOG and SOGC as a routine measurement, while the WAPM and AWMF consider it optional.

“Finally, the FL is recommended by the AIUM, ISUOG and SOGC as a routine measurement, while the WAPM and AWMF consider it optional.”

Classified as probably not a substantial claim.

The ASUM advises using crown-rump length in cases of unknown last menstrual period, a difference of more than 5 days prior to 10 gestational weeks, or more than 7 days between 10 and 14 weeks of gestation.

“In detail, the AIUM recommends using the CRL if a difference of more than 7 days from the LMP is identified between 9 and 13+6 gestational weeks, whereas the ASUM advises its use in cases of unknown LMP, a difference of more than 5 days prior to 10 gestational weeks, or more than 7 days between 10 and 14 weeks of gestation.”

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

The AIUM suggests that first-trimester ultrasound should be reserved only for groups at high risk for skeletal anomalies.

“In contrast, the AIUM suggests that it should be reserved only for groups at high risk for skeletal anomalies, while the ASUM mentions that it can be performed upon request.”

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

The ISUOG mentions that the minimum requirements of fetal anatomy evaluation should include the head and brain, neck, heart, abdomen and extremities, while a more detailed scan should include the face, thorax, genitalia and spine.

“Of note, the ISUOG mentions that the minimum requirements of the fetal anatomy evaluation should include the head and brain, neck, heart, abdomen and extremities, while a more detailed scan should include the face, thorax, genitalia and spine.”

Classified as probably not a substantial claim.

The AIUM recommends using crown-rump length if a difference of more than 7 days from the last menstrual period is identified between 9 and 13+6 gestational weeks.

“In detail, the AIUM recommends using the CRL if a difference of more than 7 days from the LMP is identified between 9 and 13+6 gestational weeks, whereas the ASUM advises its use in cases of unknown LMP, a difference of more than 5 days prior to 10 gestational weeks, or more than 7 days between 10 and 14 weeks of gestation.”

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

Biparietal diameter alone (ASUM, AWMF) or in combination with head circumference (AIUM, ISUOG, SOGC, WAPM) are considered the parameters for evaluating the fetal head.

“More specifically, the BPD alone (ASUM, AWMF) or in combination with the HC (AIUM, ISUOG, SOGC, and WAPM) are considered the parameters for evaluating the fetal head.”

Classified as probably not a substantial claim.

The SOGC suggests using alternative biometric indices for fetuses with a crown-rump length greater than 84 mm.

“Consequently, the SOGC suggests using alternative biometric indices for fetuses with a CRL greater than 84 mm.”

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

A thorough measurement of the nuchal translucency should be obtained, as suggested by all the reviewed medical societies.

“In addition, a thorough measurement of the nuchal translucency (NT) should be obtained, as suggested by all the reviewed medical societies.”

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

The ASUM mentions that cervical evaluation should be conducted after 14 gestational weeks.

“Notably, the ASUM mentions that cervical evaluation should be conducted after 14 gestational weeks.”

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

The AIUM, ASUM and ISUOG recommend routine assessment of the uterus, mainly for the presence of fibroids and congenital malformations.

“Regarding the evaluation of the maternal structures, the AIUM, ASUM and ISUOG recommend routine assessment of the uterus, mainly for the presence of fibroids and congenital malformations.”

Probably not a substantial claim: may not pass S3 (load-bearing), S4 (based).

A detailed evaluation of the fingers and toes is not recommended and should be restricted to only high-risk cases for specific musculoskeletal disorders.

“Notably, a detailed evaluation of the fingers and toes is not recommended and should be restricted to only in high-risk cases for specific musculoskeletal disorders.”

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

All the reviewed guidelines referring to the placenta mention that its texture, location and insertion should be examined.

“All the reviewed guidelines referring to the topic mention that its texture, location and insertion should be examined.”

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

Measurement of the cervical length is recommended routinely by the AIUM, while the AWMF, ISUOG and SOGC suggest its optional evaluation.

“Furthermore, measurement of the cervical length is recommended routinely by the AIUM, while the AWMF, ISUOG and SOGC suggest its optional evaluation.”

May combine two claims.

The WAPM mentions only evaluation of the fetal profile as part of the routine examination, while assessment of the eye orbits, bony palate and upper lip are not routinely recommended.

“In contrast, the WAPM mentions only evaluation of the fetal profile as part of the routine examination, while assessment of the eye orbits, bony palate and upper lip are not routinely recommended.”

Probably not a substantial claim: may not pass S3 (load-bearing), S4 (based). May combine two claims.

The ISUOG recommends a complete assessment of the placenta during the detailed first-trimester scan, while the minimum requirements consider evaluation of the placental texture alone as sufficient.

“Notably, ISUOG recommends a complete assessment of the placenta during the detailed first-trimester scan, while the minimum requirements consider evaluation of the placental texture alone as sufficient.”

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

The WAPM specifically mentions that measurement of the femur and humerus is not recommended during the first-trimester examination.

“Notably, the WAPM specifically mentions that measurement of the femur and humerus is not recommended during this examination.”

Classified as probably not a substantial claim.

The AIUM, ISUOG and SOGC support the inclusion of femoral length measurement as routine.

“Therefore, the AIUM, ISUOG and SOGC support the inclusion of this measurement as routine.”

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

Visualization of the ovaries and adnexa is described by the AIUM, ASUM and SOGC, with the AIUM additionally recommending evaluation of the cul-de-sac.

“Moreover, visualization of the ovaries and adnexa is described by the AIUM, ASUM and SOGC, with the AIUM additionally recommending evaluation of the cul-de-sac.”

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

The AIUM, AWMF and ISUOG suggest routine evaluation of the sonographic markers, with the AIUM and ISUOG including assessment of the orbits, lenses and upper lip.

“Interestingly, the AIUM, AWMF and ISUOG suggest routine evaluation of the above-mentioned sonographic markers, with the AIUM and ISUOG including assessment of the orbits, lenses and upper lip.”

Probably not a substantial claim: may not pass S3 (load-bearing), S4 (based).

As highlighted by the AIUM, AWMF and ISUOG, the umbilical cord insertion should be looked for in the first-trimester sonographic assessment.

“As highlighted by the AIUM, AWMF and ISUOG, the umbilical cord insertion should be looked for in the first-trimester sonographic assessment.”

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

Specific recommendations regarding the anatomic evaluation of the fetal spine are made by the AIUM, AWMF, ISUOG and WAPM.

“Specific recommendations regarding the anatomic evaluation of the fetal spine are made by the AIUM, AWMF, ISUOG and WAPM.”

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

The WAPM mentions that evaluation of the bowel is not recommended as routine during the first-trimester ultrasound scan.

“Notably, the WAPM mentions that evaluation of the bowel is not recommended as routine during this ultrasound scan.”

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

The AWMF mentions that the cfDNA test should be repeated in 2 weeks in case of inconclusive initial results.

“Notably, the AWMF mentions that the test should be repeated in 2 weeks in case of inconclusive initial results”

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

The AWMF, ISUOG, WAPM and SOGC (only in high-risk women) suggest assessment of flow through the tricuspid valve.

“Firstly, the flow through the tricuspid valve is suggested by the AWMF, ISUOG, WAPM and SOGC (only in high-risk women).”

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

The WAPM recommends routine evaluation of the cranial posterior fossa.

“Notably, the WAPM recommends routine evaluation of the cranial posterior fossa”

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

The AWMF and ISUOG mention that in high-risk women, with a risk of more than 1 in 100 of developing preeclampsia, the administration of 150 mg of aspirin daily should be recommended until 36 gestational weeks.

“Of note, the AWMF and ISUOG mention that in high-risk women, with a risk of more than 1 in 100 of developing preeclampsia, the administration of 150 mg of aspirin daily should be recommended until 36 gestational weeks [77].”

• cites [77] Tsakiridis, 2021, Gestational Hypertension and Preeclampsia: An Overview of National and International Guidelines, Obstet. Gynecol. Surv. sourceNot checked — no full text of the source

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

The AIUM mentions that invasive testing should be suggested in cases where fetal anomalies are detected in early gestation.

“The AIUM mentions that it should be suggested in cases where fetal anomalies are detected in early gestation”

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

Routine maternal free beta-human chorionic gonadotropin and pregnancy-associated plasma protein A are recommended by the ASUM, AWMF, ISUOG and SOGC, while the ISUOG additionally mentions the utility of placental growth factor.

“Evaluation of maternal biochemistry in combination with ultrasound parameters serves as a helpful tool for calculating the risk for several chromosomal anomalies; routine maternal free beta-human chorionic gonadotropin (β-hCG) and pregnancy-associated plasma protein A (PAPP-A) are recommended by the ASUM, AWMF, ISUOG and SOGC, while the ISUOG additionally mentions the utility of placental growth”

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

Invasive testing is discussed by the AIUM, AWMF and SOGC, with different recommendations among them.

“Invasive testing is discussed by the AIUM, AWMF and SOGC, with different recommendations among them.”

Classified as probably not a substantial claim.

Specific recommendations regarding screening for preeclampsia and fetal growth restriction during the first-trimester scan are provided by the AWMF, ISUOG and SOGC.

“Specific recommendations regarding screening for preeclampsia and fetal growth restriction (FGR) during the first-trimester scan are provided by the AWMF, ISUOG and SOGC.”

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

The ISUOG mentions that Doppler examinations can be helpful in the prediction of SGA/FGR.

“while the ISUOG mentions that Doppler examinations can be helpful in their prediction.”

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

The ISUOG mentions that cfDNA examination may be extended to cover rare, structural anomalies or microdeletions, duplications or monogenic defects in the future.

“On the other hand, the ISUOG mentions that cfDNA examination may be extended to cover these conditions in the future.”

Classified as probably not a substantial claim.

The AWMF is against the use of cfDNA for rare, structural anomalies or for microdeletions, duplications or monogenic defects.

“while the AWMF is against its use for rare, structural anomalies or for microdeletions, duplications or monogenic defects.”

Classified as probably not a substantial claim.

The AWMF, ISUOG and SOGC mention that screening for preeclampsia should be made according to the FMF protocol, with minor discrepancies among them.

“Of note, the AWMF, ISUOG and SOGC mention that screening for preeclampsia should be made according to the FMF protocol, with minor discrepancies among them.”

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

The ASUM, ISUOG, SOGC and WAPM emphasize the importance of having trained personnel conduct the nuchal translucency examination.

“Moreover, the ASUM, ISUOG, SOGC and WAPM emphasize the importance of having trained personnel conduct this specific examination.”

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

Examination of nasal bone is routinely recommended by the ISUOG and in intermediate-risk women by the AWMF, while the SOGC does not recommend its routine evaluation.

“Furthermore, the examination of nasal bone is routinely recommended by the ISUOG and in intermediate-risk women by the AWMF, while the SOGC does not recommend its routine evaluation.”

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

The SOGC suggests routine screening for the prediction of preeclampsia, but mentions that UtA-PI should not be routinely included in the algorithm.

“Similarly, the SOGC suggests routine screening for the prediction of preeclampsia, but mentions that UtA-PI should not be routinely included in the algorithm.”

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

The SOGC recommends invasive testing in fetuses with an NT ≥ 3.5 mm.

“the SOGC recommends it in fetuses with an NT ≥ 3.5 mm”

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

Ductus venosus flow is recommended as a routine by the AWMF and ISUOG and for high-risk women by the SOGC, whereas the WAPM states that this assessment should not be performed routinely.

“With regards to the ductus venosus flow, it is recommended as a routine by the AWMF and ISUOG and for high-risk women by the SOGC, whereas the WAPM states that this assessment should not be performed routinely.”

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

The AWMF and ISUOG suggest the combination of maternal history, uterine artery Pulsatility Index (UtAPI), and maternal biochemistry, with the ISUOG specifically mentioning only PlGF and MAP.

“More specifically, the AWMF and ISUOG suggest the combination of maternal history, uterine artery Pulsatility Index (UtAPI), and maternal biochemistry, with the ISUOG specifically mentioning only PlGF and MAP.”

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

cfDNA testing is mentioned only by the AWMF and ISUOG.

“Continuing with a more advanced screening during the first trimester, cfDNA testing is mentioned only by the AWMF and ISUOG.”

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

The SOGC mentions that a combination of maternal characteristics, history, MAP and UtA-PI, although not as a routine, should be used for small-for-gestational-age (SGA) fetuses and prediction of fetal growth restriction (FGR).

“Moreover, with regards to small-for-gestational-age (SGA) fetuses and prediction of fetal growth restriction (FGR), the SOGC mentions that a combination of maternal characteristics, history, MAP and UtA-PI, although not as a routine, should be used”

May combine two claims.

Invasive diagnostic testing is discussed by the AIUM, AWMF and SOGC, with differences among them regarding the indications for performing such procedures.

“Furthermore, invasive diagnostic testing is discussed by the AIUM, AWMF and SOGC, with differences among them regarding the indications for performing such procedures.”

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

The SOGC guidelines are updated from the previous version published in 2001 and provide information regarding the evaluation for the risk of preeclampsia and SGA, the assessment of a multiple pregnancy and other pregnancy complications, and guidelines on the examination of additional ultrasound markers (tricuspid and ductus venosus flow and nasal bone).

“More specifically, the SOGC guidelines are updated from the previous version published in 2001 and provide information regarding the evaluation for the risk of preeclampsia and SGA, the assessment of a multiple pregnancy and other pregnancy complications, and guidelines on the examination of additional ultrasound markers (tricuspid and ductus venosus flow and nasal bone).”

May combine two claims.

An exception exists regarding the ISUOG and WAPM guidelines, which propose a minimum-requirements protocol that includes only a limited set of anatomical areas, as well as a more detailed scan protocol.

“An exception exists regarding the ISUOG and WAPM guidelines, which propose a minimum-requirements protocol that includes only a limited set of anatomical areas, as well as a more detailed scan protocol.”

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

The SOGC does not specify the exact anatomical structures to be assessed, but instead classifies structural defects based on how frequently they are detected during the first-trimester scan.

“Notably, the SOGC does not specify the exact anatomical structures to be assessed, but instead classifies structural defects based on how frequently they are detected during the first-trimester scan.”

May combine two claims.

All the reviewed guidelines agree on the main parameters that should be examined, including determination of fetal number and viability, accurate pregnancy dating, detailed evaluation of the fetal anatomy and assessment of chorionicity and amnionicity in multiple gestations.

“In summary, all the reviewed guidelines agree on the main parameters that should be examined, including determination of fetal number and viability, accurate pregnancy dating, detailed evaluation of the fetal anatomy and assessment of chorionicity and amnionicity in multiple gestations.”

• AssumptionRests on an assumption: The reviewed guidelines (AIUM, ASUM, AWMF, ISUOG, SOGC, WAPM) are the relevant major guidelines for first-trimester ultrasound.

May combine two claims.

The ISUOG guidelines are upgraded since 2013, introducing both a minimum-required and a detailed fetal anatomic protocol, as well as a systematic evaluation of intracranial anatomy, additional ultrasound markers, placental assessment and uterine artery Doppler, while also presenting the importance of screening for obstetric complications, such as preterm preeclampsia.

“Finally, the ISUOG guidelines are also upgraded since 2013, introducing both a minimum-required and a detailed fetal anatomic protocol, as well as a systematic evaluation of intracranial anatomy, additional ultrasound markers, placental assessment and uterine artery Doppler, while also presenting the importance of screening for obstetric complications, such as preterm preeclampsia.”

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

cfDNA is addressed only by the AWMF and ISUOG, with similar recommendations regarding its appropriate use and associated cautions.

“Finally, cfDNA is addressed only by the AWMF and ISUOG, with similar recommendations regarding its appropriate use and associated cautions.”

May combine two claims.

Agreement exists regarding the experience and qualifications of the examiner, the use of both transvaginal and transabdominal transducers when required, and the necessity of obtaining informed patient consent.

“Moreover, agreement exists regarding the experience and qualifications of the examiner, the use of both transvaginal and transabdominal transducers when required, and the necessity of obtaining informed patient consent.”

May combine two claims.

With regards to the placenta, uterus and adnexa, there is a general agreement among the reviewed medical societies, with some requiring a more detailed examination, and others a more basic one.

“Similarly, with regards to the placenta, uterus and adnexa, there is a general agreement among the reviewed medical societies, with some requiring a more detailed examination, and others a more basic one.”

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

The AWMF guidelines are an upgrade of 2018 version and provide more detailed information regarding overall fetal and maternal risk stratification (aneuploidies, preeclampsia, SGA, etc.) and pregnancy management, whereas the 2018 guidelines focused mainly on aneuploidy screening and cfDNA implementation.

“Similarly, the AWMF guidelines, which are an upgrade of 2018 version, provide more detailed information regarding overall fetal and maternal risk stratification (aneuploidies, preeclampsia, SGA, etc.) and pregnancy management, whereas the 2018 guidelines focused mainly on aneuploidy screening and cfDNA implementation.”

Probably not a substantial claim: may not pass S4 (based). May combine two claims.

FGR is addressed by the AWMF and SOGC, with the SOGC providing a more comprehensive protocol for screening for FGR during the first trimester.

“More specifically, FGR is addressed by the AWMF and SOGC, with the SOGC providing a more comprehensive protocol for screening for FGR during the first trimester.”

May combine two claims.

Differentiation exists regarding the proper management of gestational dating, with the AIUM and ASUM mentioning pregnancy dating based on the LMP as a first choice, whereas the AWMF, ISUOG and SOGC consider the CRL measurement more accurate in cases of spontaneous conception.

“Moreover, differentiation exists regarding the proper management of gestational dating, with the AIUM and ASUM mentioning pregnancy dating based on the LMP as a first choice, whereas the AWMF, ISUOG and SOGC consider the CRL measurement more accurate in cases of spontaneous conception.”

Classified as probably not a substantial claim.

First-trimester sonographic examination is a fundamental part of antenatal care.

“First-trimester sonographic examination remains a fundamental part of antenatal care, providing crucial information for the well-being of both the mother and fetus and leading to the best possible perinatal outcomes.”

• Also stated in: § 1. Introduction · plain

  “The first-trimester scan is a fundamental part of antenatal care, focused on the evaluation of early pregnancy [1].”

• cites [1] Boureka, 2024, Antenatal Care: A Comparative Review of Guidelines, Obstet. Gynecol. Surv. sourceNot checked — no full text of the source

May combine two claims.

Increased nuchal translucency is the most frequent abnormal finding in the first trimester and may prompt further genetic evaluation with invasive testing.

“Increased NT is the most frequent abnormal finding in the first trimester and may prompt further genetic evaluation with invasive testing [6].”

• cites [6] Esteves, 2023, The value of detailed first-trimester ultrasound in the era of noninvasive prenatal testing, Am. J. Obstet. Gynecol. sourceNot checked — no full text of the source

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

The first-trimester scan is typically performed between 11+0 and 13+6 weeks.

“It is typically performed between 11+0 and 13+6 weeks and serves as a valuable tool for the confirmation of intrauterine pregnancy; evaluation of the presence, location and number of gestational sacs; determination of gestational age; assessment of fetal number, chorionicity and amnionicity; and evaluation of early fetal anatomy [2].”

• cites [2] Syngelaki, 2019, Diagnosis of fetal non-chromosomal abnormalities on routine ultrasound examination at 11–13 weeks’ gestation, Ultrasound Obstet. Gynecol. sourceNot checked — no full text of the source

Classified as probably not a substantial claim.

Using the crown-rump length of the larger fetus in multiple pregnancies is intended to avoid overlooking early fetal growth restriction.

“This approach is intended to avoid overlooking early fetal growth restriction (FGR).”

Probably not a substantial claim: may not pass S2 (checkable). May combine two claims.

Improved prenatal screening protocols and specialized ultrasound surveillance are needed in multiple gestations.

“With regards to twin pregnancies, results from a population study showed that the detection rate of anatomic anomalies was only 27.3% (95% CI: 15.0–42.8), highlighting the need for improved prenatal screening protocols and specialized ultrasound surveillance in multiple gestations [15].”

• cites [15] Familiari, 2016, Sensitivity of first-trimester ultrasound in the detection of congenital anomalies in twin pregnancies: Population study and systematic review, Acta Obstet. Gynecol. Scand. sourceNot checked — no full text of the source

May combine two claims.

Careful visualization of the skull, midline echo, choroid plexuses, midbrain and brain stem resulted in identification of all cases of acrania, holoprosencephaly, and encephalocele, as well as 59% of open spina bifida cases and 13% of cerebellum abnormalities.

“Moreover, according to a large study, careful visualization of the skull, midline echo, choroid plexuses, midbrain and brain stem resulted in identification of all cases of acrania, holoprosencephaly, and encephalocele, as well as 59% of open spina bifida cases and 13% of cerebellum abnormalities [2].”

• cites [2] Syngelaki, 2019, Diagnosis of fetal non-chromosomal abnormalities on routine ultrasound examination at 11–13 weeks’ gestation, Ultrasound Obstet. Gynecol. sourceNot checked — no full text of the source

May combine two claims.

With proper clinical training, the first-trimester ultrasound scan proves both clinically and cost-effective for diagnosing major fetal structural anomalies, especially when using specific standardized protocols.

“In fact, results from recent studies showed that with proper clinical training, the first-trimester ultrasound scan proves both clinically and cost-effective for diagnosing major fetal structural anomalies [32,33], especially when using specific standardized protocols [34].”

• cites [32] Karim, 2025, Clinical and cost-effectiveness of detailed anomaly ultrasound screening in the first trimester: A mixed-methods study, Health Technol. Assess. sourceNot checked — no full text of the source
• cites [33] Buijtendijk, 2024, Diagnostic accuracy of ultrasound screening for fetal structural abnormalities during the first and second trimester of pregnancy in low-risk and unselected populations, Cochrane Database Syst. Rev. sourceNot checked — no full text of the source
• cites [34] Liao, 2021, Routine first-trimester ultrasound screening using a standardized anatomical protocol, Am. J. Obstet. Gynecol. sourceNot checked — no full text of the source

May combine two claims.

Femoral length shows high variability in its measurement and therefore cannot be used reliably for gestational age.

“Both recommendations are justified, as the FL shows high variability in its measurement and therefore cannot be used reliably for gestational age [27].”

• cites [27] Salomon, 2003, Revisiting first-trimester fetal biometry, Ultrasound Obstet. Gynecol. sourceNot checked — no full text of the source

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

The SOGC indirectly implies that the head and brain, neck, heart, abdomen, urogenital tract, spine and extremities should be evaluated during the first-trimester scan.

“Consequently, the SOGC indirectly implies that the head and brain, neck, heart, abdomen, urogenital tract, spine and extremities should be evaluated during the first-trimester scan.”

May combine two claims.

The detection rate of structural anomalies in high-risk women was 61% (95% CI: 37.71-82.19%) compared to only 32% in low-risk pregnancies (95% CI: 22.45-43.12%).

“Published data showed that the detection rate of structural anomalies in high-risk women was 61% (95% CI: 37.71–82.19%) compared to only 32% in low-risk pregnancies (95% CI: 22.45–43.12%) [14].”

• cites [14] Karim, 2017, Systematic review of first-trimester ultrasound screening for detection of fetal structural anomalies and factors that affect screening performance, Ultrasound Obstet. Gynecol. sourceNot checked — no full text of the source

Classified as probably not a substantial claim.

Abdominal circumference should be considered an integral component of first-trimester fetal evaluation.

“Of note, studies have shown that measurement of the AC demonstrates high intra- and inter-observer precision and should be considered an integral component of first-trimester fetal evaluation [29,30].”

• cites [29] Afshar, 2019, First-Trimester Abdominal Circumference (Versus Crown Rump Length) Improves Precision in Inter- and Intraobserver Variability, J. Ultrasound Med. sourceNot checked — no full text of the source
• cites [30] Fritzer, 2002, Fetal transabdominal biometry at 11–14 weeks of gestation, Ultrasound Obstet. Gynecol. sourceNot checked — no full text of the source

May combine two claims.

The prediction error of crown-rump length between 8 and 16 weeks was 7.7 days, while the error by last menstrual period was a little more than 10 days.

“This is based on a study that showed that the prediction error of CRL between 8 and 16 weeks was 7.7 days, while the error by LMP was a little more than 10 days; therefore, the CRL is considered a more accurate method [21].”

• cites [21] Taipale, 2001, Predicting delivery date by ultrasound and last menstrual period in early gestation, Obstet. Gynecol. sourceNot checked — no full text of the source

May combine two claims.

Low cord insertion presented in approximately 12% of pregnancies, out of which 4.7% presented with velamentous cord insertion compared to the normal ones (OR: 6.67; 95% CI: 2.67-16.63).

“Data from a prospective study showed that low cord insertion presented in approximately 12% of pregnancies, out of which 4.7% presented with velamentous cord insertion compared to the normal ones (OR: 6.67; 95% CI: 2.67–16.63) [63].”

• cites [63] Derisbourg, 2021, First trimester ultrasound prediction of velamentous cord insertions: A prospective study, J. Matern. Fetal Neonatal Med. sourceNot checked — no full text of the source

May combine two claims.

A longitudinal bladder diameter of 7 to 15 mm was associated with an abnormal karyotype in approximately one out of every four cases, but spontaneous resolution occurred in nearly 90% of these cases.

“Furthermore, the bladder diameter plays a crucial role in determining the fetal outcome: a longitudinal bladder diameter of 7 to 15 mm was associated with an abnormal karyotype in approximately one out of every four cases, but spontaneous resolution occurred in nearly 90% of these cases [53].”

• cites [53] Liao, 2003, Megacystis at 10–14 weeks of gestation: Chromosomal defects and outcome according to bladder length, Ultrasound Obstet. Gynecol. sourceNot checked — no full text of the source

May combine two claims.

A maxillary gap was seen in 96% of cases with cleft lip and/or palate with additional anomalies, and in 65% the finding was isolated.

“More specifically, a maxillary gap was seen in 96% of cases with cleft lip and/or palate with additional anomalies, and in 65% the finding was isolated [40].”

• cites [40] Chaoui, 2015, Maxillary gap at 11–13 weeks’ gestation: Marker of cleft lip and palate, Ultrasound Obstet. Gynecol. sourceNot checked — no full text of the source

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

The spine should be carefully evaluated in cases where spina bifida is suspected from the presence of anomalies in the posterior fossa.

“Notably, the spine should be carefully evaluated in cases where spina bifida is suspected from the presence of anomalies in the posterior fossa [55,56].”

• cites [55] Chaoui, 2009, Assessment of intracranial translucency (IT) in the detection of spina bifida at the 11–13-week scan, Ultrasound Obstet. Gynecol. sourceNot checked — no full text of the source
• cites [56] Karl, 2015, Fluid area measurements in the posterior fossa at 11–13 weeks in normal fetuses and fetuses with open spina bifida, Fetal Diagn. Ther. sourceNot checked — no full text of the source

May combine two claims.

Mid-gut herniation is associated with gestational age, presenting in approximately 60% of fetuses before 10 weeks and in only 5% at 12 weeks.

“Additionally, mid-gut herniation is associated with gestational age, presenting in approximately 60% of fetuses before 10 weeks and in only 5% at 12 weeks, a fact that should be considered when evaluating the abdominal wall [50].”

• cites [50] Bogers, 2019, Evaluation of First-Trimester Physiological Midgut Herniation Using Three-Dimensional Ultrasound, Fetal Diagn. Ther. sourceNot checked — no full text of the source

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

Ovarian masses are a relatively common finding in pregnancy, although they tend to resolve spontaneously during the antenatal period.

“Ovarian masses are a relatively common finding in pregnancy, although they tend to resolve spontaneously during the antenatal period [67,68].”

• cites [67] Schwartz, 2009, Adnexal masses in pregnancy, Clin. Obstet. Gynecol. sourceNot checked — no full text of the source
• cites [68] Rocha, 2016, Investigation and Management of Adnexal Masses in Pregnancy, ScientificaNot checked yet

  Not checked in the free run.

May combine two claims.

While the majority of abdominal cysts resolved antenatally with no remaining consequences for the neonate, four cases with lower abdomen cysts were diagnosed with anorectal malformations postnatally.

“Data from a cohort study showed that while the majority of cysts resolved antenatally, with no remaining consequences for the neonate, four cases with lower abdomen cysts were diagnosed with anorectal malformations postnatally [49].”

• cites [49] Khalil, 2014, Outcome of first-trimester fetal abdominal cysts: Cohort study and review of the literature, Ultrasound Obstet. Gynecol. sourceNot checked — no full text of the source

May combine two claims.

Hyperechogenic fetal bowel is associated with several fetal pathological conditions, such as cystic fibrosis, chromosomal anomalies and Zellweger syndrome, all of which require advanced management at a specialized center.

“Specifically, hyperechogenic fetal bowel is associated with several fetal pathological conditions, such as cystic fibrosis, chromosomal anomalies, Zellweger syndrome, etc., all of which require advanced management at a specialized center [51].”

• cites [51] Vena, 2023, Hyperechogenic fetal bowel: Current evidence-based prenatal diagnosis and management, J. Clin. Ultrasound sourceNot checked — no full text of the source

May combine two claims.

The nuchal translucency was above the 95th centile in 82.2% of fetuses with trisomy 21 and 77.9% with other chromosomal defects.

“According to a large study of almost 10,000 women, the NT was above the 95th centile in 82.2% of fetuses with trisomy 21 and 77.9% with other chromosomal defects, therefore presenting as a valuable marker for identification of fetal abnormalities [45].”

• cites [45] Snijders, 1998, UK multicentre project on assessment of risk of trisomy 21 by maternal age and fetal nuchal-translucency thickness at 10–14 weeks of gestation. Fetal Medicine Foundation First Trimester Screening Group, Lancet sourceNot checked — no full text of the source

May combine two claims.

A combination of maternal age, fetal nuchal translucency, maternal free β-hCG and PAPP-A resulted in a detection rate of trisomy 21 of 90% (95% CI: 84-96%) with a false-positive rate of 3%, compared to only 81% (95% CI: 73-89%) for screenings with maternal age and fetal NT and 63% (95% CI: 56-72%) for screenings with maternal age and maternal serum biochemistry alone.

“According to a large prospective study of almost 20,000 women, a combination of maternal age, fetal NT, maternal free β-hCG and PAPP-A resulted in detection rate of trisomy 21 of 90% (95% CI: 84–96%) with a false-positive rate of 3%, compared to only 81% (95% CI: 73–89%) for screenings with maternal age and fetal NT and 63% (95% CI: 56–72%) for screenings with maternal age and maternal serum”

• cites [69] Kagan, 2009, Prospective validation of first-trimester combined screening for trisomy 21, Ultrasound Obstet. Gynecol. sourceNot checked — no full text of the source

May combine two claims.

In singletons, screening with cfDNA resulted in the detection of fetuses with trisomy 21, 18 and 13 at rates of more than 99%, 98% and 99%, respectively, with a false-positive rate of 0.13%.

“This was also highlighted by a meta-analysis that demonstrated that in singletons, screening with cfDNA resulted in the detection of fetuses with trisomy 21, 18 and 13 at even higher rates of more than 99%, 98% and 99%, respectively, with a false-positive rate of 0.13% [81].”

• cites [81] Gil, 2017, Analysis of cell-free DNA in maternal blood in screening for aneuploidies: Updated meta-analysis, Ultrasound Obstet. Gynecol. sourceNot checked — no full text of the source

May combine two claims.

The nuchal translucency protocol, in combination with maternal biochemistry, identifies approximately 90% of fetuses with trisomy 21, with a false positive rate of 5%.

“Of note, this protocol, in combination with maternal biochemistry, identifies approximately 90% of fetuses with trisomy 21, with a false positive rate of 5% [72].”

• cites [72] Nicolaides, 2004, Nuchal translucency and other first-trimester sonographic markers of chromosomal abnormalities, Am. J. Obstet. Gynecol. sourceNot checked — no full text of the source

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

The crown-rump length of the examined fetus should be between 45 mm and 84 mm according to the protocol described by Nicolaides et al.

“More specifically, the CRL of the examined fetus should be between 45 mm and 84 mm according to the protocol described by Nicolaides et al. [45].”

• cites [45] Snijders, 1998, UK multicentre project on assessment of risk of trisomy 21 by maternal age and fetal nuchal-translucency thickness at 10–14 weeks of gestation. Fetal Medicine Foundation First Trimester Screening Group, Lancet sourceNot checked — no full text of the source

May combine two claims.

For women of Afro-Caribbean origin, the prediction rates for early, preterm and term preeclampsia are 100%, 92% and 75%, respectively.

“while for women of Afro-Caribbean origin, the rates are 100%, 92% and 75%, respectively [71].”

• cites [71] Tan, 2018, Screening for pre-eclampsia by maternal factors and biomarkers at 11–13 weeks’ gestation, Ultrasound Obstet. Gynecol. sourceNot checked — no full text of the source

May combine two claims.

A reversed a-wave on the ductus venosus was observed in 66.4% of fetuses with trisomy 21 and 75% of those with Turner syndrome.

“According to a study, a reversed a-wave on the ductus venosus was observed in 66.4% of fetuses with trisomy 21 and 75% of those with Turner syndrome [74].”

• cites [74] Maiz, 2009, Ductus venosus Doppler in screening for trisomies 21, 18 and 13 and Turner syndrome at 11–13 weeks of gestation, Ultrasound Obstet. Gynecol. sourceNot checked — no full text of the source

May combine two claims.

For an NT over 3.5 mm, pathogenic variants were detected in 13.8% of fetuses, as well as in 6.5% of cases with an NT over 3.0 mm.

“This is based on a study that showed that for an NT over 3.5 mm, pathogenic variants were detected in 13.8% of fetuses, as well as in 6.5% of cases with an NT over 3.0 mm [85].”

• cites [85] Maya, 2017, Cut-off value of nuchal translucency as indication for chromosomal microarray analysis, Ultrasound Obstet. Gynecol. sourceNot checked — no full text of the source

May combine two claims.

Placental growth factor concentration was significantly associated with fetuses with trisomy 21 (p < 0.0001), but its use is targeted mainly for the detection of preeclampsia in high-risk patients.

“Notably, the PlGF concentration was significantly associated with fetuses with trisomy 21 (p < 0.0001), but its use is targeted mainly for the detection of preeclampsia in high-risk patients [70].”

• cites [70] Spencer, 2001, First trimester maternal serum placenta growth factor (PIGF)concentrations in pregnancies with fetal trisomy 21 or trisomy 18, Prenat. Diagn. sourceNot checked — no full text of the source

May combine two claims.

The nuchal translucency in combination with maternal age has a sensitivity of 82.2% and a negative predictive value of 99.9%.

“On the other hand, the NT in combination with maternal age has a sensitivity of 82.2% and a negative predictive value of 99.9% [45].”

• cites [45] Snijders, 1998, UK multicentre project on assessment of risk of trisomy 21 by maternal age and fetal nuchal-translucency thickness at 10–14 weeks of gestation. Fetal Medicine Foundation First Trimester Screening Group, Lancet sourceNot checked — no full text of the source

May combine two claims.

When examination of tricuspid valve flow is added to the algorithm (maternal age, NT, fetal heart rate, serum β-hCG and PAPP-A), the detection rate for trisomy 21 is 96%, and for trisomy 18, 13 and Turner syndrome are 92%, 100% and 100%, respectively.

“Moreover, when the examination of tricuspid valve flow was added to the algorithm (maternal age, NT, fetal heart rate, serum β-hCG and PAPP-A), the detection rate for trisomy 21 was 96%, while the detection rates for trisomy 18, 13 and Turner syndrome were 92%, 100% and 100%, respectively [73].”

• cites [73] Kagan, 2009, Tricuspid regurgitation in screening for trisomies 21, 18 and 13 and Turner syndrome at 11 + 0 to 13 + 6 weeks of gestation, Ultrasound Obstet. Gynecol. sourceNot checked — no full text of the source

May combine two claims.

In 3.7% of women undergoing cfDNA the results were inconclusive, and therefore confirmation of the findings with invasive testing was necessary.

“Similarly, according to a study, in 3.7% of women undergoing cfDNA the results were inconclusive, and therefore confirmation of the findings with invasive testing was necessary [87].”

• cites [87] Oneda, 2014, High-resolution chromosomal microarrays in prenatal diagnosis significantly increase diagnostic power, Prenat. Diagn. sourceNot checked — no full text of the source

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

All the above-mentioned updated versions focus on a more comprehensive fetal and maternal assessment, supporting earlier detection of fetal anomalies and allowing for more individualized antenatal management and follow-up.

“All the above-mentioned updated versions focus on a more comprehensive fetal and maternal assessment, supporting earlier detection of fetal anomalies and allowing for more individualized antenatal management and follow-up.”