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

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).