Audit of level II scans in a tertiary center of a middle-income country (MIC)

Abstract

Context: Significant anomalies are those that are lethal or those that require prolonged follow-up and unaffordable treatments. Detection of these anomalies allows early termination or the support systems necessary for pregnancies with these diagnoses. Anxiety associated with overdiagnosis makes the woman a victim of modern imaging technology. However, accurate detection of significant anomalies in a busy scan room of a developing country with the need to cater to large numbers is particularly challenging. Aims: The aim was to audit the diagnostic accuracy in a busy scan room. Settings and Design: Retrospective cohort in a tertiary center. Methods and Materials: Audit of significant anomalies identified at the 20-week scan was performed after the expected date of confinement. Anomalies that were missed or overdiagnosed were noted. Statistical Analysis Used: All the categorical variables in this research were summarized using counts and percentages. Results: Twenty-eight thousand women underwent morphology ultrasound during the study period. 963 (3.4%) women were detected to have anomalies at birth. Multiple anomalies were seen in 285 (30%) cases and isolated ones in 678 (70%) cases. Anomalies of the genitourinary system were the commonest followed by the anomalies of central nervous system. Only 53 (0.2%) anomalies were missed. They were mainly syndromes and anomalies of the cardiovascular system. The most significant anomalies that were identified could be diagnosed with a basic ultrasound machine. Conclusions: 910/963 (95%) of significant anomalies can be identified even in busy centers if a systematic assessment approach is ensured.

Keywords

• congenital anomalies
• detection of anomalies
• level-ii ultrasound
• missed diagnosis
• morphology scan