Routine Anomaly Scan

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Routine Anomaly Scan

• Ilse Erasmus

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Routine Anomaly Scan

• Timing
• 18 23 weeks
• Costs
• about R 230 00

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RCOG Guidelines October 1997Timing of sonars
Best Acceptable Less Accept
Dating 8-10 10-20 24
Viability gt7
Twins Anytime
Chorionicity 8-12 13-15
Fetal anomaly 18-20
NT 8-15 15-16 18-20
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Routine Anomaly Scan

• Waste of resource to request routine anomaly scan
  in the late second or 3rd trimester
• Waste of resource to request growth scan in 3rd
  trimester in the absence of an early sonar

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Routine Anomaly Scan

• Indication in SA cost considerations???
• Routine late bookers
• High risk
• Previous fetal/ neonatal anomalies
• Previous IUD
• AMA
• Maternal
• disease index pregnancy / history of
• Medication
• Congenital anomalies

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Routine Anomaly Scan

• Cochrane Database
• Reduction in post term inductions
• Twin Pregnancies
• Radius?!?

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Routine Anomaly Scan

• Screening?
• 1/55 babies born with major anomaly
• Structural anomalies gt single gene defects
• UK Fetal anomalies 15 of perinatal deaths and
  15 of deaths in first year of life

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Routine Anomaly Scan

• Screening?
• Six objectives
• Reassurance that baby is apparently normal
• Or the identification of
• Non viable anomalies
• Anomalies associated with high morbidity and
  long term handicap
• Fetal conditions with the potential for
  intrauterine therapy
• Fetal conditions requiring postnatal
  investigation and/ or therapy
• Parental preparation

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Routine Anomaly Scan

• Screening?
• Lethal anomalies anencheph, BRA, thanatophoric
  dwarfs
• High morbidity and long term handicap NTD,
  cardiac,aneuploidy
• Potential intrauterine therapy RH, Parvo,TTS
• Fetal conditions requiring postnatal
  investigation and/ or therapy renal, facial
  cleft
• Parental preparation

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RCOG Guidelines October 1997Detection Rates for
Specific anomalies
Anomaly lt24w Sensitivity Specificity
Anencheph/Enc 87 100 (gt95) 99 100
Intracranial Path 27 100 (70) 99 100
Renal Agenesis 75 - 100 (85) 99 100
Cystic Lung 0- 100 (100) 99 100
Cardiac Major 4 77 (47) 98 99
CD hernia 0 100 (40) 99 100
Exomphalos 0 100 (gt95) 99 100
Gastroschisis 0 100 (66) 0 - 100
Muscuoloskeletal 0 100 (50) 0 - 100
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RCOG Guidelines October 1997Detection Rates for
Specific anomalies
Anomaly lt 24 Sensitivity Specificity
Spina Bifida 69 100 (78) 99 100
Major Renal 26 100 (60) 99 100
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RCOG Routine sonar in PregnancyJuly 2000
6 year Scottish Study
Booking scan only Minimum standard scan
Anencheph 97 100 ( better)
Spina Bifida 61 92 (better)
Major cardiac (hypoplastic LV) 14 61 (better)
CD Hernia 30 62 (better)
Gastroshcisis 86 100 (better)
Exomphalos 45 92 (same)
Major renal Renal agenesis 76 85 (better)
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RCOG 2000 JulyMinimum standard for a 20 week
anomaly scan

• Gestational age
• BPD, HC, FL, AC

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Measurments
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RCOG 2000 JulyMinimum standard for a 20 week
anomaly scan

• Gestational age
• BPD, HC, FL, AC
• Fetal Normality
• Head shape and internal structures
• CSP, Cerebellum, Ventricular size at atrium
  (lt10mm)
• Spine longitudinal and transverse
• Abdominal shape and content at the level of the
  stomach

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RCOG 2000 JulyMinimum standard for a 20 week
anomaly scan

• Renal Pelvis (lt5mm AP)
• Longitudinal axis abdominal thoracic appearance
  (diaphragm/bladder)
• Thorax at level of 4ch cardiac view
• Arms 2 x 3 long bones hands (not counting
  fingers)
• Legs - 2 x 3 long bones feet (not counting
  toes)

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RCOG 2000 JulyMinimum standard for a 20 week
anomaly scan
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RCOG 2000 JulyOptimal standard for a 20 week
anomaly scan

• The above plus
• Cardiac outflow tracts
• Face and lips

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RCOG 2000 JulyMarker scans

• Not considered routine
• Isolated markers of dubious value
• Increased overall detection rate increase from
  51 - 55 but FPR from 1/2332 to 1/188!!!!!
  (Boyd PA Lancet 1998)
• Two or more markers significant
• Screening using maternal age, age NT, age
  serum will identify 50 80
• So marker scan as screening in unscreened
  population unlikely to be of use

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RCOG 2000 JulyMarker scans

• Markers
• CPC
• Ventriculomegaly(gt10mm at atrium)
• Echogenic bowel(equivalent to bone density)
• Head shape
• Nuchal skinfold thickness(gt5mm at 20 weeks)
• CM
• Cleft lip
• Echogenic intracardiac focus

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RCOG 2000 JulyMarker scans

• Dilated renal pelvis(gt5mmAP)
• Short Femur/Humerus
• Talipes
• Sandal gap
• Clinodactyly
• Clenched hand
• Two vessel cord

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RCOG 2000 JulyMarker scans

• Other risk factors
• Maternal age gt 35
• Serum screening results
• Nuchal translucency at 11 14 weeks

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Standard views

• Pilu, Nicolaides CD - ROM
• ISUOG Standards

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Standard views

• Intrauterine
• Amount of fetuses
• Cardiac activity
• Placental Position, Appearance
• Cord vessels
• Liquor

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Standard viewsHead and Brain
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Standard viewsFace
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Standard viewsFace
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Standard viewsSpine
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Standard viewsHeart
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Standard viewsGIT
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Standard viewsLimbs
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Anomaly scan

• Skull Brain
• Normal and abnormal

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Anomaly scan

• Face
• Normal and abnormal

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Anomaly scan

• Spine
• Normal and abnormal

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NormalSpine
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Abnormal Spine
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Anomaly scan

• GIT
• Normal and abnormal

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Anomaly scan

• Heart
• Normal and abnormal

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Anomaly scan

• Kidneys
• Normal and abnormal

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Anomaly scan

• Limbs
• Normal and abnormal

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