{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,22]],"date-time":"2026-09-22T23:01:09Z","timestamp":1790118069157,"version":"4.0.1"},"reference-count":32,"publisher":"Public Library of Science (PLoS)","issue":"11","license":[{"start":{"date-parts":[[2025,11,25]],"date-time":"2025-11-25T00:00:00Z","timestamp":1764028800000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/501100000664","name":"Health Technology Assessment Programme","doi-asserted-by":"publisher","award":["HTA 17\/19\/10"],"award-info":[{"award-number":["HTA 17\/19\/10"]}],"id":[{"id":"10.13039\/501100000664","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/501100013373","name":"NIHR Oxford Biomedical Research Centre","doi-asserted-by":"publisher","id":[{"id":"10.13039\/501100013373","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["www.plosmedicine.org"],"crossmark-restriction":false},"short-container-title":["PLoS Med"],"abstract":"<jats:sec id=\"sec001\">\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Major fetal anomalies are an important cause of perinatal morbidity and mortality. While routine second-trimester ultrasound screening around 20 weeks is the current standard, advances in imaging have enabled earlier anatomical assessment in the first trimester. Despite increasing practice of early screening in England, there is no national policy recommending first-trimester anatomical evaluation, and little is known about its impact on detection rates at population level. Our aim was to examine if different policies of fetal anatomical ultrasound practice have an impact on earlier diagnosis of major fetal anomalies.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"sec002\">\n                    <jats:title>Methods and findings<\/jats:title>\n                    <jats:p>\n                      We conducted a nationwide, population-based study linking data from a national survey of first-trimester ultrasound protocols in all NHS maternity units in England with congenital anomaly registration data from the National Congenital Anomaly and Rare Disease Registration Service (NCARDRS) for pregnancies between April 2017 and March 2019. NHS trusts were classified into four protocol groups: no anatomical assessment, basic, advanced, and extended anatomical protocols. We evaluated the proportion of 14 predefined major congenital anomalies detected prior to 16 weeks\u2019 gestation across these groups. A total of 1,030,224 pregnancies were included from 110 NHS trusts (84% response rate), with 5,895 fetuses affected by one of the anomalies of interest. First-trimester anatomical assessment was routinely conducted in 75% of trusts, though the scope varied. Overall, 32.7% (95% CI 31.5\u201333.9) of anomalies were detected before 16 weeks, with detection rates increasing stepwise by protocol detail: 27.7% (95% CI 25.4\u201330.0) in trusts with no protocol to 40.4% (95% CI 37.3\u201343.4) in those with extended protocols (\n                      <jats:italic>p<\/jats:italic>\n                      \u2009&lt;\u20090.0001 for trend). Conditions such as acrania, exomphalos, and gastroschisis were commonly detected early regardless of protocol, whereas for anomalies such as spina bifida, limb reduction defects, and major cardiac malformations, detection was significantly higher in centers employing detailed first-trimester anatomical protocols. Due to data access restrictions and confidentiality considerations, analyses were conducted at the level of protocol group rather than individual hospitals. Hospital-level characteristics, including sonographer expertise and patient population risk, could not be adjusted for and may act as confounders.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"sec003\">\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>More detailed first-trimester anatomical screening protocols are associated with significantly higher early detection rates of major fetal anomalies. While current practices vary considerably across England, this study provides population-level evidence suggesting that systematic first-trimester screening could improve the timeliness of anomaly detection. These findings support the consideration of standardized national guidance to reduce inequity and enhance prenatal care.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1371\/journal.pmed.1004709","type":"journal-article","created":{"date-parts":[[2025,11,25]],"date-time":"2025-11-25T18:21:55Z","timestamp":1764094915000},"page":"e1004709","update-policy":"https:\/\/doi.org\/10.1371\/journal.pmed.corrections_policy","source":"Crossref","is-referenced-by-count":7,"title":["Impact of first-trimester ultrasound on early detection of major fetal anomalies: Nationwide population-based study of over 1 million pregnancies"],"prefix":"10.1371","volume":"22","author":[{"given":"Jehan N.","family":"Karim","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4450-2147","authenticated-orcid":true,"given":"Jennifer M.","family":"Broughan","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nicholas","family":"Aldridge","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6462-6905","authenticated-orcid":true,"given":"Pranav","family":"Pandya","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0007-4763-0666","authenticated-orcid":true,"given":"Annette","family":"McHugh","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8143-2232","authenticated-orcid":true,"given":"Aris T.","family":"Papageorghiou","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"name":"for the ACCEPTS study group","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"340","published-online":{"date-parts":[[2025,11,25]]},"reference":[{"issue":"5","key":"pmed.1004709.ref001","doi-asserted-by":"crossref","DOI":"10.1136\/adc.2008.137919","article-title":"Ultrasound structural fetal anomaly screening: an update","volume":"94","author":"S Pathak","year":"2009","journal-title":"Arch Dis Child Fetal Neonatal Ed"},{"issue":"1","key":"pmed.1004709.ref002","doi-asserted-by":"crossref","first-page":"2","DOI":"10.1258\/jms.2011.010139","article-title":"Monitoring the prenatal detection of structural fetal congenital anomalies in England and Wales: register-based study","volume":"18","author":"PA Boyd","year":"2011","journal-title":"J Med Screen"},{"key":"pmed.1004709.ref003","volume-title":"WHO recommendations on antenatal care for a positive pregnancy experience","author":"World Health Organization","year":"2016"},{"issue":"4","key":"pmed.1004709.ref004","doi-asserted-by":"crossref","first-page":"211","DOI":"10.1576\/toag.13.4.211.27685","article-title":"Fetal anomaly ultrasound scanning: the development of a national programme for England","volume":"13","author":"P Ward","year":"2011","journal-title":"Obstet Gynaecol"},{"key":"pmed.1004709.ref005","unstructured":"Antenatal care\u2014routine care for the healthy pregnant woman; 2008."},{"key":"pmed.1004709.ref006","unstructured":"Public Health England. National congenital anomaly and rare disease registration service: congenital anomaly official statistics report, 2021; 2023."},{"key":"pmed.1004709.ref007","volume-title":"First trimester ultrasound diagnosis of fetal abnormalities","author":"AZ Abuhamad","year":"2017"},{"issue":"5","key":"pmed.1004709.ref008","doi-asserted-by":"crossref","first-page":"561","DOI":"10.1016\/j.bpobgyn.2012.06.002","article-title":"Early fetal anatomical sonography","volume":"26","author":"JC Donnelly","year":"2012","journal-title":"Best Pract Res Clin Obstet Gynaecol"},{"issue":"7","key":"pmed.1004709.ref009","doi-asserted-by":"crossref","first-page":"730","DOI":"10.1002\/uog.1775","article-title":"Assessment of fetal anatomy at the 11-14-week ultrasound examination","volume":"24","author":"AP Souka","year":"2004","journal-title":"Ultrasound Obstet Gynecol"},{"issue":"6","key":"pmed.1004709.ref010","doi-asserted-by":"crossref","first-page":"675","DOI":"10.3109\/14767058.2011.587058","article-title":"Detailed fetal anatomy assessment in the first trimester at 11, 12 and 13 weeks of gestation","volume":"25","author":"C Luchi","year":"2012","journal-title":"J Matern Fetal Neonatal Med"},{"issue":"1","key":"pmed.1004709.ref011","doi-asserted-by":"crossref","first-page":"90","DOI":"10.1002\/pd.2642","article-title":"Challenges in the diagnosis of fetal non-chromosomal abnormalities at 11-13 weeks","volume":"31","author":"A Syngelaki","year":"2011","journal-title":"Prenat Diagn"},{"issue":"6","key":"pmed.1004709.ref012","doi-asserted-by":"crossref","first-page":"1160","DOI":"10.1097\/AOG.0000000000000015","article-title":"Accuracy of ultrasonography at 11-14 weeks of gestation for detection of fetal structural anomalies: a systematic review","volume":"122","author":"AC Rossi","year":"2013","journal-title":"Obstet Gynecol"},{"issue":"2","key":"pmed.1004709.ref013","doi-asserted-by":"crossref","first-page":"141","DOI":"10.1515\/jpm-2013-0130","article-title":"Evaluation of the role of first-trimester obstetric ultrasound in the detection of major anomalies: a systematic review","volume":"42","author":"S Farraposo","year":"2014","journal-title":"J Perinat Med"},{"issue":"4","key":"pmed.1004709.ref014","doi-asserted-by":"crossref","first-page":"429","DOI":"10.1002\/uog.17246","article-title":"Systematic review of first-trimester ultrasound screening for detection of fetal structural anomalies and factors that affect screening performance","volume":"50","author":"JN Karim","year":"2017","journal-title":"Ultrasound Obstet Gynecol"},{"issue":"7","key":"pmed.1004709.ref015","doi-asserted-by":"crossref","first-page":"863","DOI":"10.1515\/jpm-2022-0125","article-title":"First trimester examination of fetal anatomy: clinical practice guideline by the World Association of Perinatal Medicine (WAPM) and the Perinatal Medicine Foundation (PMF)","volume":"50","author":"N Volpe","year":"2022","journal-title":"J Perinat Med"},{"issue":"1","key":"pmed.1004709.ref016","doi-asserted-by":"crossref","first-page":"127","DOI":"10.1002\/uog.26106","article-title":"ISUOG Practice Guidelines (updated): performance of 11-14-week ultrasound scan","volume":"61","author":"International Society of Ultrasound in Obstetrics and Gynecology","year":"2023","journal-title":"Ultrasound Obstet Gynecol"},{"key":"pmed.1004709.ref017","volume-title":"Antenatal care\u2014routine care for the health pregnant woman","author":"National Collaborating Centre for Women\u2019s and Children\u2019s Health","year":"2008"},{"key":"pmed.1004709.ref018","unstructured":"UK National Screening Committee. Antenatal ultrasound screening\u2014Ultrasound Survey of England: 2002; 2005."},{"key":"pmed.1004709.ref019","article-title":"Ultrasound survey of England 2008: mapping of 1st and 2nd trimester fetal screening services in the NHS","author":"FPH Maddocks","year":"2009"},{"issue":"1","key":"pmed.1004709.ref020","doi-asserted-by":"crossref","DOI":"10.1136\/bmjopen-2023-077743","article-title":"Cohort profile: the National Congenital Anomaly Registration Dataset in England","volume":"14","author":"JM Broughan","year":"2024","journal-title":"BMJ Open"},{"issue":"1","key":"pmed.1004709.ref021","doi-asserted-by":"crossref","first-page":"51","DOI":"10.1111\/1471-0528.17287","article-title":"Detection rates of a national fetal anomaly screening programme: a national cohort study","volume":"130","author":"N Aldridge","year":"2023","journal-title":"BJOG"},{"key":"pmed.1004709.ref022","author":"EUROCAT","year":"2022"},{"issue":"5","key":"pmed.1004709.ref023","doi-asserted-by":"crossref","first-page":"449","DOI":"10.1002\/pd.4802","article-title":"Maternal attitude towards first trimester screening for fetal abnormalities","volume":"36","author":"N Maiz","year":"2016","journal-title":"Prenat Diagn"},{"issue":"1","key":"pmed.1004709.ref024","doi-asserted-by":"crossref","DOI":"10.1371\/journal.pone.0245938","article-title":"Psychological outcomes, knowledge and preferences of pregnant women on first-trimester screening for fetal structural abnormalities: a prospective cohort study","volume":"16","author":"F Bardi","year":"2021","journal-title":"PLoS One"},{"key":"pmed.1004709.ref025","article-title":"Acceptability of the first trimester anomaly scan amongst parents in the UK","volume":"128","author":"J Karim","year":"2021","journal-title":"BJOG"},{"key":"pmed.1004709.ref026","unstructured":"Department of Health and Social Care. Abortion statistics, England and Wales: 2010; May 2011. 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