Controversial ultrasound findings

Meredith Rochon, Keith Eddleman

Research output: Contribution to journalReview articlepeer-review

27 Scopus citations

Abstract

This article has reviewed a few of the more controversial findings in the field of obstetric ultrasound. For each one evidence-based strategies for the management of affected pregnancies have been suggested, derived from what the authors believe is the best information available. In some cases, this information is very limited, which can make counseling these patients extremely difficult. Some physicians find using specific likelihood ratios helpful in these complex discussions. An example of the relative likelihood ratios for several markers of trisomy 21 is illustrated in Table 10 Table 10 Ultrasound criteria and likelihood ratios aa Likelihood ratio = sensitivity or false-positive rate for each as an isolated finding. assigned for the detection of trisomy 21 Finding Criteria Likelihood ratio Structural defect Cardiac defect, cystic hygroma, cerebral ventricular dilation 25 Nuchal thickening >5 mm in the anteroposterior plane 18.6 Echogenic bowel Subjectively increased, grades 2 or 35.5 Short humerus Observed or predicted ration ≤ 0.892.5 Short femur Observed or predicted ratio ≤ 0.912.2 Echogenic intracardiac focus Present 2 Renal pyelectasis >3 mm in the anteroposterior plane 1.6 Normal ultrasound None of the above abnormalities 0.4 Data from references [163,164].[163,164]. Although the management of each of the findings discussed in this article is different, a few generalizations can be made. To begin with, the detection of any abnormal finding on ultrasound should prompt an immediate detailed ultrasound evaluation of the fetus by someone experienced in the diagnosis of fetal anomalies. If there is more than one abnormal finding on ultrasound, if the patient is over the age of 35, or if the multiple marker screen is abnormal, an amniocentesis to rule out aneuploidy should be recommended. Of the six ultrasound findings reviewed here, the authors believe that only echogenic bowel as an isolated finding confers a high enough risk of aneuploidy to recommend an amniocentesis in a low-risk patient. The other findings in isolation in a low-risk patient seem to confer only a modest increased risk of aneuploidy, if any, and this risk is certainly less than the risk of unintended loss from amniocentesis. Wherever possible, modifiers of this risk, such as maternal age, history, and first and second multiple marker screening, should be used to define more clearly the true risk of aneuploidy. As obstetric ultrasound moves forward, particularly into the uncharted waters of clinical use of three- and four-dimensional ultrasound, one can expect a whole new crop of ultrasound findings with uncertain clinical significance. Clinicians are well advised to await well-designed studies to determine the clinical significance of these findings before altering clinical care.

Original languageEnglish
Pages (from-to)61-99
Number of pages39
JournalObstetrics and Gynecology Clinics of North America
Volume31
Issue number1
DOIs
StatePublished - Mar 2004

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