Next thing: Material and methods

All devices in Sweden that perform ultrasound exams for maternity dating purposes had been expected to perform a web-based questionnaire. Medical care in Sweden is administered in 21 counties, and contact information for the units that are ultrasound discovered through each county’s official webpage or through individual associates.

The questionnaire included 30 concern products divided in to four proportions: 1) standard details about the responder plus the device; 2) the unit’s current medical training for maternity dating; 3) former training and modifications with time; and 4) evaluation of this precision associated with calculated gestational age and just how discrepancies between your last-menstrual-period- and ultrasound-based practices had been handled. Concerns and replies had been written in Swedish (a translated copy associated with the questionnaire can be obtained on demand). The questionnaire comprised primarily multiple-response questions but included fields that are commentary.

The questionnaire had been piloted among three other obstetricians and, after modifications, had been distributed from a web-based platform. After two reminders or in instances of invalid current email address, the study had been delivered by post.

Statistical analyses

The replies had been electronically registered or entered manually for replies by post. Analyses had been carried out making use of descriptive analytical methods in IBM SPSS Statistics version In the event that responses to multiple-response concerns did perhaps perhaps not coincide using the answers in remarks, concern was handed to information stated in remarks.

Ethical approval

The Regional Ethical Review Board in Uppsala, Sweden, authorized the research (guide quantity 2012/412, amendment authorized November 15, 2017).


The reaction price had been 79%: 38 legitimate replies, five nonresponses, and five excluded reactions (two smaller devices included in bigger devices’ reactions, two dual responses, and another blank, anonymous response). There was clearly one or more answer per county (Fig. 1). In line with the reported minimal quantity of second-trimester ultrasound exams pertaining to births per county, the lacking replies at most corresponded to 16% of total births 14.

Responders’ (n = 38) replies in regards to the wide range of second-trimester ultrasound that is routine done each year. Devices with no reply (n = 5) are represented by dashed groups

Traits of responders and ultrasound devices are presented in dining dining Table 1. There is a change from maternity dating centered on final menstrual period to second-trimester ultrasound between 1980 and 1992, centered on responses from 19 units (there have been no responses about this item through the staying 19 units, of which some failed to occur during this period period). First-trimester ultrasound assessment had been introduced since the main method in one single product, during the college center in Linkoping in 1983, where second-trimester ultrasound had been added in 2007.

In 2017, once the study ended up being done, a first-trimester ultrasound assessment had been agreed to all feamales in 19 for the 38 devices, ended up being wanted to the main ladies in 17 devices, had not been available in one product, and there is no solution from a product. Between 1997 and 2016, the estimated percentage of ultrasound maternity dating done into the trimester that is first associated with the 2nd trimester increased (Fig. 2).

Calculated portion of maternity dating ultrasound examinations done in the 1st trimester as opposed to the second trimester through the years 1997–2016 on the basis of the 19 responses since the entire time. The line that is thin an approximation of this mean portion of first-trimester maternity dating ultrasounds for every 12 months, in line with the median value for every category meaning

Thirty devices used a gestational period of 39 months + 6 days to calculate the date of distribution regarding the maternity dating and five devices utilized 40 months + 0 times. Two units had been uncertain on which gestational size had been utilized ( dining dining Table 1).

In 26 devices (68%), for at minimum component of the populace, maternity dating routines had been changed through the 2nd to very very first trimester 2008–2015. In 11 devices (29%), maternity dating had been ideally according to CRL or BPD at week 11–14, following guidelines 10. In 21 devices (55%), maternity dating had been centered on a first-trimester ultrasound just in the event that BPD had been ?21 mm (corresponding to 12 days + 3 days). In five devices (13%), maternity relationship had been constantly centered on second-trimester examinations that are ultrasound although first-trimester measurements existed. One unit had answer that is missing. CRL-based pregnancy relationship had been commented: “pregnancy dating by CRL is performed just sporadically (basic fetal place, favorable circumstances)” and “We await recommendations … our experience is the fact that CRL carries out worse”. In summary, in 26 devices (68%), first-trimester ultrasound examinations between 11 days + 0 days and 12 months + 2 times weren’t useful for maternity dating ( dining Table 2).

The adherence to maternity dating suggestions ended up being high for BPD measurements, numerous pregnancies, and reproduction that is artificial pregnancies ( dining dining Table 2). Seven devices had stopped utilizing pregnancy that is CRL-based between 2014 and 2017, as a result of information supplied at nationwide conferences in the interpretation associated with recommendations plus a noticed upsurge in postterm rates 15. One product commented that the modification ended up being made “because name of senior ultrasound specialist clarified that … guidelines are legitimate limited to BPD dimensions. ” Participants commented that the devices in Stockholm County had decided to stop CRL-based dating due to an increase that is observed postterm prices: “We, in Stockholm, agreed upon dating according to BPD ?21 mm to complete the exact same. ”

More responders would contemplate using an EDD predicated on a second-trimester in the place of first-trimester ultrasound assessment when assessment ended up being performed somewhere else.: “. The EDD are going to be used if done by a professional device and ideally with the BPD. The CRL may be appropriate if coincident aided by the measurements” that is actual. Another topic that emerged through the commentary had been the need for paperwork in certain circumstances such as for instance “unreliable assessment abroad, or whenever paperwork is inadequate”.

Nationwide tips contain no strategies for the handling of discrepancies between techniques. Nonetheless, the study concerns inquired about ultimate follow-up in cases of the discrepancy. In 21 devices (55%), a followup had been planned in the event that ultrasound-based estimate had been smaller compared to anticipated in line with the final menstrual duration by at least ? 8 to ? fourteen days (median ? 2 weeks). In six devices (16%), a followup ended up being scheduled in the event that estimate had been bigger than anticipated by at least + 12 to + 14 days (median + week or two). The time that is mean followup had been 2 weeks (range 7–21 times).

In 26 devices (68%), the management that is clinicalas an example, date for work induction) wouldn’t be suffering from a significant difference in EDD in line with the women’s self-report for the date of conception or the consequence of an optimistic ovulation test in contrast to the EDD calculated by ultrasound. Nevertheless, in six devices (16%), these details could influence medical choices.: “…clear indications that the EDD might have been set at a romantic date that had been far too late will trigger specific preparation; as an example, postterm control one week earlier. ” The responses from six devices (16%) had lacking responses. Feedback included as an example that in case there is discrepancy the system performed a “repeated ultrasound assessment to validate the EDD. ”

A few facets had been reported to impact the evaluation for the dependability for the EDD that is ultrasound-based 3). Remarks expressed views that are diverse. One product wrote: “An EDD predicated on ultrasound is regarded as legitimate within our hospital; this that is, an evaluation for the method’s precision has not been talked about if someone is dated according to guidelines…”. In comparison, another device commented: “Everyone with an important discrepancy is evaluated by a doctor ultrasound” that is using.


The responders suggested overall good adherence to the nationwide recommendations, except for very very early maternity dating according to CRL dimensions. Another choosing had been that the handling of discrepancies between options for maternity dating in medical practice diverse commonly, most likely due to the not enough tips for managing such discrepancies in the national instructions 10.

Although some devices offered a first-trimester ultrasound assessment, interestingly few devices used pregnancy dating according to that assessment. The estimated proportions of very first trimester maternity dating were comparable when compared with 2016 register-based estimates of first-trimester (36%; 7% on CRL and 29% on BPD) and second-trimester pregnancy dating (64%) 16. In as much as two-thirds associated with devices, the outcomes of the first-trimester ultrasound assessment wouldn’t be employed for maternity dating purposes in the event that fetal BPD was

Option of information and materials

The complete datasets generated and/or analyzed through the current research are perhaps perhaps not publicly accessible to protect the privacy for the responders but unidentified reactions may be made offered by the matching writer on reasonable demand.