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Systematic review of methodology used in ultrasound studies aimed at creating charts of fetal size

Background Reliable ultrasound charts are necessary for the prenatal assessment of fetal size, yet there is a wide variation of methodologies for the creation of such charts.

Objective To evaluate the methodological quality of studies of fetal biometry using a set of predefined quality criteria of study design, statistical analysis and reporting methods.

Search strategy Electronic searches in MEDLINE, EMBASE and CINAHL, and references of retrieved articles.

Selection criteria Observational studies whose primary aim was to create ultrasound size charts for bi-parietal diameter, head circumference, abdominal circumference and femur length in fetuses from singleton pregnancies.

Data collection and analysis Studies were scored against a predefined set of independently agreed methodological criteria and an overall quality score was given to each study. Multiple regression analysis between quality scores and study characteristics was performed.

Main results Eighty-three studies met the inclusion criteria. The highest potential for bias was noted in the following fields: ‘Inclusion/exclusion criteria’, as none of the studies defined a rigorous set of antenatal or fetal conditions which should be excluded from analysis; ‘Ultrasound quality control measures’, as no study demonstrated a comprehensive quality assurance strategy; and ‘Sample size calculation’, which was apparent in six studies only. On multiple regression analysis, there was a positive correlation between quality scores and year of publication: quality has improved with time, yet considerable heterogeneity in study methodology is still observed today.

Conclusions There is considerable methodological heterogeneity in studies of fetal biometry. Standardisation of methodologies is necessary in order to make correct interpretations and comparisons between different charts. A checklist of recommended methodologies is proposed.

BJOG: Ioannou C, Talbot K, Ohuma E, Sarris I, Villar J, Conde-Agudelo A, Papageorghiou A. Systematic review of methodology used in ultrasound studies aimed at creating charts of fetal size. BJOG 2012;119:1425–1439