WHO Recommendation on the use of ultrasound before 24 weeks gestation

WHO Recommendation on the use of ultrasound before 24 weeks gestation

Recommendation

One ultrasound scan before 24 weeks of gestation (early ultrasound) is recommended for pregnant women to estimate gestational age, improve detection of fetal anomalies and multiple pregnancies, reduce induction of labour for post-term pregnancy, and improve a woman’s pregnancy experience

Status of the recommendation: assessed as up-to-date: November 2016

Remarks

​The benefits of an early ultrasound scan are not improved upon and cannot be replicated with a late ultrasound scan where there has not been an early ultrasound scan. Therefore, an ultrasound scan after 24 weeks of gestation (late ultrasound) is not recommended for pregnant women who have had an early ultrasound scan. However, stakeholders should consider offering a late ultrasound scan to pregnant women who have not had an early ultrasound scan, for the purposes of identifying the number of fetuses, presentation and placental location.

• The GDG noted that the effects of introducing antenatal ultrasound on population health outcomes and health systems in rural, low-resource settings are unproven. However, the introduction of ultrasound to detect pregnancy complications and confirm fetal viability to the woman and her family in these settings could plausibly increase ANC service utilization and reduce morbidity and mortality, when accompanied by appropriate gestational age estimation, diagnosis, referral and management.

• The ongoing multicountry trial that is under way should contribute further evidence on health effects, health care utilization and implementation-related information on ultrasound in rural, low-resource settings.

• The GDG acknowledged that the use of early pregnancy ultrasound has not been shown to reduce perinatal mortality. The GDG put emphasis on other benefits of ultrasound (mentioned in points above) and the increased accuracy of gestational age assessment, which would assist management in case of suspected preterm birth and reduce labour induction for post-term pregnancies.

• The GDG acknowledges that implementing and scaling up this recommendation in low-resource settings will be associated with a variety of challenges that may include political (budgeting for fees and tariffs), logistical (equipment maintenance, supplies, technical support), infrastructural (ensuring a reliable power supply and secure storage) and resources.

• The GDG noted that antenatal ultrasound is an intervention that can potentially be task shifted from trained sonographers and doctors to trained nurses, midwives and clinical officers, provided that ongoing training, staff retention, quality improvement activities and supervision are ensured.

• Stakeholders might be able to offset/reduce the cost of antenatal ultrasound if the ultrasound equipment is also used for other indications (e.g. obstetric emergencies) or by other medical departments.

• The implementation and impact of this recommendation on health outcomes, facility utilization and equity should be monitored at the health service, regional and country levels, based on clearly defined criteria and indicators associated with locally agreed targets.

• For further guidance, please refer to the WHO Manual of diagnostic ultrasound, available at: http://www.who.int/medical_devices/publications/manual_ultrasound_pack1-...

 

Evidence supporting this recommendation

Methods

Research implications

Implementation tools

 

Related links

All WHO recommendations on antenatal care

All WHO recommendations on antenatal fetal assessment

Systematic review supporting this recommendation

 

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