O'Brien Karen, Shainker Scott A, Modest Anna M, Spiel Melissa H, Resetkova Nina, Shah Neel, Hacker Michele R
Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Beth Israel Deaconess Medical Center, Boston, MA, USA.
Department of Obstetrics, Gynecology and Reproductive Biology, Harvard Medical School, Boston, MA, USA.
Birth. 2017 Mar;44(1):35-40. doi: 10.1111/birt.12262. Epub 2016 Nov 15.
To examine the clinical utility and cost of follow-up ultrasounds performed as a result of suboptimal views at the time of initial second-trimester ultrasound in a cohort of low-risk pregnant women.
We conducted a retrospective cohort study of women at low risk for fetal structural anomalies who had second-trimester ultrasounds at 16 to less than 24 weeks of gestation from 2011 to 2013. We determined the probability of women having follow-up ultrasounds as a result of suboptimal views at the time of the initial second-trimester ultrasound, and calculated the probability of detecting an anomaly on follow-up ultrasound. These probabilities were used to estimate the national cost of our current ultrasound practice, and the cost to identify one fetal anomaly on follow-up ultrasound.
During the study period, 1,752 women met inclusion criteria. Four fetuses (0.23% [95% CI 0.06-0.58]) were found to have anomalies at the initial ultrasound. Because of suboptimal views, 205 women (11.7%) returned for a follow-up ultrasound, and one (0.49% [95% CI 0.01-2.7]) anomaly was detected. Two women (0.11%) still had suboptimal views and returned for an additional follow-up ultrasound, with no anomalies detected. When the incidence of incomplete ultrasounds was applied to a similar low-risk national cohort, the annual cost of these follow-up scans was estimated at $85,457,160. In our cohort, the cost to detect an anomaly on follow-up ultrasound was approximately $55,000.
The clinical yield of performing follow-up ultrasounds because of suboptimal views on low-risk second-trimester ultrasounds is low. Since so few fetal abnormalities were identified on follow-up scans, this added cost and patient burden may not be warranted.
在一组低风险孕妇中，研究因孕中期初次超声检查时图像欠佳而进行的随访超声检查的临床实用性和成本。
我们对2011年至2013年期间妊娠16至不足24周进行孕中期超声检查的胎儿结构异常低风险女性进行了一项回顾性队列研究。我们确定了因孕中期初次超声检查时图像欠佳而进行随访超声检查的女性概率，并计算了随访超声检查时检测到异常的概率。这些概率用于估计我国当前超声检查做法的全国成本，以及在随访超声检查中发现一例胎儿异常的成本。
在研究期间，1752名女性符合纳入标准。在初次超声检查时发现4例胎儿（0.23%[95%CI 0.06 - 0.58]）有异常。由于图像欠佳，205名女性（11.7%）返回进行随访超声检查，检测到1例异常（0.49%[95%CI 0.01 - 2.7]）。2名女性（0.11%）图像仍欠佳，返回进行额外的随访超声检查，未检测到异常。当将不完全超声检查的发生率应用于类似的低风险全国队列时，这些随访扫描的年度成本估计为85457160美元。在我们的队列中，随访超声检查发现异常的成本约为55000美元。
因低风险孕中期超声检查图像欠佳而进行随访超声检查的临床收益较低。由于随访扫描中发现的胎儿异常很少，这种额外的成本和患者负担可能没有必要。
