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Open AccessArticle

Value and Diagnostic Efficacy of Fetal Morphology Assessment Using Ultrasound in a Poor-Resource Setting

1
Department of Radiology, College of Medical Sciences, University of Calabar, Calabar 540242, Nigeria
2
Department of Histopathology, College of Medical Sciences, University of Calabar, Calabar 540242, Nigeria
3
Department of Family Medicine, College of Medical Sciences, University of Calabar, Calabar 540242, Nigeria
4
Faculty of Health Sciences, The University of Sydney, Discipline of Medical Radiation Sciences, Cumberland Campus, 75 East Street, Lidcombe NSW 2141, Australia
5
Orange Medical Diagnostics, Clinical Laboratory and Research Center, Marian Road, Calabar 540222, Nigeria
*
Author to whom correspondence should be addressed.
Diagnostics 2019, 9(3), 109; https://doi.org/10.3390/diagnostics9030109
Received: 30 July 2019 / Revised: 29 August 2019 / Accepted: 29 August 2019 / Published: 1 September 2019
(This article belongs to the Section Medical Imaging)
Background: Ultrasound is operator-dependent, and its value and efficacy in fetal morphology assessment in a low-resource setting is poorly understood. We assessed the value and efficacy of fetal morphology ultrasound assessment in a Nigerian setting. Materials and Methods: We surveyed fetal morphology ultrasound performed across five facilities and followed-up each fetus to ascertain the outcome. Fetuses were surveyed in the second trimester (18th–22nd weeks) using the International Society of Ultrasound in Obstetrics and Gynecology (ISUOG) guideline. Clinical and surgical reports were used as references to assess the diagnostic efficacy of ultrasound in livebirths, and autopsy reports to confirm anomalies in terminated pregnancies, spontaneous abortions, intrauterine fetal deaths, and still births. We calculated sensitivity, specificity, positive and negative predictive values, Area under the curve (AUC), Youden index, likelihood ratios, and post-test probabilities. Results: In total, 6520 fetuses of women aged 15–46 years (mean = 31.7 years) were surveyed. The overall sensitivity, specificity, and AUC were 77.1 (95% CI: 68–84.6), 99.5 (95% CI: 99.3–99.7), and 88.3 (95% CI: 83.7–92.2), respectively. Other performance metrics were: positive predictive value, 72.4 (95% CI: 64.7–79.0), negative predictive value, 99.6 (95% CI: 99.5–99.7), and Youden index (77.1%). Abnormality prevalence was 1.67% (95% CI: 1.37–2.01), and the positive and negative likelihood ratios were 254 (95% CI: 107.7–221.4) and 0.23 (95% CI: 0.16–0.33), respectively. The post-test probability for positive test was 72% (95% CI: 65–79). Conclusion: Fetal morphology assessment is valuable in a poor economics setting, however, the variation in the diagnostic efficacy across facilities and the limitations associated with the detection of circulatory system anomalies need to be addressed. View Full-Text
Keywords: congenital anomalies; prenatal diagnosis; morphology survey; morphology ultrasound congenital anomalies; prenatal diagnosis; morphology survey; morphology ultrasound
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Ukweh, O.N.; Ugbem, T.I.; Okeke, C.M.; Ekpo, E.U. Value and Diagnostic Efficacy of Fetal Morphology Assessment Using Ultrasound in a Poor-Resource Setting. Diagnostics 2019, 9, 109.

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