Early Fetal Scan: Anomaly Scan at 12-13 weeks
We believe that currently the main target of Early Fetal Scan at 12-13 weeks is screening for congenital heart defects (CHD).
15 reasons why 11-13 weeks is the best time to detect severe CHD:
- Majority of CHD are already present
- Detection rate by experts was reported as high as 85%
- Patterns of CHD are easy recognisable
- Uncomplicated scanning protocol
- It is easy to perform standardisation of the heart examination
- Diagnosis of heart anomaly can facilitate further meticulous examination and detect extra cardiac anomalies
- Parents have much more time for decision making
- Fetus lies in the best position for heat examination
- Doctors/sonographers are easy trained for early heart scan
- There is enough time for invasive testing (if needed)
- Termination of the pregnancy (in the cases of incorrectable CHD) is less traumatic comparing to 20 weeks
- There is an option of additional transvaginal (TVS) scan
- Short examination time (fast scan)
- Not need to do sophisticated technology like STIC
- Anomalies not detected at 11-13 weeks still have chance to be diagnosed at 20 weeks (two stage protocol)
London School of Ultrasound runs Annual Early Fetal Scan Conference every autumn.
The Early Fetal Scan Conference aims to raise awareness to early diagnosis and management of different fetal anomalies.
Early Fetal Scan explained
Our main aim is to raise awareness among medical professionals regarding feasibility of detection of severe fetal structural anomalies at the early beginning of fetal stage of development (from 11 weeks of pregnancy).
We believe that now it is the time of urgent change of strategy for 11-13 weeks Fetal Ultrasound Scan. In nearest future non-invasive prenatal testing (NIPT) based on cell-free fetal DNA (cffDNA) analysis will replace ultrasound-based screening for the Down’s syndrome (Combined Test). Therefore there is a desperate need to move from nuchal translucency NT measurement-based 11-13 weeks scan to early assessment of fetal anatomy and screening for structural anomalies.
We would like to introduce new type of the early fetal assessment and introduce new terminology. We hope that this term will be used by clinicians around the World, because it is very simple and exactly describe the nature of the examination.
Early Fetal Scan (EF scan) definition:
Early Fetal Scan represents a complete anatomical assessment of the early fetus at 12-13 weeks. The main aim of EF scan is screening for structural anomalies. EF scan represents systematic from top to toe anatomical review of the fetal organs with special attention to the heart and brain.
The optimal time for EF scan is 12-13 weeks of pregnancy (around 12+5 weeks). The 11 weeks (CRL below 55 mm) is suboptimal period for EF scan due to fetal developmental immaturity (especially brain), although it is possible to perform full anatomical assessment of the fetus at this stage using transvaginal approach or/and high-resolution transabdominal probes.
In the past we have used a term Early Pregnancy Anomaly Scan (EPAS) for this type of ultrasound, We have found that Early Anomaly Scan was confusing, because many clinicians have used it for 15-16 weeks fetal assessments description. Early Fetal Scan is the best description because it refers to the earliest possible time for fetal assessment (until 10 weeks the baby is an embryo, not fetus).
London School of Ultrasound is proud to be the first training organisation offering a unique educational series comprised of three Courses and a Conference on alternative approach to 11-13 weeks scan:
- Early Pregnancy Anomaly Scan (EPAS): Alternative approach to nuchal translucency (NT) scan at 11-13 weeks (August 2017).
- Early fetal echocardiography: How to detect heart defects at 11-13 weeks (November 2017).
- Early fetal neurosonography: Anomalies of brain, spine and face at 11-13 weeks (March 2018).
- 1st Early Fetal Scan Conference: 100 Anomalies (September 2018).
This approach was supported, followed and developed by many other professionals and educational bodies including ISUOG First Trimester Certificate in Singapore (October 2018).
Moving to Virtual Broadcasting in 2020. At the end of 2019 we have reviewed our clinical experience on the 1st trimester screening as well as the evidence-based knowledge and have come with the idea of a new approach combining 12 weeks anomaly scan (Early Fetal Scan) and NIPT. We have described this approach as The Early Fetal Test (EF Test). Unfortunately, we were unable to present this new concept due to lockdowns and cancellations of the scientific events in 2020 due to COVID19 pandemic.
At the beginning of pandemic London School of Ultrasound has made immediate technical adjustments and was able to start online Worldwide training as early asn in March-April 2020 (Sonoforum-Sonomarathon 2020 – 5-days Russian language project). Our first English-language virtual course (May, 2020) was EARLY FETAL TEST: 12 weeks anomaly scan and NIPT working together.
Fetal Dysmorphology Project 2020-2022 and Early Fetal Scan.
The ideas of early detection of different anomalies will be organically incorporated into this long-term ambitious project. Every specific anomaly will be reviewed regarding feasibility of 12 weeks diagnosis and if it is impossible to perform an early diagnosis we will give full explanation why. This unique feature of the Fetal Dysmorphology Project makes it very different from the other similar training events and courses.