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Obstetrics and gynaecology
Research
Trends in resource use and effectiveness of ultrasound detection of fetal structural anomalies in France: a multiple registry-based study
  1. Clément Ferrier1,
  2. Ferdinand Dhombres1,
  3. Babak Khoshnood2,3,
  4. Hanitra Randrianaivo4,
  5. Isabelle Perthus5,
  6. Lucie Guilbaut1,
  7. Isabelle Durand-Zaleski6,7,
  8. Jean-Marie Jouannic1
  1. 1 Fetal Medicine Department, Sorbonne University, AP-HP, Armand Trousseau Hospital, Paris, France
  2. 2 INSERM U1142, LIMICS, Sorbonne University, Paris, France
  3. 3 Paris registry of congenital anomalies, Port-Royal Hospital, Paris, France
  4. 4 Reunion registry of congenital anomalies, St Pierre, Saint Pierre de la Réunion, France
  5. 5 Study center for congenital anomalies, CEMC-Auvergne, Clermont-Ferrand, France
  6. 6 INSERM CRESS UMR 1153, Paris, France
  7. 7 AP-HP, URCEco Ile de France, Hôtel-Dieu Hospital, Paris, France
  1. Correspondence to Dr Isabelle Durand-Zaleski; isabelle.durand-zaleski{at}aphp.fr

Abstract

Objective To analyse trends in the number of ultrasound examinations in relation to the effectiveness of prenatal detection of birth defects using population-based data in France.

Design A multiple registry-based study of time trends in resource use (number of ultrasounds) and effectiveness (proportion of cases prenatally diagnosed).

Setting Three registries of congenital anomalies and claims data on ultrasounds for all pregnant women in France.

Participants There were two samples of pregnant women. Effectiveness was assessed using data from three French birth defect registries. Resource use for ultrasound screening was based on the French national healthcare database.

Main outcome measures The main outcome measures were prenatal diagnosis (effectiveness) and the average number of ultrasounds (resource use). Statistical analyses included linear and logistic regression models to assess trends in resource use and effectiveness of prenatal testing, respectively.

Results The average number of ultrasound examinations per pregnancy significantly increased over the study period, from 2.47 in 2006 to 2.98 in 2014 (p=0.005). However, there was no significant increase in the odds of prenatal diagnosis. The probability of prenatal diagnosis was substantially higher for cases associated with a chromosomal anomaly (91.2%) than those without (51.8%). However, there was no evidence of an increase in prenatal detection of either over time.

Conclusions The average number of ultrasound examinations per pregnancy increased over time, whereas the probability of prenatal diagnosis of congenital anomalies did not. Hence, there is a need to implement policies such as high-quality training programmes which can improve the efficiency of ultrasound examinations for prenatal detection of congenital anomalies.

  • birth defect
  • ultrasound
  • effectiveness
  • prenatal diagnosis

This is an open access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited, appropriate credit is given, any changes made indicated, and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/.

https://doi.org/10.1136/bmjopen-2018-025482

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    Footnotes

    • Patient consent for publication Not required.

    • Contributors All authors listed on this manuscript fulfil the ICMJE criteria.CF, BK, J-MJ and ID-Z conceptualised the study and designed the analysis. FD was certified for EGB database access. CF, FD, BK, LG, HR and IP collected the data. All authors contributed to the analysis. CF, FD, BK, J-MJ, LG and ID-Z wrote the final manuscript. J-MJ and ID-Z were the guarantors of the study.

    • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

    • Competing interests None declared.

    • Ethics approval This was a time-trend observation of aggregated data provided by an analysis of anonymised individual data and did not require ethical approval. The EGB analysis, part of the SNIIRAM and property of the CNAMTS, was performed after INSERM approval and is covered by the Commission Nationale de l’Informatique et des Libertés (CNIL) (accords CNIL AT/CPZ/SVT/JB/DP/CR05222O du 14/06/2005 et DP/CR071761 du 28/08/2007).

    • Provenance and peer review Not commissioned; externally peer reviewed.

    • Data sharing statement There are no unpublished data.

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