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We planned to explore the impact of including studies with high levels of missing data in the overall assessment of treatment effect by using sensitivity analysis. To keep the calendar aligned to the seasons they added seven extra months in each period of 19 years, equivalent to the way we add an extra day in leap years. Financial costs also need to be considered. The lack of blinding in these studies is unlikely to affect some review outcomes such as perinatal mortality but outcomes relying on clinical judgement e.

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In the London study the results of the scan for the control group were not stored in case notes and therefore not available to outcome assessors although outcome assessors would be aware of group allocation by the presence or absence of the scan report. The early Helsinki data may have overestimated the efficiency of scans. Clinicians, health planners, and pregnant women need to decide if these results justify the expense of providing routine ultrasound examination in early pregnancy. Ultrasound scans are, however, popular - the potential enjoyment that parents can receive from seeing the image of their baby in utero is discussed elsewhere Neilson


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We have assessed methods for dealing with missing data in the included studies as: I had my first meeting in Gosford hospital and wasn't offered to do 19 weeks scan there.

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