Effect of Prenatal Ultrasound Screening on Perinatal Outcome

Many clinicians advocate routine ultrasound screening during pregnancy to detect congenital anomalies, multiple-gestation pregnancies, fetal growth disorders, placental abnormalities, and errors in the estimation of gestational age. However, it is not known whether the detection of these conditions through screening leads to interventions that improve perinatal outcome. We conducted a randomized trial involving 15,151 pregnant women at low risk for perinatal problems to determine whether ultrasound screening decreased the frequency of adverse perinatal outcomes. The women randomly assigned to the ultrasound-screening group underwent one sonographic examination at 15 to 22 weeks of gestation and another at 31 to 35 weeks. The women in the control group underwent ultrasonography only for medical indications, as identified by their physicians. Adverse perinatal outcome was defined as fetal death, neonatal death, or neonatal morbidity such as intraventricular hemorrhage. The mean numbers of sonograms obtained per woman in the ultrasound-screening and control groups were 2.2 and 0.6, respectively. The rate of adverse perinatal outcome was 5.0 percent among the infants of the women in the ultrasound-screening group and 4.9 percent among the infants of the women in the control group (relative risk, 1.0; 95 percent confidence interval, 0.9 to 1.2; P = 0.85). The rates of preterm delivery and the distribution of birth weights were nearly identical in the two groups. The ultrasonographic detection of congenital anomalies had no effect on perinatal outcome. There were no significant differences between the groups in perinatal outcome in the subgroups of women with post-date pregnancies, multiple-gestation pregnancies, or infants who were small for gestational age. Screening ultrasonography did not improve perinatal outcome as compared with the selective use of ultrasonography on the basis of clinician judgment., Many clinicians advocate routine ultrasound screening of the fetus during pregnancy to detect congenital anomalies, multiple-gestation pregnancies, fetal growth disorders, and placental abnormalities and to assess fetal age¹–³. Although the detection of these conditions is enhanced by ultrasonography, a beneficial effect on perinatal outcome has not been substantiated⁴–¹². The predominantly negative findings of past studies have provoked considerable interest in the United States,²,³,¹³,¹⁴ where concern about unnecessary testing, overtreatment, and cost is growing. The National Institutes of Health Consensus Conference on Ultrasound Imaging in Pregnancy, held in 1984,¹⁵ and the American College of…