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Practice Guidelines for Performance of the Routine Mid-Trimester Fetal Ultrasound Scan
ISUOG Prenatal Ultrasound Screening Task Force

Clinical Standards Committee The International Society of Ultrasound in Obstetrics and Gynecology (ISUOG) is a scientific organization that encourages sound clinical practices, teaching, and research for diagnostic imaging in women's health care. The ISUOGClinical Standards Committee (CSC) has a remit to develop Practice Guidelines and Consensus Statement s as educational recommendations that provide health care practitioners with a consensus -based approach for diagnostic imaging. They are intended to reflect what is considered by ISUOG to be currently the best practices at the time they were issued. Although ISUOG has made every effort to ensure thatguidelines are accurate when issued, neither the Society nor any of its employees or members accepts any liability for the consequences of any inaccurate or misleading data, opinion, or statements issued by the CSC. They are not intended to establish a legal standard of care because interpretation of the evidence that underpins the guidelines may be influenced by individual circumstances andavailable resources. Approved guidelines can be freely distributed with the permission of ISUOG (info@isuog.org).

This article has been accepted for publication in Ultrasound in Obstetrics & Gynecology and is currently being edited and typeset. Readers should note that this article has been fully refereed, but has not been through the technical editing, copy-editing and proof correction process.Wiley-Blackwell and the International Society of Ultrasound in Obstetrics and Gynecology cannot be held responsible for errors or consequences arising from the use of information contained in this article; nor do the views and opinions expressed necessarily reflect those of Wiley-Blackwell or the International Society of Ultrasound in Obstetrics and Gynecology

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INTRODUCTION:Ultrasonography is widely used for the prenatal evaluation of growth and anatomy as

well as for the management of multiple gestations. This procedure provides diagnostic findings that often facilitate the management of problems arising in later pregnancy. As an example, abnormal fetal growth is a leading cause of perinatal morbidity and mortality among both industrialized and developing countries. In2005, the World Health Organization (WHO) concluded that impaired fetal growth had many causes related to genetic factors, maternal characteristics, such as nutrition, lifestyle including smoking, age and disease; complications of pregnancy; and the physical, social and economic environment (1, 2). A mid-trimester fetal ultrasound scan serves as an important baseline against which later scans may becompared for the evaluation of growth and health. Ultrasonography can also be used to detect congenital anomalies (3-6). The Eurofetus study examined the accuracy of routine mid-trimester ultrasonographic examination in unselected populations (7). This multicenter project involved 61 obstetrical ultrasound units from 14 European countries. Over one -half (56%) of 4,615 malformations were detectedand 55% o major anomalies were identified f before 24 weeks of gestation.

Although many countries have developed local guidelines for the practice of fetal ultrasonography, there are still many areas of the world where they have not been implemented. Most countries offer at least one mid -trimester scan as part of standard prenatal care although obstetrical practice varies widely around theworld. This can be related to the availability of qualified practitioners and equipment, local medical practice, and legal cons iderations; in some countries, insurance-related cost reimbursements strongly influence how routine mid-trimester scans are implemented. Nonetheless, a WHO Study Group stated, “Worldwide, it is likely that much of the ultrasonography currently performed is carried out by...