Routine-Ultraschall in der deutschen Schwangerenvorsorge: Ist die Effektivität gesichert?

Abstract

Purpose: Routine ultrasound screening is a cornerstone of antenatal care in Germany. Screening examinations are carried out decentrally by specialist obstetricians in practice. The effectiveness of this established programme can no longer be assessed in a randomised trial. We investigated the reliability of ultrasound-based antepartal diagnoses in an observational study. Material and Methods: We established the presence or absence of an antepartal diagnosis of multiple pregnancy, breech presentation, placenta praevia, post maturity, malformation or intrauterine growth retardation (IUGR) in a birth cohort of 2499 consecutive life births. We then compared antepartal diagnosis and actual birth outcome. Results: The mean number of ultrasound examinations per woman was 4.7. High antepartal detection rates were achieved for multiple pregnancy (100%) and breech presentation (97%). Detection rates were low for placenta praevia (57%), post maturity (46%), malformation (41%) and IUGR (30%). Data from the Hessian Perinatal Registry show equally low detection rates for IUGR and post maturity, and no improvement with time. Conclusion: Detection rates of important target conditions of antenatal ultrasound screening are considerably lower in clinical routine than in controlled trials. Important objectives of routine screening like detecting IUGR and malformation and decreasing the frequency of induced labour are not achieved. Where routine screening has already been established, randomised controlled trials are no longer possible. Therefore, the routine screening programme in Germany should be continually evaluated using observational studies. For this purpose, process and output indicators must be developed.