Third-trimester ultrasound finds undetected fetal abnormalities.

By Kate Madden Yee, AuntMinnie.com staff writer

October 15, 2019 -- Almost a quarter of fetal abnormalities are identified for the first time during routine ultrasound at 35 to 37 weeks gestation, according to a study published on October 8 in Ultrasound in Obstetrics & Gynecology.

he study results suggest that ultrasound at this juncture of pregnancy could offer women and their babies needed support, wrote a team led by Dr. Alessandra Ficara of King's College Hospital in London.

"A high proportion of fetal abnormalities are detected for the first time during a routine ultrasound examination at 35 to 37 weeks gestation," the group wrote. "Such diagnosis and subsequent management, including selection of timing and place for delivery and postnatal investigations, could potentially improve postnatal outcome."

Assessing pregnancy at 35 to 37 weeks gestation with ultrasound helps predict the development of preeclampsia and plan delivery of a baby that is small or large for their gestational age, Ficara's team noted. But ultrasound can also identify abnormalities overlooked on early ultrasound exams.

To investigate this, Ficara and colleagues included data from 52,400 single-fetus pregnancies in women undergoing routine ultrasound exams between 35 and 37 weeks gestation.

All the women had also undergone ultrasound scans at 18 to 24 weeks of pregnancy; 47,214 had scans at 11 to 13 weeks as well. The team included pregnancies that resulted in live births or stillbirths but excluded those with known chromosomal abnormalities.

Overall, incidence of fetal abnormalities was 1.9%. Of these, 67.7% were diagnosed on ultrasound during the first or second trimester, but 24.8% were diagnosed for the first time at 35 to 37 weeks.

The most common abnormalities first identified on first- or second-trimester ultrasound but confirmed on third-trimester ultrasound included the following:

• Abdominal cyst or gastroschisis
• Cleft lip and palate
• Congenital pulmonary airway malformation
• Duplex kidney
• Hydronephrosis
• Polydactyl
• Talipes
• Unilateral multicystic kidney
• Unilateral renal agenesis and/or pelvic kidney
• Ventricular septal defect
• Ventriculomegaly

But a number of abnormalities were first identified on third-trimester ultrasound:

• Arachnoid cyst
• Duplex kidney
• Hydronephrosis
• Mild ventriculomegaly
• Ovarian cyst
• Ventricular septal defect

The study findings suggest that there's definitely a place for third-trimester ultrasound when it comes to improving pregnancy outcomes, according to the team.

"This study has highlighted the additional benefit of the late third-trimester scan in the detection of fetal abnormalities that were either missed at previous first- and second-trimester scans or became apparent only during the third trimester," the group concluded.

POCUS, MRI make ECRI's top 10 hazards list

By Kate Madden Yee, AuntMinnie.com staff writer

October 9, 2019 -- Point-of-care ultrasound (POCUS) and missing patient implant data for MRI exams are listed among the top 10 health technology hazards for 2020, according to a new report released October 7 by healthcare consultancy ECRI Institute.

POCUS scanners are portable, relatively inexpensive, and easy to use -- all features that have contributed to their rapid adoption into clinical practice, ECRI noted. But POCUS's speedy implementation has "outpaced policies and practices that could prevent misuse or misdiagnosis," the institute said.

Safety concerns around POCUS include using the technology inappropriately, misdiagnoses, and overdependence on portable ultrasound when a patient really needs a more comprehensive imaging exam.

"Safeguards for ensuring that POCUS users have the requisite training, experience, and skill have not kept pace with the speed of adoption," ECRI said. "The lack of sufficient oversight increases the potential that patients will be adversely affected by problems associated with use, or lack of use, of the technology."

The institute suggests that POCUS quality assurance policies should address user training and credentialing, exam documentation, and data archiving.

As for MRI, the report calls specific attention to missing patient implant data, which can put patients in danger and delay MRI exams.

"Some implants can heat, move, or malfunction when exposed to an MRI system's magnetic field," the ECRI said. "Thus, MRI staff must identify and follow any contraindications or conditions for safe scanning prescribed by the implant manufacturer."

But information about patient implants can be difficult to track down, since there is often no single place within the electronic health record (EHR) to make note of it, according to ECRI.

"Direct harm to the patient is possible if a scan is inappropriately conducted in the presence of an unidentified implant," the ECRI said. "Also, the patient's treatment can be adversely affected if a scan needs to be postponed while care providers search for implant information. Healthcare facilities should work with their EHR provider to create an implant list stored within the patient record."

Other hazardous issues on the ECRI list include surgical stapler misuse, sterile processing errors in medical and dental offices, unproven surgical robotic procedures, medication timing errors in patient EHRs, and loose nuts and bolts in medical equipment.

"[This] list identifies the potential sources of danger that we believe warrant the greatest attention for the coming year," ECRI said. "The list does not enumerate the most frequently reported problems or the ones associated with the most severe consequences -- although we do consider such information in our analysis. Rather, the list reflects our judgment about which risks should receive priority now."