Bricker L, Neilson J P
University Department of Obstetrics and Gynaecology, Liverpool Women's Hospital, Crown Street, Liverpool, UK, L8 7SS.
Cochrane Database Syst Rev. 2000(2):CD001451. doi: 10.1002/14651858.CD001451.
Diagnostic ultrasound is used selectively in late pregnancy where there are specific clinical indications. However, the value of routine late pregnancy ultrasound screening in unselected populations is controversial. The rationale for such screening would be the detection of clinical conditions which place the fetus or mother at high risk, which would not necessarily have been detected by other means such as clinical examination, and for which subsequent management would improve perinatal outcome.
To assess the effects on obstetric practice and pregnancy outcome of routine late pregnancy ultrasound, defined as greater than 24 weeks gestation, in women with either unselected or low risk pregnancies.
The Cochrane Pregnancy and Childbirth Group Specialised Register of Controlled Trials and the Cochrane Controlled Trials Register were searched.
All acceptably controlled trials of routine ultrasound in late pregnancy (defined as after 24 weeks).
The principal reviewer assessed trial quality and extracted data, under supervision of the co-reviewer.
Seven trials recruiting 25,036 women were included. The quality of trials overall was satisfactory. There was no difference in antenatal, obstetric and neonatal intervention or morbidity in screened versus control groups. Routine late pregnancy ultrasound was not associated with improvements in overall perinatal mortality. Placental grading as an adjunct to third trimester examination scan was associated with a significant reduction in the stillbirth rate in the one trial that assessed it. There is a lack of data with regard to long term substantive outcomes such as neurodevelopment. There is a lack of data on maternal psychological effects.
REVIEWER'S CONCLUSIONS: Based on existing evidence, routine late pregnancy ultrasound in low risk or unselected populations does not confer benefit on mother or baby. There is a lack of data about the potential psychological effects of routine ultrasound in late pregnancy, and the effects on both short and long term neonatal and childhood outcome. Placental grading in the third trimester may be valuable, but whether reported results are reproducible remains to be seen, and future research of late pregnancy ultrasound should include evaluation of placental textural assessment.
诊断性超声在妊娠晚期有特定临床指征时选择性使用。然而，在未选择人群中进行常规妊娠晚期超声筛查的价值存在争议。这种筛查的理论依据是检测出使胎儿或母亲处于高风险的临床情况，这些情况不一定能通过其他手段（如临床检查）检测出来，且后续管理可改善围产期结局。
评估在未选择或低风险妊娠的妇女中，常规妊娠晚期超声（定义为妊娠24周后）对产科实践和妊娠结局的影响。
检索了Cochrane妊娠与分娩组专业对照试验注册库和Cochrane对照试验注册库。
所有关于妊娠晚期常规超声（定义为24周后）的可接受对照试验。
主要评价者在共同评价者的监督下评估试验质量并提取数据。
纳入了7项招募25,036名妇女的试验。总体试验质量令人满意。筛查组与对照组在产前、产科和新生儿干预或发病率方面没有差异。常规妊娠晚期超声与总体围产期死亡率的改善无关。在评估胎盘分级作为孕晚期检查扫描辅助手段的一项试验中，胎盘分级与死产率显著降低有关。缺乏关于长期实质性结局（如神经发育）的数据。缺乏关于对母亲心理影响的数据。
基于现有证据，在低风险或未选择人群中进行常规妊娠晚期超声检查对母亲或婴儿没有益处。缺乏关于常规妊娠晚期超声潜在心理影响以及对新生儿和儿童短期及长期结局影响的数据。孕晚期胎盘分级可能有价值，但报告结果是否可重复仍有待观察，未来妊娠晚期超声研究应包括对胎盘质地评估的评价。
