Prenatal Ultrasonographic Management of Pregnancy: Is Routine Screening Necessary?

Abstract

Objectives: The routine use of prenatal ultrasonography in all pregnancies had been of concern, especially in resource-limited developing countries. The study aims to evaluate the prenatal use of ultrasonography in our tertiary health institution to determine the cost-effectiveness and justification of routine prenatal scan in a resource-restricted environment. Patients and Methods: This was a prospective study of all cases of obstetric ultrasonography seen in the radiology department of our health institution over a one year period from January to December 2017.  The request forms and the duplicate copies of the obstetric scans were collected and stored on a safe shelf each day after work and were later analyzed to elicit information for the study. All cases of complete abortion and pseudo-cyesis were excluded. Also excluded were request forms without clear obstetric indication for example a request for pelvic or abdominopelvic scan where the patient was found to be pregnant on ultrasonography.  The data was analyzed using the IBM SPSS Statistics for Windows, Version 20. Results: A total of 550 cases were included in the study. The mean age was 32.08±4.96 years. More than 60% of the patients were within the age range of 26 years to 35 years. The most frequent indication for the prenatal scan was for routine assessment which is ultrasound scanning performed in the absence of any clinical condition. Routine scan constituted 392(71.3%) cases; this was followed by placenta localization 24 (4.4%) cases and gestational diabetes which constituted 18(3.3%) cases. Of the routine scans done 33(8.42%) were abnormal while 35 (22.15%) of the diagnostic scans were also abnormal. The commonest abnormality detected was oligohyramnios which constituted 20(29.41%) cases. Other abnormalities include uterine fibroid 14(20.59%), intrauterine fetal death 12(17.65%), abortion 10(14.71%) and placenta previa 6(8.82%). 290(52.73%) cases were done during the 3rd trimester, and of these, 38.62% were done during the 36th -38th weeks of gestation. During the first trimester, most of the scans 19(44.18%) were done at 9th and 10th weeks of gestation while second trimester scans 41(18.89%) were mainly during the 23rd and 24th weeks of gestation. Conclusion: The study showed high rate of routine ultrasound scan without justifiable clinical indication. Majority of these scans were done during the second and third trimesters which lack the benefits associated with baseline prenatal ultrasonography usually carried out in the first trimester of gestation.