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Table 4 Impact of use of routine ultrasound scanning on stillbirth and perinatal mortality

From: Reducing stillbirths: screening and monitoring during pregnancy and labour

Source Location and Type of Study Intervention Stillbirths/Perinatal Outcomes
Reviews and meta-analyses
Bricker et al. 2008 [34] New Zealand), Norway (Trondheim), Australia, UK (Peterborough), USA.
Meta-analysis (Cochrane). 8 RCTs included (N = 21,708 women).
Assessed the effects of routine ultrasound > 24 wks (intervention) vs. no/concealed/selective ultrasound > 24 wks (control). SBR: RR = 1.11 (95% CI: 0.29–4.26) [NS]
[45/10894 vs. 38/10814 in intervention vs. control groups, respectively].
PMR: R = 0.94 (95% CI: 0.55-1.64) [NS]
[79/12198 vs. 75/12078 in intervention vs. control groups, respectively.]
Neilson 1998 [31] Finland, UK, USA, Sweden, Trondheim, South Africa.
Meta-analysis (Cochrane). 8 RCTs included (N = 34,245).
Assessed the effects of routine ultrasound (intervention) vs. the selective use of ultrasound (control) in early pregnancy (i.e. < 24 wks). PMR: OR = 0.86 (95% CI: 0.67–1.12)
Intervention studies
van Dyk et al. 2007 [167] South Africa.
Open cluster RCT. Pregnant women (N = 804).
Compared the impact of ultrasound screening (intervention) vs. no ultrasound (controls). PMR: RR = 1.05 (95% CI: 0.54–2.03, P = 0.88.) [NS]
[18/416 (4.3%) vs. 16/388 (4.1%) in intervention vs. control groups, respectively].
Observational studies
Cristina et al. 2005 [168] Spain.
Retrospective (case-control) review of all obstetric ultrasounds. Pregnant patients (N = 5,987 examined by ultrasound scan at 20 wks; N = 40 cases with a single umbilical artery, N = 82 controls).
Compared the impact of having a single umbilical artery (cases) vs. not having this condition (controls) as diagnosed by ultrasound scan on PMR. PMR: 5% (2/40) among single uterine artery cases (10× greater than overall patient rate). No statistical significance data.
Mahran et al. 1992 [32] Egypt. Tertiary care setting.
Comparison of diagnostic tests. Pregnant women (N = 828), of whom a proportion had growth-restricted neonates (N = 98).
Compared the effectiveness of diagnostic ultrasound (intervention) vs. fundal palpation (controls) in predicting growth restriction. Growth restriction: 89.7% (88/98) vs. 34.7% (34/98) detection rate in ultrasound vs. fundal palpation groups, respectively.
Sylvan et al. 2005 [169] Sweden. University clinics.
Observational cohort study. Deliveries from 1985–1996; stored data (N = 209,726).
Compared the impact of routine ultrasound screening (exposed group) vs. no routine screening (unexposed) in third trimester on PMR. PMR: [NS]
[160/56,371 vs. 488/153,355 in exposed vs. unexposed, respectively.]
Viero et al. 2004 [170] Canada.
Observational study. Structurally and chromosomally normal singleton pregnancies (N = 60) with abnormal fetoplacental blood flow < 32 wks of gestation; N = 21 of these resulted in stillbirth and were delivered vaginally.
To assess the ability of grayscale placental ultrasound to detect pathological lesions in the placentas of pre-term pregnancies. SB: charts with both abnormal uterine artery Doppler and abnormal grayscale findings strongly predictive of stillbirth (17/21 SBs; sensitivity 81%, PPV 52%, P = 0.006).