Background/Objectives: Over the years, the potential of the first-trimester (FT) ultrasound in the detection of fetal structural defects has increased. The main objectives of the first-trimester fetal screening evaluation are the detection of major structural anomalies and the diagnosis of additional sonographic markers for chromosomal disorders. When a fetal anomaly is diagnosed, patients have the right to be informed about the risks, necessary interventions, or alternatives. Depending on the severity of the anomalies and the pregnancy period, the legality of the pregnancy termination was evaluated. The aim of this study was to assess the impact of the first-trimester morphological screening of the fetus using an ultrasound protocol according to the latest international protocols (the ISUOG protocol). Methods: Between 1 January 2024 and 31 December 2024, 854 pregnancies with gestational ages between 11 weeks and 13 weeks + 6 days were morphologically evaluated during the nuchal scan in the Obstetrics and Gynecology Department of the Emergency County Hospital from Craiova. Both transabdominal and transvaginal ultrasound in 2D and in a color Doppler mode were used in the scanning technique. The ultrasound findings were correlated with the genetic testing results and pregnancy outcome. The medical law implications were related to the cases where the ultrasound was performed at about 13 weeks of gestation, and the screening genetic results showed an increased pregnancy risk, which arose during the FT. In these cases, we performed amniocentesis at about 16-17 weeks of gestation, and especially, the Non-Invasive Prenatal Testing (NIPT)-positive cases were confirmed by karyotyping. Still, at this gestational age of diagnosis, the Romanian law would not allow abortions. Results: By using this extended FT ultrasound protocol, we detected 58 cases with fetal structural anomalies. Eighteen cases were also associated with genetic syndromes after performing chorionic villous sampling (CVS). Three cases detected with minor structural anomalies (two cases with club foot and one case with a cleft upper lip) were lost to follow-up. Conclusions: Fetal morphological ultrasound evaluation is feasible in the late first trimester. By using an extended ultrasound protocol, we can detect most of the fetal structural anomalies and contribute to better medical counseling and improve pregnancy outcomes.

Keywords: fetal anomalies; first trimester; ultrasound.

背景/目标：多年来，早孕期（第1孕期）超声在检测胎儿结构缺陷方面的潜力不断增加。早期妊娠胎儿筛查评估的主要目的是发现重大结构异常，并诊断额外的染色体疾病超声标记物。方法：2024年1月1日至2024年12月31日期间，在 Craiova 应急县医院妇产科，对854个妊娠期在11周到13周+6天之间的孕产妇进行了胎儿形态学筛查。使用二维和彩色多普勒模式的经腹和经阴道超声技术进行检查。将超声结果与遗传测试结果和妊娠结局相关联。结果：通过使用此扩展的第一孕期超声波协议，我们检测到58例胎儿结构异常。在进行绒毛取样（CVS）后，其中18例还与基因综合征有关。有3例仅发现轻微结构异常的案例（两例为马蹄内翻足和一例上唇裂），但这些患者后续未跟进。结论：胎儿形态学超声检查在晚期第一孕期是可行的。通过使用扩展的超声波协议，我们可以检测到大多数胎儿结构异常，并有助于更好的医疗咨询并改善妊娠结局。

关键词：胎儿异常；第1孕期；超声。