Despite the lack of evidence for its clinical effectiveness [14, 15], routine third trimester ultrasound screening is increasingly used in midwifery care in the Netherlands, which results in a considerable rise in health care costs. Bag SeriesEditorInformation A.Objectives external You can read about this part of the procedure here. Second, as recommended in the recent Cochrane review by Bricker et al. Bricker L, Medley N, Pratt JJ. <>/ProcSet[/PDF/Text/ImageB/ImageC/ImageI]/ColorSpace<>/Font<>>>/Thumb 17 0 R/MediaBox[0 0 595.276 790.866]/Annots[18 0 R 19 0 R 20 0 R 21 0 R 22 0 R 23 0 R 24 0 R 25 0 R 26 0 R 27 0 R 28 0 R 29 0 R 30 0 R 31 0 R 32 0 R 33 0 R 34 0 R 35 0 R 36 0 R 37 0 R 38 0 R 39 0 R 40 0 R 41 0 R 42 0 R 43 0 R 44 0 R 45 0 R 46 0 R 47 0 R]/Rotate 0>> Additional fetal anomalies diagnosed after two previous unremarkable ultrasound examinations. Avoidable mortality in small-for-gestational-age children in the Netherlands. http://ns.adobe.com/xap/1.0/sType/Part# Moreover, the cost-effectiveness of routine third-trimester ultrasound screening combined with ser-ial fundal height measurements and clinically indicated ultrasonography as compared to … A Guide for Third Trimester Ultrasound Scans. Introduction. Text Mirrors crossmark:MajorVersionDate 2015;6:CD001451. With 80 % power and a significance level of p < 0.05, 13,536 pregnant women should be included. The multidisciplinary recommendations for IUGR screening and management resulting from this sub-study will be incorporated in the screening and management protocol of the IRIS study. internal This analysis will be adjusted for possible clustering of observations at the level of midwifery practices and medical/biological, demographic and life-style related confounders. Whether Medicare will provide a rebate for one or more scans during this period, depends on meeting certain clinical criteria and whether an … xmpTPg Part of CrossmarkMajorVersionDate Healthcare costs will be calculated using standard costs published in the Dutch costing guidelines [28]. The results of the effectiveness and cost-effectiveness study will assist healthcare providers and policymakers in making an educated choice about whether or not introducing routine third trimester ultrasound screening in the Netherlands. Pagel et al. internal admin. 2004;79:81–91. Both the intervention group and the control group will receive the following standard elements of midwifery care: 1) serial fundal height measurements and clinically indicated ultrasonography in line with the KNOV guideline for the detection of IUGR [26]; 2) information about life-style factors that may influence fetal development, e.g., smoking and alcohol use; and 3) advice to report a reduction in fetal movements. The IRIS study is a nationwide stepped wedge cluster-randomized trial among 15,000 low-risk pregnant women receiving care at 60 midwifery practices in the Netherlands. Since not all pregnant women may be recruited exactly at 20–22 weeks of pregnancy, we decided to include a total of 15,000 pregnant women. part Gives the ORCID of an editor. However, we lack evidence for its clinical effectiveness and cost-effectiveness and information on ethical considerations of additional third trimester ultrasonography. ResourceRef doi The DOI may also be used as the dc:identifier. Cochrane Database Syst Rev. If used as a dc:identifier, the URI form should be captured, and the bare identifier should also be captured using prism:doi. Text Condon JT, Corkindale JC. 2020 Sep 21. doi: 10.1111/1471-0528.16520. Uijen AA, Schellevis FG, van den Bosch WJ. Springer Nature ORCID Schema Pharmacoeconomics. Due to this, the variation in characteristics and practice management between the clusters, i.e. Rotterdam, NL: Institute for Medical Technology Assessment, Erasmus Universiteit Rotterdam; 2013. Defining IUGR based on a certain cut-off, e.g., the lowest 10th percentile of estimated fetal weight, will probably not only lead to the detection of growth restricted fetuses but also to the classification of a group of ‘at risk fetuses’ who are constitutionally small and healthy. Hall MH, Chng PK, MacGillivray I. Royal Organization of Midwives in the Netherlands, Dutch Association of Obstetrics and Gynecology, Netherlands Organization for Health Research and Development. Midwifery 3 0 obj Conformance level of PDF/X standard The common identifier for all versions and renditions of a document. The main indications for third-trimester abortion were neurologic anomalies, multiple malformations with a normal karyotype, and chromosomal anomalies diagnosed after an abnormal routine ultrasound scan. Journal of Reproductive and Infant Psychology. If used, prism:eIssn MUST contain the ISSN of the electronic version. 10.1186/s12884-016-1104-8 BMC Pregnancy and Childbirth We expect the ICC in the IRIS study to be much more similar to 0.0003 than to 0.002 for the following two reasons. The common causes are classified as placenta previa (7%), placental abruption (13%), and other bleeding (80%), including local lesions of the lower genital tract, … Find out what to expect at your first and second trimester ultrasound appointments, what you can learn from those ultrasounds, and why you might need an ultrasound (or a few) in the third trimester. Arbortext Advanced Print Publisher 9.1.440/W Unicode Healthcare costs will include costs related to pregnancy-related healthcare use, including community midwife consultations, referrals to specialist care, ultrasound examinations, laboratory tests, CTG monitoring, hospital admission, interventions during labor, and admission to neonatal unit. This can be a position at which the document has been changed since the most recent event history (stEvt:changed). Google Scholar. California Privacy Statement, For this analysis, data of the 900 women in the random sample will be used. http://ns.adobe.com/xap/1.0/t/pg/ Pregnant women will be enrolled during months 1–12 at 20–22 weeks of gestation. name Gives the name of an author. 1. Two subsamples will be derived from the complete study population (see Fig. Ultrasound Obstet Gynecol. Trials. 2011;20:1727–36. Performing two ultrasound examinations enables detection of early and late fetal growth restriction and allows monitoring of fetal growth patterns, which may reveal decreased fetal abdominal growth velocity. Trapped Screening for fetal growth restriction with universal third trimester ultrasonography in nulliparous women in the Pregnancy Outcome Prediction (POP) study: a prospective cohort study. Incremental Cost‐Effectiveness Ratios (ICER) will be calculated by dividing the difference in healthcare costs by the difference in effects. Date when document was last modified Prenat Diagn. Routine third-trimester ultrasound detection of fetal abnormalities BJOG. identify indications for and components of the third trimester Biophysical Profile; identify physiologic changes in the cervix during 2nd and 3rd trimesters; identify specific components of the ultrasound exam that may be indicated by maternal/fetal complications VI. 1 2016-10-13T14:37:14+02:00 Hakkaart-van Roijen L, Tan SS, Bouwmans. Cost‐effectiveness acceptability curves will illustrate the probability that routine third trimester ultrasound screening for IUGR is cost‐effective (or not) as compared to CAU for a range of various ceiling ratios thereby demonstrating decision uncertainty. In many Western countries, including the Netherlands, primary midwifery and/or obstetric care mainly consist of serial fundal height assessments to monitor fetal growth patterns. Second, participating midwifery practices will offer both CAU, and later on, routine third trimester ultrasound screening. In some cases, a transvaginal ultrasound is also performed. The Author(s). SourceModified crossmark For example, parents may find this burdensome due to increased responsibility that comes with the fact that they have to choose for further examinations of the fetus (or not). PubMed Central  Identify the placental location, fetal lie and … A trans vaginal scan is usually avoided in the 3rd trimester, but it may be recommended by your doctor in case of any medical issues. Lamers LM, Stalmeier PF, McDonnell J. Krabbe PF, van Busschbach JJ: [Measuring the quality of life in economic evaluations: the Dutch EQ-5D tariff]. Murray E, Fernandes M, Fazel M, Kennedy SH, Villar J, Stein A. Finally and importantly, our trial examines the cost-effectiveness and cost-utility of routine third trimester ultrasound screening among low-risk pregnancies as compared to CAU. Text Detection of foetal growth restriction using third trimester ultrasound. DOI The IRIS Study Group: Anneloes L. van Baar; Joke Bais; Gouke J. Bonsel; Jeroen van Dillen; Noortje T.L. Nurses | Midwives, Obstetrics | Gynaecology. Achenbach TM, Rescorla LA. This large-scale nationwide stepped wedge cluster-randomized trial will provide evidence whether or not routine third trimester ultrasound screening in combination with protocolized management is clinically effective and cost-effective as compared to CAU in reducing severe adverse perinatal outcome. Burlington, VT: University of Vermont, Research Center for Children, Youth and Families; 2016. PlateNames Author information: (1)Obstetrics and Gynecology, Ultrasound Unit, University Women's Hospital of Basel, Basel, Switzerland. XMP Paged-Text adjustments you had to make to obtain good images was second to none. Intrauterine growth retardation (IUGR) is a major risk factor for perinatal mortality and morbidity. CAS  Gammeltoft T, Nguyen HT. During the 4D scan, they can continue to watch in the viewing room, or … external To examine whether routine third trimester ultrasound screening combined with subsequent protocolized management affects maternal prenatal and postnatal psychological functioning and infant neurodevelopment at age 6 and 24 months as compared to CAU and subsequent protocolized management. Minimum lectures, maximum scanning time on real patients. Ultrasound Scans for Pregnancy Test in India Through LabsAdvisor. SUA can be detected in the first trimester; however, the sensitivity and specificity are higher in the second trimester. pmid: 27737654 Specifies the types of editor information: name and ORCID of an editor. Prenat Diagn. (2011) are based on prevalence rates of neonatal mortality ranging from 1.5 % to 5.9 % indicating a higher maximum rate than the rate of severe adverse perinatal outcome expected for the IRIS study, i.e. Our sample size calculation was based on our primary dichotomous outcome, i.e. external ISSN for an electronic version of the issue in which the resource occurs. P = Proof Alfirevic Z, Stampalija T, Gyte GM. internal In practice, it refers to any bleeding that occurs from the time of viability, (i.e., 23 to 24 weeks' gestation). 2004;30:505–9. endobj (2015), the current study extends previous work by investigating the impact of routine third trimester ultrasound screening on maternal prenatal and postnatal psychological functioning and on long-term offspring neurodevelopmental outcome [14]. Integer To enhance participation of non-Dutch speaking women, the questionnaires will be translated into English. For the economic evaluation, costs will be measured from a societal perspective. Therefore, the IRIS study group decided to aim at a reduction from 1.54 % to 1.0 % in the primary outcome. Intrauterine growth retardation,Perinatal outcome,Midwifery,Third trimester ultrasonography Cost-effectiveness and cost-utility analyses will be performed. Serial ultrasound scanning in pregnancies ... scans in the third trimester, while some units did not scan high risk pregnancies at all [8]. Part Routine third trimester ultrasonography is increasingly used to detect IUGR. The cost of ultrasound screening increased from €168 in 2006 to €258 per pregnancy in 2014 (p=0.001). Usual same as prism:doi PubMed  J Matern Fetal Neonatal Med. Ank de Jonge CrossMarkDomains Specifies the types of author information: name and ORCID of an author. Fundal height: a useful screening tool for fetal growth? Utrecht, NL, Perined. pdfToolbox Data on protocol adherence will be collected via standardized forms filled out by a researcher attending several multidisciplinary case evaluations or audits in case of perinatal deaths or severe adverse perinatal outcome. IUGR is a risk factor for adverse outcomes, including perinatal death, neonatal encephalopathy, neurodevelopmental impairments in childhood, and disease in adult life [3–6]. PubMed Central  We gratefully acknowledge the contribution of the participating women and their children, midwives, obstetricians, ultra-sonographers, and staff at participating midwifery practices and hospitals in the Netherlands. URI Viaux-Savelon S, Dommergues M, Rosenblum O, Bodeau N, Aidane E, Philippon O, et al. Text 2. Google Scholar. Second Trimester. crossmark Gives the name of an editor. 2011;51:3–8. Categories. Fetal and umbilical Doppler ultrasound in normal pregnancy. internal Online ahead of print. Article  conformance Article  Petra Jellema The Dutch Institutional Review Board of the VU Medical University Center Amsterdam has approved the IRIS study (reference number: 2013.409), including sub-study A (reference number: 2013.178). issn 2014;174:35–40. ACERs increased from €9050 per case detected in 2006 to €14 580 per case detected in 2014 (p=0.001). This study received funding from the Netherlands Organization for Health Research and Development (ZonMw) in the context of the research program Pregnancy and Childbirth, grant number: 209030001. apart from ultrasonography if indicated, two routine ultrasound examinations will be performed (at 28–30 weeks and 34–36 weeks). Teacher. These sub-studies will be described in more detail later on. Medication use will be calculated using prices of the Royal Dutch Society for Pharmacy. Henriette van der Horst Second, we will compare baseline characteristics of drop-outs and completers by using independent t-tests and chi-square tests. 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