Publication
Effectiveness of routine third trimester ultrasonography to reduce adverse perinatal outcomes in low risk pregnancy (the IRIS study): nationwide, pragmatic, multicentre, stepped wedge cluster randomised trial
IRIS Study Grp, Henrichs, J., Verfaille, V., Jellema, P., Viester, L., Pajkrt, E., Wilschut, J., van der Horst, H. E., Franx, A. & de Jonge, A., 15-Oct-2019, In : BMJ-British Medical Journal. 367, 13 p., 5517.Research output: Contribution to journal › Article › Academic › peer-review

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- Effectiveness of routine third trimester ultrasonography to reduce adverse perinatal outcomes in low risk pregnancy (the IRIS study) nationwide, pragmatic, multicentre, stepped wedge cluster randomised trial
Final publisher's version, 481 KB, PDF document
DOI
OBJECTIVES
To investigate the effectiveness of routine ultrasonography in the third trimester in reducing adverse perinatal outcomes in low risk pregnancies compared with usual care and the effect of this policy on maternal outcomes and obstetric interventions.
DESIGN
Pragmatic, multicentre, stepped wedge cluster randomised trial.
SETTING
60 midwifery practices in the Netherlands.
PARTICIPANTS
13 046 women aged 16 years or older with a low risk singleton pregnancy.
INTERVENTIONS
60 midwifery practices offered usual care (serial fundal height measurements with clinically indicated ultrasonography). After 3, 7, and 10 months, a third of the practices were randomised to the intervention strategy. As well as receiving usual care, women in the intervention strategy were offered two routine biometry scans at 28-30 and 34-36 weeks' gestation. The same multidisciplinary protocol for detecting and managing fetal growth restriction was used in both strategies.
MAIN OUTCOME MEASURES
The primary outcome measure was a composite of severe adverse perinatal outcomes: perinatal death, Apgar score
RESULTS
Between 1 February 2015 and 29 February 2016, 60 midwifery practices enrolled 13 520 women in mid-pregnancy (mean 22.8 (SD 2.4) weeks' gestation). 13 046 women (intervention n=7067, usual care n=5979) with data based on the national Dutch perinatal registry or hospital records were included in the analyses. Small for gestational age at birth was significantly more often detected in the intervention group than in the usual care group (179 of 556 (32%) v 78 of 407 (19%), P
CONCLUSION
In low risk pregnancies, routine ultrasonography in the third trimester along with clinically indicated ultrasonography was associated with higher antenatal detection of small for gestational age fetuses but not with a reduced incidence of severe adverse perinatal outcomes compared with usual care alone. The findings do not support routine ultrasonography
Original language | English |
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Article number | 5517 |
Number of pages | 13 |
Journal | BMJ-British Medical Journal |
Volume | 367 |
Publication status | Published - 15-Oct-2019 |
- FETAL-GROWTH RESTRICTION, BIRTH-WEIGHT, NULLIPAROUS WOMEN, MANAGEMENT, ULTRASOUND, PREDICTION, STILLBIRTH, CONSENSUS, INFANTS
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