Sage Journals: Discover world-class research

Abstract

This consensus report was developed by the 76811 Task Force, under the leadership of the American Institute of Ultrasound in Medicine (AIUM) and the Society for Maternal-Fetal Medicine (SMFM). The document was developed with the assistance of and reviewed by the American College of Obstetricians and Gynecologists (ACOG) and has been reviewed and endorsed by the AIUM, SMFM, American College of Osteopathic Obstetricians and Gynecologists (ACOOG), American College of Radiology (ACR), Society of Diagnostic Medical Sonography (SDMS), and Society of Radiologists in Ultrasound (SRU).

Initially developed for detailed ultrasound studies performed for pregnancies with increased risk of fetal anomalies, there has been little consistency in the application of the Current Procedural Terminology (CPT) code 76811 (“ultrasound, pregnant uterus, real time with image documentation, maternal evaluation plus detailed fetal anatomic examination, transabdominal, single or first gestation”) since it was first included in the 2003 edition of CPT.^1,2

On April 9, 2013, the AIUM and the SMFM hosted a meeting in New York, New York, to develop the appropriate indications for performing a detailed fetal anatomic ultrasound examination, the components of the examination, and the training required to interpret it. Participants included representatives from the AIUM, SMFM, ACOG, ACOOG, ACR, SDMS, and SRU.

Indications

The detailed fetal anatomic examination (CPT 76811) is not intended to be the routine ultrasound examination performed for all pregnancies. Rather, it is an indication-driven examination performed for a known or suspected fetal anatomic abnormality, known fetal growth disorder, genetic abnormality, or increased risk for a fetal anatomic or genetic abnormality. Thus, the performance of the detailed fetal anatomic examination should be rare outside referral practices with special expertise in the identification and diagnosis of fetal anomalies. Only one such medically indicated study per pregnancy per practice is appropriate. If one or more required structures are not adequately demonstrated during the 76811 examination, the patient may be brought back for a focused assessment (76816). A second detailed fetal anatomic survey should not be performed unless there are extenuating circumstances.

Indications for a detailed fetal anatomic examination include but are not limited to the following conditions:

Previous fetus or child with a congenital, genetic, or chromosomal abnormality³;

Known or suspected fetal anomaly or known growth disorder in the current pregnancy³;

Fetus at increased risk for a congenital anomaly, such as the following:

Maternal pregestational diabetes or gestational diabetes diagnosed before 24 weeks’ gestation⁴;

Pregnancy conceived via assisted reproductive technology⁵;

High maternal body mass index (≥35 kg/m²)^6,7;

Multiple gestation⁸;

Abnormal maternal serum analytes, including α-fetoprotein level and unconjugated estriol⁹;

Teratogen exposure¹⁰;

First-trimester nuchal translucency measurement of 3.0 mm or greater¹¹;

Fetus at increased risk for a genetic or chromosomal abnormality, such as the following:

Parental carrier of a chromosomal or genetic abnormality³;

Maternal age of 35 years or older at delivery³;

Positive screening test results for aneuploidy, including noninvasive prenatal testing³;

Soft aneuploidy marker noted on an ultrasound examination¹²;

First-trimester nuchal translucency of 3.0 mm or greater¹¹;

Other conditions affecting the fetus, including the following:

Congenital infections¹³;

Maternal drug dependence¹³;

Isoimmunization¹⁴;

Oligohydramnios¹⁵; and

Polyhydramnios.¹⁵

Table 1 includes examples of International Classification of Diseases, Ninth Revision codes associated with various indications for the 76811 examination.

Table 1.

Examples of International Classification of Diseases, Ninth Revision, Codes Associated With Various Indications for the 76811 Examination.

Code	Indication
278.01	Morbid obesity (severe obesity with a body mass index of ≥35 kg/m²)
647.43	Malaria complicating pregnancy, antepartum condition or complication
647.63	Other viral diseases complicating pregnancy, antepartum condition or complication
647.83	Other specified infectious and parasitic diseases complicating pregnancy, antepartum condition or complication
648.03	Diabetes mellitus complicating pregnancy, antepartum condition or complication
648.33	Drug dependence complicating pregnancy, antepartum condition or complication
648.53	Congenital cardiovascular disorders complicating pregnancy, antepartum condition or complication
651.03	Twin pregnancy, antepartum condition or complication
651.13	Triplet pregnancy, antepartum condition or complication
651.23	Quadruplet pregnancy, antepartum condition or complication
651.33	Twin pregnancy with fetal loss and retention of 1 fetus, antepartum condition or complication
651.43	Triplet pregnancy with fetal loss and retention of 1 or more fetus(es), antepartum condition or complication
651.53	Quadruplet pregnancy with fetal loss and retention of 1 or more fetus(es), antepartum condition or complication
653.63	Hydrocephalic fetus causing disproportion complicating pregnancy, antepartum condition or complication
653.73	Other fetal abnormality causing disproportion complicating pregnancy, antepartum condition or complication
655.03	Central nervous system malformation in fetus complicating pregnancy, antepartum condition or complication
655.13	Chromosomal abnormality in fetus complicating pregnancy, antepartum condition or complication
655.23	Hereditary disease in family possibly affecting fetus complicating pregnancy, antepartum condition or complication
655.33	Suspected damage to fetus from viral disease in mother complicating pregnancy, antepartum condition or complication
655.43	Suspected damage to fetus from other disease in mother complicating pregnancy, antepartum condition or complication
655.53	Suspected damage to fetus from drugs complicating pregnancy, antepartum condition or complication
655.63	Suspected damage to fetus from radiation complicating pregnancy, antepartum condition or complication
655.83	Other known or suspected fetal abnormality, not elsewhere classified, complicating pregnancy, antepartum condition or complication
655.93	Unspecified known or suspected fetal abnormality affecting management of mother, antepartum condition or complication
656.13	Rhesus isoimmunization complicating pregnancy, antepartum condition or complication
656.23	Isoimmunization from other and unspecified blood group incompatibility, antepartum condition or complication
656.53	Poor fetal growth complicating pregnancy, antepartum condition or complication
657.03	Polyhydramnios complicating pregnancy antepartum condition or complication
658.03	Oligohydramnios complicating pregnancy, antepartum condition or complication
659.53	Elderly primigravida complicating pregnancy, antepartum condition or complication
659.63	Elderly multigravida complicating pregnancy, antepartum condition or complication
659.73	Abnormality in fetal heart rate or rhythm, antepartum condition or complication
663.83	Other umbilical cord complications, antepartum condition or complication
665.93	Unspecified obstetric trauma, antepartum condition or complication
793.6	Nonspecific abnormal findings on radiologic and other examinations of abdominal area, including retroperitoneum
793.99	Other nonspecific abnormal findings on radiologic and other examinations of body structure
V23.81	Supervision of high-risk pregnancy of elderly primigravida
V23.82	Supervision of high-risk pregnancy of elderly multigravida
V23.85	Pregnancy resulting from assisted reproductive technology
V28.2	Other antenatal screening based on amniocentesis
V85.35–V85.45	Body mass index ≥35–70 kg/m² and over, adult

These examples are provided to assist clinicians and are not intended to be all-inclusive.

Specifications of the Examination

A detailed comprehensive fetal ultrasound examination (76811) includes, in addition to all of the components of a basic fetal ultrasound examination (76805), a detailed anatomic survey, fetal and maternal, as outlined in Table 2. Some components depend on the gestational age at the time the examination is performed. Components in Table 2 marked with a superscript footnote (^a) are performed when medically indicated.

Table 2.

Components of CPT 76811 (Basic and Detailed Examinations).

Component	Basic	Detailed
Head and neck	Lateral cerebral ventricles	Third ventricle^a,16
	Choroid plexus	Fourth ventricle^a,16
	Midline falx	Lateral ventricles^b,16
	Cavum septi pellucidi	Cerebellar lobes, vermis, and cisternamagna^b,17
	Cerebellum	Corpus callosum^a,18
	Cisterna magna	Integrity and shape of cranial vault¹⁹
		Brain parenchyma²⁰
		Neck^21,22
		Profile^23–25
Face	Upper lip	Coronal face (nose/lips/lens^a)²³
		Palate,^a maxilla, mandible, and tongue^a,26,27
		Ear position and size^a
		Orbits^a
Chest	Cardiac activity	Aortic arch
Heart and thorax	Four-chamber view	Superior and inferior vena cavae^28,29
	Left ventricular outflow tract	Three-vessel view³⁰
	Right ventricular outflow tract	Three-vessel and trachea view³⁰
		Lungs^31,32
		Integrity of diaphragm³³
		Ribs^a,34,35
Abdomen	Stomach (presence, size, and situs)	Small and large bowel^a,36–38
	Kidneys	Adrenal glands^a,39
	Urinary bladder	Gallbladder^a,40,41
	Cord insertion site into fetal abdomen	Liver^38,42
	Umbilical cord vessel number	Renal arteries^a,43
		Spleen^a,42
		Integrity of abdominal wall^b,44
Spine	Cervical	Integrity of spine and overlying soft tissue^b,45,46
	Thoracic	Shape and curvature^45,46
	Lumbar
	Sacral spine
Extremities	Legs	Number: architecture and position^47–51
	Arms	Hands^51–53
		Feet^51–54
		Digits: number and position^a,51,52
Genitalia	In multiple gestations	Sex^a,55
	When medically indicated
Placenta	Location	Masses^56,57
	Relationship to internal os	Placental cord insertion⁵⁸
	AppearancePlacental cord insertion (when possible)	Accessory/succenturiate lobe with location of connecting vascular supply to primary placenta^a,59,60
Standard evaluation	Fetal number
	Presentation
	Qualitative or semiqualitative estimate of amniotic fluid
Maternal anatomy	Cervix (transvaginal when indicated)
	Uterus
	Adnexa
Biometry	Adnexa	Cerebellum^a,61
	Biparietal diameter	Inner and outer orbital diameters^a,62
	Head circumference	Nuchal thickness (16–20 wk)^63–66
	Femur length	Nasal bone measurement (15–22 wk)^63–66
	Abdominal circumference	Humerus^a,63–65
	Fetal weight estimate	Ulna/radius^a
		Tibia/fibula^a

Performed when medically indicated.

Also included in the basic obstetric examination.

Qualifications to Perform and/or Interpret the Detailed Fetal Anatomic Ultrasound Examination

Performance and interpretation of a detailed fetal anatomic scan (76811) require advanced skills and knowledge and the ability to effectively communicate the findings to the patient and her referring physician. For quality assurance, the physician should obtain outcomes of anomalous cases when possible and maintain records showing the correlation between the outcomes and the sonographic findings. Detailed anatomic scans of the fetus are optimally performed in facilities that are accredited in ultrasound by organizations such as the ACR and AIUM.

Training

Physicians performing and/or interpreting detailed fetal anatomic ultrasound examinations must meet at least 1 of the following qualifying criteria:

The physicians are appropriately trained obstetricians, maternal-fetal medicine specialists, or radiologists with special expertise in fetal imaging who have acquired the appropriate knowledge and skills mentioned above. The training required to acquire those skills may include subspecialty fellowships such as maternal-fetal medicine, or fellowships of at least 1 year that include obstetric ultrasound training under the formal supervision of a qualified physician.^a

In lieu of subspecialty training, physicians can keep a log showing that they participated in the scanning and interpretation of at least 100 detailed fetal anatomic scans performed in pregnancies in which there is increased risk of a fetal anatomic or genetic abnormality, under the formal supervision of a qualified physician.^a The physicians should also be involved in the interpretation of at least 25 fetal cases with major morphologic abnormalities. This log should include a signed attestation by the supervising physician.

^aThe supervising interpreting physician must meet 1 of the 2 qualifying criteria mentioned. The supervising physician reviews, discusses, and confirms the diagnosis of the physician being supervised. The supervising interpreting physician does not have to be present at the time of the initial interpretation. However, the supervising physician must review and, if necessary, correct the final interpretation.

Maintenance of Competence

All physicians performing detailed fetal anatomic ultrasound examinations should maintain continuing competence in the interpretation and reporting of these examinations. Once qualifying criteria have been met, ongoing experience is the best method for avoiding the erosion of skills. The performance of an average of 1 or 2 detailed fetal anatomic surveys per week (100 per annum) should allow a physician to maintain competence.

Continuing Medical Education

The physician should complete 10 hours of AMA PRA Category 1 Credits in obstetric ultrasound examinations of fetal anomalies and/or other components of the detailed fetal anatomic ultrasound examination every 3 years.

Conclusions

The goal of any diagnostic medical procedure is to improve patient care. Adherence to these recommendations may promote the performance of appropriately detailed ultrasound examinations when medically indicated, improve diagnostic accuracy when interpreted by a qualified physician, and reduce excess charges and patient copayments for more expensive examinations when a complete basic examination is sufficient.

76811 Task Force Members

AIUM

Joseph Wax, MD, Cochair

ACOG

Howard Minkoff, MD

ACOOG

Anthony Johnson, DO

ACR

Beverly Coleman, MD

Deborah Levine, MD

SMFM

Andrew Helfgott, MD, Cochair

Daniel O’Keeffe, MD

SDMS

Charlotte Henningsen, MS, RT, RDMS, RVT

SRU

Carol Benson, MD

Footnotes

Authors’ Note

Reprinted with permission from the American Institute of Ultrasound in Medicine.

Declaration of Conflicting Interests

The authors declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Funding

The authors received no financial support for the research, authorship, and/or publication of this article.

References

American Medical Association: CPT Professional 2003. Chicago, IL, American Medical Association, 2003.

Copel

: At long last, a CPT change for obstetric sonography. J Ultrasound Med 2003;22:1–3.

American College of Obstetricians and Gynecologists, Committee on Practice Bulletins: ACOG Practice Bulletin No. 77: screening for fetal chromosomal abnormalities. Obstet Gynecol 2007;109:217–227.

Knight

Thornburg

Pressman

: Pregnancy outcomes in type 2 diabetic patients as compared with type 1 diabetic patients and nondiabetic controls. J Reprod Med 2012;57:379–404.

Davies

Moore

Willson

: Reproductive technologies and the risk of birth defects. N Engl J Med 2012;366:1803–1813.

Rasmussen

Chu

Kim

Schmid

Lau

: Maternal obesity and risk of neural tube defects: a metaanalysis. Am J Obstet Gynecol 2008;198:611–619.

Stothard

Tennant

Bell

Rankin

: Maternal overweight and obesity and the risk of congenital anomalies: a systematic review and meta-analysis. JAMA 2009;301:636–650.

Vink

Wapner

D’Alton

: Prenatal diagnosis in twin gestations. Semin Perinatol 2012;36:169–174.

Zarzour

Gahert

Diket

St Amant

Miller

Jr : Abnormal maternal serum alpha fetoprotein and pregnancy outcome. J Matern Fetal Med 1998;6:304–307.

10.

Brent

Beckman

Landel

: Clinical teratology. Curr Opin Pediatr 1993;5:201–211.

11.

De Dominico

Faraci

Hyseni

: Increased nuchal translucency in normal karyotype fetuses. J Prenat Med 2011;5:23–26.

12.

Breathnach

Fleming

Malone

: The second trimester genetic sonogram. Am J Med Genet Part C Semin Med Genet 2007;145C:62–72.

13.

Rasmussen

Erickson

Reef

Ross

: Teratology: from science to birth defects prevention. Birth Defects Res A Clin Mol Teratol 2009;85:82–92.

14.

Dukler

Oepkes

Seaward

Windrim

Ryan

: Noninvasive tests to predict fetal anemia: a study comparing Doppler and ultrasound parameters. Am J Obstet Gynecol 2003;188:1310–1314.

15.

Oyelese

: Placenta, umbilical cord and amniotic fluid: the not-less-important accessories. Clin Obstet Gynecol 2012;55:307–323.

16.

Wax

Bookman

Cartin

Pinette

Blackstone

: Mild fetal cerebral ventriculomegaly: diagnosis, clinical associations, and outcomes. Obstet Gynecol Surv 2003;58:407–414.

17.

Kapur

Mahony

Finch

Siebert

: Normal and abnormal anatomy of the cerebellar vermis in midgestational human fetuses. Birth Defects Res A Clin Mol Teratol 2009;85:700–709.

18.

Santo

D’Antonio

Homfray

: Counseling in fetal medicine: agenesis of the corpus callosum. Ultrasound Obstet Gynecol 2012;40:513–521.

19.

Joó

Beke

Szigeti

: Craniospinal malformations in a twelve-year fetopathological study: the efficiency of ultrasonography in view of fetopathological investigations. Early Hum Dev 2008;84:115–119.

20.

Pugash

Hendson

Dunham

Dewar

Money

Prayer

: Sonographic assessment of normal and abnormal patterns of fetal cerebral lamination. Ultrasound Obstet Gynecol 2012;40:642–651.

21.

Rauff

Kien

: Ultrasound diagnosis of fetal neck masses: a case series. Case Rep Obstet Gynecol 2013;2013:243590.

22.

Liberty

Boldes

Shen

Shaul

Cohen

Yagel

: The fetal larynx and pharynx: structure and development on two- and three-dimensional ultrasound. Ultrasound Obstet Gynecol 2013;42:140–148.

23.

McGahan

Ramos

Landry

: Multislice display of the fetal face using 3-dimensional ultrasonography. J Ultrasound Med 2008;27:1573–1581.

24.

Lee

McNie

Chaiworapongsa

: Three-dimensional ultra-sonographic presentation of micrognathia. J Ultrasound Med 2002;21:775–781.

25.

Wang

Leung

Tang

: Prenatal evaluation of facial clefts by three-dimensional extended imaging. Prenat Diagn 2007;27:722–729.

26.

Pilu

Segata

: A novel technique for visualization of the normal and cleft fetal secondary palate: angled insonation and three-dimensional ultrasound. Ultrasound Obstet Gynecol 2007;29:166–169.

27.

Wong

Tait

Pringle

: Viewing of the soft and the hard palate on routine 3-D ultrasound sweep of the fetal face: a feasibility study. Fetal Diagn Ther 2008;24:146–154.

28.

Hofstaetter

Plath

Hansmann

: Prenatal diagnosis of abnormalities of the fetal venous system. Ultrasound Obstet Gynecol 2000;15:231–241.

29.

Rollins

Acherman

Castillo

Evans

Restrepo

: Aorta larger than pulmonary artery in the fetal 3-vessel view. J Ultrasound Med 2009;28:9–12.

30.

Yagel

Arbel

Anteby

Raveh

Achiron

: The three vessels and trachea view (3VT) in fetal cardiac scanning. Ultrasound Obstet Gynecol 2002;20:340–345.

31.

Bahlmann

Merz

Hallermann

Stopfkuchen

Krämer

Hofmann

: Congenital diaphragmatic hernia: ultrasonic measurement of fetal lungs to predict pulmonary hypoplasia. Ultrasound Obstet Gynecol 1999;14:162–168.

32.

Moeglin

Talmant

Duyme

Lopez

: Fetal lung volumetry using two- and three-dimensional ultrasound. Ultrasound Obstet Gynecol 2005;25:119–127.

33.

Metkus

Filly

Stringer

Harrison

Adzick

: Sonographic predictors of survival in fetal diaphragmatic hernia. J Pediatr Surg 1996;31:148–151.

34.

Ruano

Molho

Roume

Ville

: Prenatal diagnosis of fetal skeletal dysplasias by combining two-dimensional and three-dimensional ultrasound and intrauterine three-dimensional helical computer tomography. Ultrasound Obstet Gynecol 2004;24:134–140.

35.

Dugoff

Coffin

Hobbins

: Sonographic measurement of the fetal rib cage perimeter to thoracic circumference ratio: application to prenatal diagnosis of skeletal dysplasias. Ultrasound Obstet Gynecol 1997;10:269–271.

36.

Goetzinger

Cahill

Macones

Odibo

: Echogenic bowel on second-trimester ultrasonography: evaluating the risk of adverse pregnancy outcome. Obstet Gynecol 2011;117:1341–1348.

37.

Mailath-Pokorny

Klein

Klebermass-Schrehof

Hachemian

Bettelheim

: Are fetuses with isolated echogenic bowel at higher risk for an adverse pregnancy outcome? Experiences from a tertiary referral center. Prenat Diagn 2012;32:1295–1299.

38.

McNamara

Levine

: Intraabdominal fetal echogenic masses: a practical guide to diagnosis and management. Radiographics 2005;25:633–645.

39.

van Vuuren

Damen-Elias

Stigter

: Size and volume charts of fetal kidney, renal pelvis and adrenal gland. Ultrasound Obstet Gynecol 2012;40:659–664.

40.

Shen

Rabinowitz

Yagel

Gal

: Absent gallbladder on fetal ultrasound: prenatal findings and postnatal outcome. Ultrasound Obstet Gynecol 2011;37:673–677.

41.

Duguépéroux

Scotet

Audrézet

: Nonvisualization of fetal gallbladder increases the risk of cystic fibrosis. Prenat Diagn 2012;32:21–28.

42.

Smrcek

Baschat

Germer

Gloeckner-Hofmann

Gembruch

: Fetal hydrops and hepatosplenomegaly in the second half of pregnancy: a sign of myeloproliferative disorder in fetuses with trisomy 21. Ultrasound Obstet Gynecol 2001;17:403–409.

43.

Sepulveda

Stagiannis

Flack

Fisk

: Accuracy of prenatal diagnosis of renal agenesis with color flow imaging in severe second-trimester oligohydramnios. Am J Obstet Gynecol 1995;173:1788–1792.

44.

Kuleva

Khen-Dunlop

Dumez

Ville

Salomon

: Is complex gastroschisis predictable by prenatal ultrasound? BJOG 2012;119:102– 109.

45.

Lennon

Gray

: Sensitivity and specificity of ultrasound for the detection of neural tube and ventral wall defects in a high-risk population. Obstet Gynecol 1999;94:562–566.

46.

Dashe

Twickler

Santos-Ramos

McIntire

Ramus

: Alpha-fetoprotein detection of neural tube defects and the impact of standard ultrasound. Am J Obstet Gynecol 2006;195:1623–1628.

47.

Schramm

Gloning

Minderer

: Prenatal sonographic diagnosis of skeletal dysplasias. Ultrasound Obstet Gynecol 2009;34:160–170.

48.

Dighe

Fligner

Cheng

Warren

Dubinsky

: Fetal skeletal dysplasia: an approach to diagnosis with illustrative cases. Radiographics 2008;28:1061–1077.

49.

Parilla

Leeth

Kambich

Chilis

MacGregor

: Antenatal detection of skeletal dysplasias. J Ultrasound Med 2003;22:255–258.

50.

Bowerman

: Anomalies of the fetal skeleton: sonographic findings. AJR Am J Roentgenol 1995;164:973–979.

51.

Bromley

Benacerraf

: Abnormalities of the hands and feet in the fetus: sonographic findings. AJR Am J Roentgenol 1995;165:1239–1243.

52.

Holder-Espinasse

Devisme

Thomas

: Pre- and postnatal diagnosis of limb anomalies: a series of 107 cases. Am J Med Genet A 2004;124A:417–422.

53.

Stoll

Wiesel

Queisser-Luft

Froster

Bianca

Clementi

: Evaluation of the prenatal diagnosis of limb reduction deficiencies. EUROSCAN Study Group. Prenat Diagn 2000;20:811–818.

54.

Canto

Cano

Palau

Ojeda

: Prenatal diagnosis of clubfoot in low-risk population: associated anomalies and long-term outcome. Prenat Diagn 2008;28:343–346.

55.

Lev-Toaff

Ozhan

Pretorius

Bega

Kurtz

Kuhlman

: Three-dimensional multiplanar ultrasound for fetal gender assignment: value of the mid-sagittal plane. Ultrasound Obstet Gynecol 2000;16:345–350.

56.

Sepulveda

Alcalde

Schnapp

Bravo

: Perinatal outcome after prenatal diagnosis of placental chorioangioma. Obstet Gynecol 2003;102:1028–1033.

57.

Lopriore

Sueters

Middeldorp

Klumper

Oepkes

Vandenbussche

: Twin pregnancies with two separate placental masses can still be monochorionic and have vascular anastomoses. Am J Obstet Gynecol 2006;194:804–808.

58.

Hasegawa

Matsuoka

Ichizuka

Sekizawa

Okai

: Ultrasound diagnosis and management of umbilical cord abnormalities. Taiwan J Obstet Gynecol 2009;48:23–27.

59.

Hasegawa

Farian

Nakamura

: Analysis of the ultrasonographic findings predictive of vasa previa. Prenat Diagn 2010;30:1121–1125.

60.

Gagnon

Morin

Bly

: Guidelines for management of vasa previa. J Obstet Gynaecol Can 2009;31:748–760.

61.

Malinger

Lev

Lerman-Sagie

: The fetal cerebellum: pitfalls in diagnosis and management. Prenat Diagn 2009;29:372–380.

62.

Goldstein

Tamir

Zimmer

Itskovitz-Eldor

: Growth of the fetal orbit and lens in normal pregnancies. Ultrasound Obstet Gynecol 1998;12:175–179.

63.

Bethune

: Literature review and suggested protocol for managing ultrasound soft markers for Down syndrome: thickened nuchal fold, echogenic bowel, shortened femur, shortened humerus, pyelectasis and absent or hypoplastic nasal bone. Australas Radiol 2007;51:218–225.

64.

Agathokleous

Chaveeva

Poon

LCY

Kosinski

Nicolaides

: Meta-analysis of second-trimester markers for trisomy 21. Ultrasound Obstet Gynecol 2013;41:247–261.

65.

Benacerraf

: The history of the second-trimester sonographic markers for detecting fetal Down syndrome, and their current role in obstetric practice. Prenat Diagn 2010;30:644–652.

66.

Cusick

Provenzano

Sullivan

Gallousis

Rodis

: Fetal nasal bone length in euploid and aneuploid fetuses between 11 and 20 weeks’ gestation: a prospective study. J Ultrasound Med 2004;23:1327–1333.

Consensus Report on the Detailed Fetal Anatomic Ultrasound Examination

Abstract

Indications

Specifications of the Examination

Qualifications to Perform and/or Interpret the Detailed Fetal Anatomic Ultrasound Examination

Training

Maintenance of Competence

Continuing Medical Education

Conclusions

76811 Task Force Members

Footnotes

Authors’ Note

Declaration of Conflicting Interests

Funding

References