Ultrasonography In Early Pregnancy Research Articles

Evaluation of Retained Products of Conception (RPOC) By Ultrasonography in Early Pregnancy Abortion (5weeks 10 Weeks)

This is a retrospective study which was conducted from January 2016 to January 2018. The aim of this study is to evaluate the Retained products of conception findings by Ultrasonography in early pregnancy ( 5 weeks to 10 weeks) abortion. Different Biomarkers of many authors & research papers were taken in guidance of our study. Out of total 120 cases 55 % was utero-vaginal bleeding with pain who presented clinically at our centre. After USG evaluation it was found that 48.3% was having intracavitary mass with vascularity and 30 % was having only intracavitary mass. 53.3 % was in the gestational age of 9 weeks to 10 weeks of duration of pregnancy. So it is concluded that after evaluation by USG if there is both intracavitary mass & vascularity within the endometrium, then the possibility of RPOC detection accuracy is more.

Late diagnosis of a cesarean scar pregnancy: Rare form of an ectopic pregnancy case

Caesarean scar pregnancy (CSP) is a rare form of ectopic pregnancy, which occurs with the placement of pregnancy to the defective myometrium area in the old cesarean scar. The incidence of CSP has been increasing in recent years because of the increasing cesarean rates and the more frequent use of transvaginal ultrasonography in early pregnancy all over the world. We present here our clinical approach in the cesarean scar pregnancy diagnosed at the 14th week of pregnancy at the age of 39, who had previously undergone 3 cesarean section operations.

Sirenomelia: A Rare Congenital Anomaly

ABSTRACTIntroductionSirenomelia is a congenital structural anomaly characterized by abnormal development of the caudal region of the body. The peculiar characteristics of sirenomelia are complete fusion of bilateral lower limbs giving the fetus an appearance of mermaid. The other anatomical defects may be renal agenesis, gastrointestinal defects, and absent external genitalia. The outcome of the condition is usually fatal for the baby despite attempts for corrective surgery. This abnormality was initially confused with caudal regression syndrome, but later was given a new name, i.e., sirenomelia mermaid syndrome.Case reportWe present a case of a 23-year-old primigravida unbooked case reported at 25 weeks 6 days period of gestation with complaint of decreased fetal movements. The ultrasound was suggestive of single live intrauterine fetus of 24 weeks with severe oligohydramnios (amniotic fluid index 1–2 cm). Based on fetal magnetic resonance imaging, which revealed multiple congenital anomalies including nonvisualization of kidneys and poorly formed lower limbs, provisional diagnosis of sirenomelia with renal aplasia incompatible with life was made. She delivered a baby 943 gm with features and appearance suggestive of mermaid syndrome (sirenomelia). Patient was discharged with advice to report early in next pregnancy.ConclusionSirenomelia is a very rare disorder, with prevalence of 1 in 100,000 live births with a total of 300 cases reported until today in which 9 are from India. The precise etiology of sirenomelia is not well understood. Many theories have been proposed, but none of these is considered definitive. It is very important to diagnose this universally fatal condition by ultrasonography in early pregnancy, so that termination of pregnancy can be carried out.How to cite this articleVerma P, Bhardwaj D, Sinha SK, Heer AK. Sirenomelia: A Rare Congenital Anomaly. J South Asian Feder Obst Gynae 2017;9(3):271-273.

Gebelikte adneksiyel kitleye yaklaşım: olgu sunumu ve derleme.

Adnexal masses during pregnancy which have a wide spectrum treatment from conservative follow -up to complicated surgery have no well established approach algorithm for management. Most of these masses are asymptomatic and thanks to rutin ultrasonography in early pregnancy these lesions can be determined easily. The majority of them are benign and disappear spontaneously as pregnancy grows. But, if the mass persist, it can be challenging for physician and patient in terms of management. For all these reasons, we wanted to review the diagnosis, follow-up and recent treatment options in the light of literature inspired by a case which has reffered to our clinic with the diagnosis of adnexal mass during pregnancy.

Adverse pregnancy outcomes and long-term morbidity after early fetal hypokinesia in maternal smoking pregnancies

The aim of this study is to evaluate perinatal outcome and subsequent morbidity and neurodevelopment in 10-year-old children with fetal hypokinesia intrauterinely verified by ultrasonography in early pregnancy as a pattern of abnormal fetal behavior due to maternal chronic smoking. This study revealed significant global fetal hypokinesia as well as head and arm hypokinesia in early pregnancy in mothers' chronic smokers (group 3-more than 20 cigarettes a day). This retrospective study was performed in mothers and their 10-year-old children included in the study of the effect of cigarette smoking on fetal movements in early pregnancy. Perinatal outcome was assessed according to maternal data, course, and outcome of pregnancy and delivery. Data on the long-term (10 years) development and morbidity from infancy during childhood until age 10 years were obtained from the children's medical histories and medical rehabilitation records, maternal, and paternal histories. The psycholinguistic development was estimated. In group 3, there was a poor overall perinatal outcome and high rate of the bronchoconstrictive syndrome and recurrent infections, while one case of the sudden infant death syndrome. Poor school performance was recorded in five children, attention-deficit/hyperactivity disorder in four, and autism, dystonia syndrome, social maladaptation, and minimally cerebral disfunction in one child each. Retarded psycholinguistic development was found in seven children, only three of them attending speech therapy (P < 0.05). Fetal hypokinesia in early pregnancy related with maternal smoking was found to correlate with poor perinatal outcome, subsequent morbidity, and developmental impairments in 10-year-old children born to mothers smoking more than 20 cigarettes a day.

Improved Assessment of Renal Lesions in Pregnancy With Magnetic Resonance Imaging

To ascertain the potential utility of magnetic resonance imaging in providing additional clarification of those solid renal mass lesions identified at routine antenatal ultrasonography in early pregnancy and influencing the management of such lesions. We present 7 patients in whom magnetic resonance imaging was used to diagnose, stage, and monitor renal lesions detected during pregnancy. Magnetic resonance imaging provided for improved imaging of renal mass lesions identified at antenatal ultrasonography, without the use of ionizing radiation, and permitted management determined by optimal radiographic assessment of such lesions without fetal irradiation. Magnetic resonance imaging is the most appropriate method to further investigate renal masses identified at routine antenatal ultrasonography early in pregnancy.

Sonographische Diagnostik von Trophoblasterkrankungen in der Frühschwangerschaft

Gestational trophoblastic disease (GTD) is classified as a metastatic or non-metastatic lesion, furthermore, villous GTD is distinguished from non-villous GTD. Because of their higher incidence and their risk of persistent gestational trophoblastic neoplasia (pGTN), early diagnosis of molar pregnancies is of clinical importance. Advances in ultrasound (US) technology and frequent application of transvaginal sonography in early pregnancy have changed the clinical and pathological presentation of molar pregnancies. Based on US imaging and histopathological examination of products of conception, the majority of cases are diagnosed in early pregnancy, either as incidental findings or in women presenting with symptoms of miscarriage. Molar pregnancies have characteristic sonographic features which are more pronounced as pregnancy advances. In early pregnancy, overall US detection rates for molar pregnancies range between 34-56% depending on gestational age, sonographic features, histologic morphology, apparative equipment, and operator expertise. There also seems to be an intrinsic limit to US detection rates based on histomorphometric features of the hydropic villi. Thus, in early pregnancy, lack of typical sonographic features does not exclude molar pregnancy. If a condition predisposing for pGTN is not recognized at the time of evacuation, prognosis is worse. With increasing demand for medical management of miscarriages and abortions, when products of conception are usually not submitted for histological examination, sonographic assessment of the chorion is mandatory. In the case of suspicious findings, surgical management and histological examination are indicated.

Extrauterine pregnancy

Extrauterine pregnancies contribute substantially to maternal mortality in all parts of the world. The most common cause of these deaths is massive bleeding after rupture of the ectopic pregnancy. The advent of transvaginal ultrasonography in early pregnancy and the use of quantitative measurement of the &#946;-unit of human chorionic gonadotropin have revolutionized the management of this condition. These diagnostic modalities allow its early detection and, in many cases, treatment before rupture occurs. There is an ever increasing body of evidence supporting expectant, medical, and surgical management of ectopic pregnancy according to certain criteria. The indications and criteria for the different management options are described in the literature and in clear guidelines from institutions such as the Royal College of Obstetricians and Gynaecologists. Methotrexate, in a single dose protocol, is widely used in the medical management of ectopic pregnancy. Surgical therapy can be either laparoscopic or via laparotomy. Be that as it may, ruptured ectopic pregnancy will continue to present as a gynecologic emergency requiring prompt and appropriate care. Resuscitation of these patients should be an organized, systematic, and rapid process with the ultimate goal of getting them to the operating theatre in the best possible hemodynamic status. The aim of surgery should be to stop active bleeding by the most expedient method. The use of autotransfusion is well established in cardiac surgery, vascular surgery, orthopedic surgery, and trauma. Using autologous blood should be considered also in the treatment of ruptured extrauterine pregnancy when faced with massive bleeding and a need for transfusion. Despite a reduction in maternal mortality due to ectopic pregnancy in the developed world during the preceding period, it would appear that no further inroads have been made in the last two decades. In developing countries, the problem is far greater, and problems with resources and infrastructure persist. It remains a challenge to all practitioners caring for women to apply available resources and use the published evidence-based guidelines to manage these women effectively and safely.O & G Forum Vol. 17 (1) 2007: pp. 6-11

The Prevalence of Incidental Simple Ovarian Cysts ≥ 3 cm Detected by Transvaginal Sonography in Early Pregnancy

ObjectiveTo determine the prevalence of simple ovarian cysts of ≥ 3 cm diameter detected by transvaginal sonography (TVS) in a population of asymptomatic women in early pregnancy. MethodsWe conducted a retrospective review of 10 830 consecutive women presenting prior to 14 weeks’ gestational age (GA) for early dating TVS. The records of all women with simple cysts ≥ 3 cm in diameter were included. The study population was divided into five groups by GA: ≤ 6 weeks; 6.1–8 weeks; 8.1–10 weeks; 10.1–12 weeks; and 12.1–14 weeks. ResultsA simple cyst ≥ 3 cm in diameter was present in 4.9% of women at ≤ 6 weeks’ gestation, in 5.1% between 6.1 and 8 weeks, in 5.3% between 8.1 and 10 weeks, in 3.2% between 10.1. and 12 weeks, and in 1.5% between 12 and 14 weeks. Overall, a simple cyst ≥ 3 cm was present in 516 women (4.8%). Prior to 10 weeks, 5.1% had simple cysts ≥ 3 cm, dropping to 2.7% after 10 weeks, a statistically significant decrease (P < 0.0001). Between 10.1 weeks and 12 weeks, the prevalence dropped to 3.2%, and then to 1.5% in the 12.1–14 week group. ConclusionThis investigation provides reference data on the prevalence of detecting simple ovarian cysts ≥ 3 cm by TVS in an asymptomatic early pregnancy population. A progressive decline in the frequency of detecting simple ovarian cysts ≥ 3 cm begins after 10 weeks’ gestational age.

The significance of uterine notching in Doppler sonography in early pregnancy as a predictor for pathologic outcome of the pregnancy

Doppler sonography of maternal vessels as a predictor for preeclampsia is an established screening method in the second trimester. Considering the first trimester its benefit has not been conclusively proven so far. Up to now the flow pattern of maternal vessels in the first trimester has only been insufficiently characterized and documented. Thus, there are only few pieces of information concerning the predictive value of the different kinds of flow patterns during the early pregnancy as regards the pathological and physiological outcome of the pregnancy. This survey aimed at evaluating the significance and the clinical importance of Doppler sonographical examinations of the Aa. uterinae during early pregnancy. It had to be analyzed whether various perfusions can be applied as a predictive value for the specific development during the pregnancy and whether therefore a risk group for pregnancy-associated hypertension can already be detected during the early pregnancy. A non-selected collective of 104 pregnant patients was examined with Doppler sonography and retrospectively divided into a standard collective and a high-risk collective. The standard collective contained 89 patients, who in the course of their pregnancy remained without any pathological findings. Fifteen patients, who were assigned to the high-risk collective, either developed a pregnancy-induced hypertension during their pregnancy or an intrauterine fetal growth retardation. The Doppler-sonographic examination of the Aa. uterinae was applied for the first time between the 6 and 8 weeks gestation (WG), then in the 9 WG, 10 WG, 11 WG, between the 12 and 14 WG, as well as between the 20 and 24 WG. Contrary to published data, there can be traced a completely transformed flow pattern in the Aa. uterinae already during the first trimester to an increasing extent. This correlates with a positive outcome of the pregnancy. There is a definite association between pathological Doppler sonography in the first third of the pregnancy and the development of a uteroplacental insufficiency as well as a pregnancy-associated hypertension (SIH) in the further course of the pregnancy. Doppler sonography is an approved method in order to become early attentive of a reduced uterine blood flow. Applying Doppler sonographic treatment of the maternal vessels, uteroplacental insufficiency can be traced at an early stage. Pregnancies, which might develop a pregnancy-associated hypertension (SIH) or a placental insufficiency, can be detected during the early pregnancy to decrease the morbidity rate and the mortality of premature newborns. Further studies in larger collectives are necessary to obtain adequate solid datasets and to further evaluate the clinical meaning and the significance concerning pathological maternal Doppler parameters.

Ruptured extrauterine pregnancy

Extrauterine pregnancies contribute substantially to maternal mortality in all parts of the world. The most common cause of these deaths is massive bleeding after rupture of the ectopic pregnancy. The advent of transvaginal ultrasonography in early pregnancy and the use of quantitative measurement of the β-unit of human chorionic gonadotropin have revolutionized the management of this condition. These diagnostic modalities allow its early detection and, in many cases, treatment before rupture occurs. There is an ever increasing body of evidence supporting expectant, medical, and surgical management of ectopic pregnancy according to certain criteria. The indications and criteria for the different management options are described in the literature and in clear guidelines from institutions such as the Royal College of Obstetricians and Gynaecologists. Methotrexate, in a single dose protocol, is widely used in the medical management of ectopic pregnancy. Surgical therapy can be either laparoscopic or via laparotomy. Be that as it may, ruptured ectopic pregnancy will continue to present as a gynecologic emergency requiring prompt and appropriate care. Resuscitation of these patients should be an organized, systematic, and rapid process with the ultimate goal of getting them to the operating theatre in the best possible hemodynamic status. The aim of surgery should be to stop active bleeding by the most expedient method. The use of autotransfusion is well established in cardiac surgery, vascular surgery, orthopedic surgery, and trauma. Using autologous blood should be considered also in the treatment of ruptured extrauterine pregnancy when faced with massive bleeding and a need for transfusion. Advanced abdominal pregnancy is a rare condition with high perinatal and maternal morbidity and mortality. Placental management at delivery remains a dilemma. The risk of massive bleeding upon removal must be balanced against the risk of infection and other complications during the long time needed for resorption of the placenta if left in situ. Despite a reduction in maternal mortality due to ectopic pregnancy in the developed world during the preceding period, it would appear that no further inroads have been made in the last two decades. In developing countries, the problem is far greater, and problems with resources and infrastructure persist. It remains a challenge to all practitioners caring for women to apply available resources and use the published evidence-based guidelines to manage these women effectively and safely.

Learning curve in ultrasonographic screening for selected fetal structural anomalies in early pregnancy

Objective To assess the value of first trimester screening by ultrasonography in detecting structural anomalies of the fetus in a general obstetric population. Methods During 1993–1998, 20,465 consecutive pregnant women who resided in a defined geographic area participated in ultrasonographic screening for major malformations. These included anomalies of the central nervous system, urinary tract, abdominal wall, and long bones. Heart anomalies were not expected to be detected. The examinations were offered at 13–14 weeks’ gestation as part of routine maternal care and were done by specially trained midwives. The pregnancy outcomes were ascertained from obstetric and pediatric records, and the data were completed by information from the national birth and malformation registries. Results A total of 307 fetuses (1.5%) with a major malformation were found; 67 fetuses (0.3%) had noncardiac major structural defects expected to be detectable by ultrasonography in early pregnancy. Thirty-five of 67 (52%) were identified at the early scan. Sensitivity for these defects increased from 22% to 79% from the first to the last (sixth) study year ( P = .009). Conclusion In a low-risk population, adequate sensitivity in screening for major malformations by early ultrasonography can be achieved after a learning curve of 3–4 years.

Three-Dimensional Sonography for Assessment of Morphology and Vascularization of the Fetus and Placenta

To analyze the potential of three-dimensional power Doppler sonography in morphologic and functional assessment of the fetus and placenta. Review of the recent literature on three-dimensional sonography in early pregnancy and in the second and third trimester. Three-dimensional sonography plays an important role in obstetrics predominantly for assessing fetal anatomy. Multiplanar images and rotation of the object allow systematic review of anatomic structures, such as limb buds, cerebral cavities, cord insertion, stomach, and bladder. Using this modality, volumes of the gestational sac, yolk sac, and fetal organs can be obtained easily. Three-dimensional power Doppler sonography has the potential to study the intervillous and placental circulation and evaluate the development of the embryonic and fetal cardiovascular system. Three-dimensional ultrasound imaging complements pathologic and histologic evaluation of the developing embryo, giving rise to the new term "three-dimensional sonoembryology." It is evident that three-dimensional ultrasonography improves the visualization of the normal and abnormal fetal anatomy giving a realistic impression of the extent of the defects. These data are useful not only for obstetricians but also for pediatricians and pediatric surgeons.

Types of pregnancy loss in recurrent miscarriage: implications for research and clinical practice

In recurrent pregnancy loss, there is much debate about cause and association, as exact pathophysiological mechanisms have not been elucidated. The aim of this study was to assess whether recurrent pregnancy loss (RPL) patterns differ according to causal/associated conditions, suggesting differing disease processes. Following investigation, 427 women with RPL were classified into the following 'diagnostic' groups: idiopathic, oligomenorrhoea, antiphospholipid syndrome (APS) and 'possible' APS. A total of 323 subsequently conceived, and underwent serial ultrasonography in early pregnancy; of these, 87 (26.9%) miscarried, and the types of pregnancy loss for the four diagnostic groups were allocated to either embryo loss (fetal heart never seen) and fetal loss (fetal heart seen prior to pregnancy loss). Overall, there were 75 embryonic losses and 12 fetal losses. The fetal loss rates in each group were similar: idiopathic 5.1%, oligomenorrhoea 3.4%, 'possible' APS 4.9% and APS 4.8%. Serial ultrasound helps to discriminate type of pregnancy loss and demonstrates that embryo loss is more common than fetal loss. More importantly, pregnancy loss patterns do not seem to differ between diagnostic groups in a treated population. The fetal loss rate in each of the diagnostic groups is similar to that in other reported populations.

Three-dimensional ultrasonography in early pregnancy

Three-dimensional ultrasound was introduced into clinical use over a decade ago. Early attempts on three-dimensional ultrasound were primitive and limited to experimental use only. Recently, it was used as a powerful tool to display three-dimensional fetal appearance and assess normal and pathological conditions. Because of the improvement in image resolution and reconstruction speed, three-dimensional ultrasound is now more and more popular in many centers, and used commonly as an adjunct in prenatal diagnosis. Indeed, a skillful sonographer may usually make the correct diagnosis of fetal anomaly with simply two-dimensional ultrasound. Nonetheless, the situation is gradually changing, because some anomalies have been diagnosed only based on the findings of three-dimensional ultrasound. In spite of that, the application of three-dimensional ultrasound is still less discussed in early pregnancy. In this article, the authors clarify the capability of three-dimensional ultrasound in different anatomic areas, and catalog its clinical merits in the early pregnancy to date. We also present the safety guidelines for its use in the first trimester.

P10Development of cardiac size in early pregnancy

BackgroundThe relationships between measurement of cardiac circumference, obtained by transvaginal sonography in early pregnancy, and other sonar fetal parameters – crown rump length, biparietal diameter, head, toracic and abdominal circumference, femur, humerus and foot length – were analysed in order to assess the role of these variables for the identification of fetuses at risk of abnormal cardiac development.MethodsStudy population consists of 1435 euploid fetuses at 9–16 weeks of gestation. Ultrasound examinations were performed using high‐resolution apparatus (model SSA‐270 A and SSA‐340 A; Toshiba Medical Corporation, Tokyo, Japan) equipped with 5.0–7.0 MHz transvaginal probes with a maximal angle of vision of 86° and 121°, respectively. au scans were performed by the authors. Nomograms were established for cardiac circumference vs. eight sonographic parameters.ResultsCardiac circumference demonstrates to be highly correlated with abdominal circumference (r2of 0.65) with narrow confidence interval of cardiac circumference ranging from 6 to 19%.ConclusionOur results showed also a good correlation between cardiac circumference and the other variables suggesting that cardiac measurement in early pregnancy could be a screening tool for identifying fetuses at risk of disorders affecting heart growth.

Acceptability of early transvaginal or abdominal sonography in the first half of pregnancy.

To evaluate the acceptability of early transvaginal sonography by pregnant patients. A questionnaire was completed by 246 patients and the resulting data were analysed. The incidence of discomfort was higher for the transabdominal than for the transvaginal route. Moreover, the transvaginal approach in early pregnancy, when compared with other transvaginal sonographic examinations was described as more satisfactory in 95% of cases. Transvaginal sonography in early pregnancy is better tolerated than transabdominal sonography.

Clinical significance of placenta previa detected at early routine transvaginal scan.

Transvaginal ultrasonography in early pregnancy was used to determine the prevalence of placenta previa and the rate of persistence until delivery. The location of the placenta was registered systematically in 2342 pregnant women who underwent transvaginal ultrasonography at 10 to 16 weeks' gestation as a primary examination. The outcome of pregnancy as well as the presence or absence of placenta previa at delivery was noted in a total of 2158 cases. A receiver operating characteristic curve was generated for the different measurements from the edge of the placenta to the internal cervical os versus placenta previa at delivery. In 105 of the 2158 women screened in the early stages of pregnancy (4.9%) the placenta extended to or over the internal cervical os, and in 34 of 2158 patients (1.6%) the distance to the placental edge beyond the internal cervical os was equal to or greater than 14 mm. Of the eight cases of placenta previa at delivery, six (75%) were identified in our study, and two cases were missed. When a cutoff value of greater than 14 mm is used for the receiver operating characteristic curve the likelihood is 17.6% (95% confidence interval = 6.8 to 34.5) for placenta previa at delivery. Although a high percentage of false-positive results occur owing to the low prevalence at delivery, this screening procedure can identify high-risk patients who should be rescanned later in pregnancy.

NATURAL HISTORY OF FETAL SIMPLE RENAL CYSTS DETECTED IN EARLY PREGNANCY

Purpose In this 12-year prospective, longitudinal study we investigated the natural history of fetal simple renal cysts identified by ultrasonography in early pregnancy. Materials and Method A detailed sonographic examination of the fetus was performed between January 1987 and June 1998 in 29,984 consecutive pregnancies at 14 to 16 weeks of gestation. Amniocenteses and chromosomal investigations were done in all cases in which a simple renal cyst was detected in the fetus. Followup sonography was done in all cases of renal cyst during pregnancy, infancy and, when indicated, childhood. Results Simple renal cysts were diagnosed at 14 to 16 weeks of gestation in 28 fetuses (1/1,100 pregnancies, 0.09%). In 25 fetuses the cysts resolved during pregnancy. In 2 fetuses the cysts remained benign but persisted postnatally and in 1 a renal cyst that was initially defined as simple was the first sign of unilateral multicystic dysplastic kidney. Except for nonseptated cystic hygroma in 1 fetus, none of the others had associated anomalies of the urinary or other organ systems and no chromosomal anomalies. Postnatal followup in all cases revealed healthy children. Conclusions A fetal simple renal cyst can be identified by ultrasonography in early pregnancy. In the absence of associated anatomical or chromosomal abnormalities, the majority of cysts will resolve during pregnancy without any sequelae. Given the transient nature of most fetal simple renal cysts detected in early pregnancy, it is possible that these cysts represent a distinct entity within the spectrum of cystic kidney diseases.

The value of sonography in early pregnancy for the detection of fetal abnormalities in an unselected population.

To determine the value of early pregnancy sonography in detecting fetal abnormalities in an unselected obstetric population. DESIGN Prospective cross-sectional study. All women initially underwent transabdominal sonography and when the anatomical survey was considered to be incomplete, transvaginal sonography was also performed (20.1%). Nuchal translucency was measured and karyotyping was performed as appropriate. University Department of Obstetrics and Gynaecology. 6634 sequential unselected women (mean maternal age 29.9 years, range 13-50; mean gestational age 12+4 weeks, range 11+0-14+6), carrying 6443 live fetuses participated in this study. Detection rate of fetal anomalies and the associated cost per case detected in early pregnancy. The incidence of anomalous fetuses was 1.4% (92/6443) including 43 chromosomal abnormalities. The detection rate for structural abnormalities was 59.0% (37/63, 95% CI 46.5-72.4) and the specificity was 99.9% in early pregnancy. When the first and second trimester scans were combined, the detection for structural abnormalities was 81.0% (51/63, 95% CI 67.7-89.2). Seventy-eight percent (31/40) of chromosomal abnormalities (excluding three cases of XXY) were diagnosed at 11-14 weeks, either because of a nuchal translucency greater than or equal to the 99th centile for gestational age (43%; 17/40, 95% CI 27.4-60.4), or due to the presence of structural abnormalities (35%; 14/40, 95% CI 21.2-52.8). Sixty-five percent (15/23) of cases of trisomy 21 were also diagnosed either because of having a nuchal translucency greater than or equal to the 99th centile (57.0%; 13/23) or due to the presence of a structural abnormality (9.0%; 2/23). Overall, the detection rate of structurally abnormal fetuses was 59% (37/63) in early pregnancy and 81% in combination with the second trimester scan. The cost per abnormality diagnosed in early pregnancy is estimated to be pound sterling 6258 per structurally abnormal fetus, pound sterling 7470 per chromosomal abnormality and pound sterling 4453 per anomalous fetus. The majority of fetal structural and chromosomal abnormalities can be detected by sonographic screening at 11-14 weeks, but the second trimester scan should not be abandoned.