Third Trimester Ultrasound Scan for Detection of Congenital Abnormalities and Associated Factors, at Abebech Gobena MCH Hospital, a Cross Sectional Study

Third Trimester Ultrasound Scan for Detection of Congenital Abnormalities and Associated Factors, at Abebech Gobena MCH Hospital, a Cross Sectional Study | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Third Trimester Ultrasound Scan for Detection of Congenital Abnormalities and Associated Factors, at Abebech Gobena MCH Hospital, a Cross Sectional Study Tesfaye Bisenebit, Ephrem Mamo, Birhanu Kebede, Eyob Gelan, Kokeb Haile This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-6304485/v1 This work is licensed under a CC BY 4.0 License Status: Under Review Version 1 posted 12 You are reading this latest preprint version Abstract Background: Congenital anomaly is a structural or functional anomaly that occurs during intrauterine life. Growing number of evidences suggest that systematic evaluation of the fetal anatomy during 3rd trimester routine scan increases detection of congenital abnormalities that have been missed in earlier scans, occurred late in gestation or progressed from previous findings. Objective: to find out the magnitude of congenital abnormalities and associated factors detected at third trimester ultrasound scan. Methods: This was a facility based cross-sectional study. Data was collected for a sample size of 490 pregnant mother using pre-tested structured questionnaire from the participants and electronic records; by two trained nurses and principal investigator. Ultrasound examinations were done by Maternal Fetal Medicine (MFM) Fellows at third trimester and suspected abnormality cases were confirmed by MFM Consultants. Data entered in to Epi Data version 4.6 & Statistical analysis made through SPSS version 29. Descriptive statistics and tables used to describe the study finding. Analysis was made using chi-square test. P value <0.05 was used to show presence of statistically significant association. Results: During the study period 490 3rd tri ultrasound scans were performed at Y12HMC/AGH. 30 congenital anomalies detected, making the prevalence 6.1%. Of these 30 anomalies 6 of them were diagnosed in the 2nd tri anatomic scan; hence, 1st time detected anomalies during the 3rd tri scan was 4.9%. The commonest organ affected by congenital anomaly detected during 3rd tri scan was Central nervous system (CNS) 9 (30%). The single most common type of congenital anomaly was Urinary Tract Dilation (UTD) 6 (20%). Congenital Pulmonary Airway Malformation (CPAM), skeletal dysplasia, diaphragmatic hernia, multi cystic dysplastic kidney disease, abdominal cyst and cleft lip and palate each contributed for two cases. Ventricular septal defect (VSD), left ventricular hypoplasia, omphalocele, dandy walker malformation and encephalocele each contributed for one anomaly. Not taking folic acid periconception (P value 0.001), medication use during early pregnancy (P value 0.006) and advanced maternal age (P value 0.019) are associated with congenital malformation. Conclusion: high prevalence of 3rd tri congenital anomaly detected in this study; CNS was the commonest organ affected by 3rd tri congenital anomaly. Not using folic acid, medication use early during pregnancy and advanced maternal age are associated with congenital malformations. Congenital anomaly Third trimester ultrasound Anatomic scan Figures Figure 1 Figure 2 1. Introduction 1.1 Background Information One of the essential components of antenatal care to a pregnant woman is ascertaining the normal development of the fetus while bearing in mind the aim of detecting congenital abnormalities, hence every pregnant woman should have at least one detailed ultrasound examination in the mid second trimester of pregnancy [1]. For detection of congenital abnormalities different professional associations recommend detailed ultrasound anatomic scanning with standardized criteria to be met during scanning by trained and skilled professional at first trimester from 11 to 14 weeks of gestation and second trimester from 18 to 24weeks [2] [3] [4]. Growing number of evidences also suggest that systematic evaluation of the fetal anatomy during 3rd trimester routine scan shall be done with additional goal of detecting congenital abnormalities that have been missed in earlier scans, occurred late in gestation or progressed from previous findings. The sensitivity of 2nd trimester ultrasound in detection of congenital abnormalities could be as high as 93%. Taking these facts in to consideration while disclosing a normal 2nd trimester anatomic scan, clients should be informed the inherent gap of the result and possibility of diagnosing congenital abnormalities in the third trimester, as 0.5 to 2% of anomalies might be diagnosed late in gestation among women who had a normal anatomic scan at 2nd trimester [5] [6] [7]. Intrauterine abnormal development may result from environmental factors, genetic factors or a combination of both that affect normal embryogenesis. These insults at the critical embryogenesis period causes altered cytogenesis, histogenesis and morphogenesis the final result being a birth defect also called congenital anomaly [8] [9]. Congenital anomaly is a structural or functional anomaly that occurs during intrauterine life that can be detected prenatally, at birth or later in life. These defects of prenatal origin result from defective embryogenesis or intrinsic abnormalities. Based on World health organization report annually, 240000 babies die within 4weeks of birth and 170000 children die with in 1month to 5years of age due to congenital anomaly worldwide [10]. Congenital anomaly is a major cause of health burden during childhood as well a significant cause of infant morbidity and mortality worldwide, particularly in developing countries [11] [12]. Affected pregnancies might end up in still birth, and those who are delivered alive almost two third of cases don’t make it past their 1st month. And most of the remaining live births need complicated post-natal care and multiple surgical interventions which has a significant psychosocial and economic burden. Despite interventions complete recovery may not be achieved resulting in variable degree of physical disabilities [13] [14] [15]. 1.2 Statement of the problem Third trimester ultrasound scan is done for ascertaining the fetal wellbeing, presentation, localization of placenta, fetal growth assessment, prediction of preeclampsia besides systematic evaluation of the fetal anatomy helps to detect congenital abnormalities [5] [6] [7]. Congenital abnormalities detected at third trimester scan might be due to the evolving nature of pregnancy where some congenital malformations appearing late in third trimester; these malformations include: skeletal dysplasia like achondroplasia, central nervous system malformations: ventriculomegaly, megalencephally, polymicrogyria, renal malformations include: pyelectasis, polycystic kidney disease [7]. The other reason for late detection of congenital malformations could be due to late occurring insults like congenital infections, hemorrhagic insults; missed malformations at second trimester routine scanning or technical factors affecting the detection accuracy of ultrasound: maternal body habitus, size of the fetus, fetal position [16] [17]. Detection for congenital abnormalities at third trimester might be distressing for the client as well as for the attending physician as it is a surprising news after a reassuring normal ultrasound report at second trimester scan. This has to be handled with vigilance without imposing blame in the accuracy of the second trimester scanner, as described above the new abnormality finding may not necessarily be failure of detection of 2nd trimester scan rather owing for multiple reasons. Knowing this avoids unnecessary distress to both client and attending physician and gives them opportunity to discuss about the implication of the findings, decide place of delivery, need of neonatal care and possible surgical management options in the post-natal period depending on the abnormality type [10] [18] [19]. Different studies revealed that congenital abnormalities are associated with different factors [20]. Having low socio-economic status, illiteracy, surface water source for drinking, pesticides exposure, drug use in the 1st and 2nd trimester, chronic illness like diabetes, having no ANC follow up, previous bad obstetric outcomes are associated with congenital abnormalities. While use of folic acid supplement was found to be protective [21] [22]. So, knowing that there is a significant percentage of congenital abnormalities being diagnosed in the 3rd trimester helps while revealing a normal 2nd trimester scan result to the client, the potential risk of late appearing abnormalities in the index pregnancy. For those diagnosed at third trimester gives opportunity for psychosocial adjustment as well as planning a head the management of pregnancy. Identifying associated factors also provides physicians to educate their clients in terms of reducing exposure to potential risk factors and promote preventive factors [7] [23] [24]. 1.3 Significance of the study Around 2 percent of pregnancies might have 3rd trimester diagnosed congenital abnormalities and having diagnosed congenital abnormalities in the 3rd trimester though it imposes a significant psychological distress to the unsuspecting parents as well as attending physicians, it has a benefit of giving time for psychosocial adjustment as well as helps to decide place of delivery, timing of delivery, post-natal care and planning a head for surgical interventions depending on the type of congenital abnormalities. So, this study with aim of determining the magnitude of congenital abnormalities and classifying the abnormalities based on affected organ involvement increases the awareness for the need of systematic anatomic evaluation of the fetus in the third trimester along with the routine 3rd trimester ultrasound scanning goals. Since there are no studies in the area regarding 3rd tri abnormalities the findings of the study would also serve as a baseline for further large-scale studies that could have impact on standardizing and integrating 3rd tri anatomic scanning in to the routine care of a pregnant woman. 2. Literature Review 2.1 Prenatal ultrasound detection of anomaly and its burden on morbidity and mortality For detection of congenital abnormalities different professional associations recommend detailed ultrasound anatomic scanning with standardized criteria to be met during scanning by trained and skilled professional at first trimester from 11 to 14 weeks of gestation and second trimester from 18 to 24weeks [2] [3] [4]. Growing number of evidences also suggest that systematic evaluation of the fetal anatomy during 3rd trimester routine scan shall be done with additional goal of detecting congenital abnormalities that have been missed in earlier scans, occurred late in gestation or progressed from previous findings. The sensitivity of 2nd trimester ultrasound in detection of congenital abnormalities could be as high as 93%. While disclosing a normal 2nd trimester anatomic scan, clients should be informed the possibility of diagnosing congenital abnormalities in the third trimester, as 0.5 to 2% of anomalies might be diagnosed late in gestation among women who had a normal anatomic scan at 2nd trimester [5] [6] [7]. Congenital anomaly is a structural or functional anomaly that occurs during intrauterine life that can be detected prenatally, at birth or later in life. These defects of prenatal origin result from defective embryogenesis or intrinsic abnormalities. Based on World health organization report annually, 240000 babies die within 4weeks of birth and 170000 children die with in 1month to 5years of age due to congenital anomaly worldwide [10]. Congenital anomaly is a major cause of health burden during childhood as well a significant cause of infant morbidity and mortality worldwide, particularly in developing countries [11] [12]. Affected pregnancies might end up in still birth, and those who are delivered alive almost two third of cases don’t make it past their 1st month. And most of the remaining live births need complicated post-natal care and multiple surgical interventions which has a significant psychosocial and economic burden. Despite interventions complete recovery may not be achieved resulting in variable degree of physical disabilities [13] [14] [15]. 2.2 Magnitude of congenital anomaly The prevalence of congenital anomaly in USA 3%, India 2.5%, UK 2 to3% and Japan 1% [25] [26] [27]. While a study in Nigeria 6.3% and pooled prevalence in Africa 2.3% [18] [19]. A systematic review of 13 studies were done and pooled prevalence of 3rd trimester anomaly was found to be 0.3% [16]. While a study done in kings’ college, UK from ultrasound done at 35 to 37weeks of gestation the prevalence of congenital anomalies was 1.9%. And for the 1st time diagnosed abnormalities in 3rd tri was 0.5% [7]. Studies done in Jimma, Bishoftu and north west Ethiopia found that the prevalence of congenital anomaly was 4.1%, 1% and 1.6% respectively [20] [22] [24]. All these variations in the prevalence of congenital anomaly can be explained by social, ecological, racial and economic influences. 2.3 Congenital anomaly types detected in 3rd trimester Congenital abnormalities detected at third trimester scan might be due to the evolving nature of pregnancy where some congenital malformations appearing late in third trimester; these malformations include: skeletal dysplasia like achondroplasia, central nervous system malformations: ventriculomegaly, megalencephally, polymicrogyria, renal malformations include: pyelectasis, polycystic kidney disease [7]. The other reason for late detection of congenital malformations could be due to late occurring insults like congenital infections, hemorrhagic insults; missed malformations at second trimester routine scanning or technical factors affecting the detection accuracy of ultrasound: maternal body habitus, size of the fetus, fetal position [16] [17]. A systematic review of 13 studies were done and the commonest 3rd trimester anomaly was genitourinary system accounting 55% of which renal pelvis dilatation was the highest; the 2nd common was central nervous system anomaly 18% of which ventriculomegaly was the highest and the 3rd common was cardiac defects [16]. In a study done in kings’ college, UK from ultrasound done at 35 to 37weeks of gestation the most common abnormalities diagnosed in the 3rd tri include: hydronephrosis, ventriculomegaly, duplex kidney, ventricular septal defect, ovarian cyst, arachnoid cyst, hematocolpus and microcephaly [7]. 2.4. Factors associated with congenital anomaly As shown in Fig. 1 below, using conceptual framework, congenital anomalies are affected by multiple factors including: sociodemographic, obstetric, environmental, genetic, chronic illness and exposure to different teratogens. A systematic review on studies done in Africa showed not taking folic acid, chronic illness, medication exposure, alcohol use and khat chewing during pregnancy were associated with congenital anomaly while a study done in Nigeria didn’t find any association in these factors with congenital anomaly [18] [19]. In a case control study in Addis Ababa and Amhara region: unidentified medication use, maternal alcohol use and chemical exposure during early pregnancy were found to be significantly associated with congenital abnormalities and folic acid use before and during pregnancy were found to be protective against congenital anomaly [21]. A study done in Jimma, chewing khat and having chronic illness during pregnancy were found to be associated with congenital abnormalities while taking folic acid supplement was protective [20]. A study done in Bishoftu, maternal age above 35, parity above 3, and low birth weight were found to be associated with congenital abnormalities and folic acid supplement was protective [22]. In a case control study in South West Ethiopia, unidentified drug use early in pregnancy, exposure to pesticides, surface water for drinking, passive smoking, having no ANC were associated with congenital abnormalities while folic acid use was found to be protective [23]. In a study in north west Ethiopia, absence of folic acid use, chronic illness, alcohol use and history of medication use during pregnancy were found to be associated with congenital abnormalities [24]. 3. Objectives 3.1 General objective: to assess the magnitude of congenital abnormalities and associated factors detected at third trimester ultrasound scan at AGH, Addis Ababa, Ethiopia. 3.2 Specific Objectives 1. To determine the magnitude of congenital abnormalities detected at third trimester ultrasound scan at AGH, Addis Ababa, Ethiopia. 2. To identify factors associated with congenital abnormalities detected at third trimester ultrasound scan at AGH, Addis Ababa, Ethiopia. 4. Methods 4.1 Study design This was a facility based cross-sectional study of third trimester ultrasound scan for detection of congenital abnormalities and associated factors. 4.2 Study setting and period The study was conducted between July 1, 2024 to December 30, 2024 at Yekatit 12 Hospital Medical College - Abebech Gobena MCH, one of the teaching hospitals under Addis Ababa city administration health bureau. Abebech Gobena MCH is an affiliate of Yekatit 12 Hospital Medical College which was established in 2021 at Lemikura sub city, Addis Ababa. It is equipped with 400 beds, including 12 labor ward beds and NICU. Since its inauguration, on average 700 to 1000 monthly deliveries were attended in the MCH. 4.3 Source population All pregnant women having ANC at Yekatit 12 Hospital Medical College - Abebech Gobena MCH. 4.4 Study population All pregnant women who had third trimester ultrasound scan during the study period. 4.4 Inclusion criteria All pregnant women who had third trimester ultrasound scan from 28weeks to 42 weeks of gestation during the study period and were willing to participate in the study included. 4.5 Exclusion Criteria Pregnant women who did not have second trimester anatomic scan ultrasound were excluded. Pregnant women who had intra uterine fetal deaths were excluded. 4.6 Sample size determination The desired sample size was determined using single population proportion formula N = [(z)2*p (1–p) /d2 Z = the value of the standard normal curve score corresponding to the given confidence interval = 1.96 (corresponding to 95% confidence level) N = desired sample size P = prevalence of congenital anomaly (major/ minor) d = the permissible Margin of error 3% from the study conducted in UK the prevalence of congenital anomaly was found to be 1.9%; using this proportion the calculated sample size was 79. Sample size calculated using associated factors S.No Factors Power % of unexposed Ratio AOR CI Sample 1 ANC visit 80 4% 1:1 3.2 95 426 2 Folic acid use 80 5% 1:1 0.036 95 420 3 Medication use 80 3.9% 1:1 4.6 95 230 4 Alcohol use 80 8.7% 1:1 2.4 95 414 5 Pesticide exposure 80 0.5% 1:1 11.48 95 446 6 Residence 80 2.3% 1:1 4.2 95 430 Among the samples calculated the largest sample size 446 was taken and considering nonresponse rate of 10%, the desired sample size was 490. 4.7 Sampling technique and procedure From the pattern for two months, weekly on average 25 third trimester ultrasound scans were made every week which gave a total of 600 scans over 6month period and the ratio to the sample size 490 was 1.2; hence, all study subjects who fulfilled the inclusion and exclusion criteria during the study period were included until the desired sample size was achieved. 4.8 Data collection procedure Data was collected using pre-tested & interviewer administered structured questionnaire ( annex 1) from the participants and electronic records. Two trained nurses filled the socio demographic, obstetric and clinical data & additional data was filled by the principal investigator from ultrasound examination findings which were done by Maternal Fetal Medicine Fellows at 28 to 42weeks and whenever there was a need for further scan on suspected abnormality, the scan was confirmed by Maternal Fetal Medicine Consultants. 4.9 Study variables Dependent variable: presence of third tri congenital abnormality. Independent variable: socio demographic characteristics: age, literacy, economic status, marital status, religion, residence Obstetric factors: parity, abortion history, history of still birth, history of congenital malformation, number of ANC visit Medical illness: diabetes, hypertension, asthma and other Drug exposure, Radiation exposure, Pesticide exposure, Herbal medication Water source Folic acid supplement Cigarette smoking, Passive smoking, Alcohol use, Khat chewing. 4.10 Data analysis Data entered in to Epi Data version 4.6 & Statistical analysis made through SPSS version 29. Frequency tables and figures were used to describe the study finding. Analysis was made using chi-square test to see the presence of association between third trimester congenital anomaly and different obstetric, medical and environmental factors. Pearson Chi-square test was used if any of the cells during analysis has no count less than five and Fisher’s Exact test were used for analysis if any of the cells has count less than five. P value < 0.05 was used to show presence of statistically significant association. Cramer’s V was included to show strength of association. 4.11 Data management / Data quality assurance 5% of the filled data was checked for accuracy by the principal investigator. The principal investigator attended random record review sessions to monitor the data collection. Abnormal ultrasound findings were rescanned by a different scanner/ MFM consultants. Frequency output and sorting were used to check missing values and outliers. Data was checked for inconsistencies or ambiguities and data cleansing was performed. 4.12 Dissemination of results Findings of the study will be presented to relevant stakeholders and will be published. 4.13 Ethical consideration Before beginning data collection, ethical clearance was obtained from Yekatit 12 Hospital Medical College (Y12HMC) Institutional Review Board in accordance with the declaration of Helsinki. At the same time, written consent was taken from each pregnant woman during the data collection period, using information sheet and consent form (annex 2). 4.14 Operational definitions Congenital anomaly – any form of structural fetal abnormality detected by prenatal ultrasound scan. Third trimester ultrasound- systematic evaluation of the fetal anatomy at 28 to 42 weeks of gestation. Severe congenital anomaly- an anomaly that can jeopardize extrauterine survival of the new born and those who survived might sustain physical and mental disability despite intervention. Mild congenital anomaly- an anomaly that doesn’t have impact on extrauterine survival and anomaly cold be corrected with intervention without having long standing mental or physical disability. 4.15 Source of Support: Y12HMC. Conflicts of Interest: None. 5. Result 5.1. prevalence, sociodemographic and obstetric characteristics. As shown in figure 2 below , during the study period from July 1 to December 30, 2024 a total of 490 third trimester ultrasound scans were performed and thirty congenital anomalies detected during the 3rd trimester scan, making the prevalence 6.1%. Of these 30 anomalies 6 of them were diagnosed in the 2nd tri anatomic scan and pregnancy was managed expectantly, making the 1st time detected anomalies during the 3rd tri scan 4.9%. As shown in table 1 below : 189 (38.6%) pregnant women were nulliparous while 301(61.4%) were parous. Of 344 pregnant women who had more than one pregnancy 127 (36.9%) mothers had history of abortion. Of the 301 women who had one or more deliveries 16 (5.3%) of them had history of still birth. Of the 490 pregnancies 466 (95.1%) were Singleton, 23 (4.7%) were twin pregnancies and there was one (0.2%) triplet pregnancy. Of the multiple gestations one of the twins had congenital anomaly. The rest 29 anomalies were among the singleton pregnancies. 476 (97.1%) pregnant mothers were married, 10 (2%) were single, 3 (0.6%) widowed and one (0.2%) divorced. 23 (4.7%) pregnant mothers had no formal education, 179 (36.5%) had primary education ,209 (42.7%) had secondary education and 79 (16.1%) had higher education. Majority of pregnant mothers 254 (51.8%) were house wives, 182 (37.1%) were self-employed ,49 (10%) were government employed and 5 (1%) were daily laborers. The mean per household monthly income was 7148 Eth Birr. Table 1: Frequency distribution of sociodemographic characteristics of study subjects at Y12HMC, Addis Ababa, 2024. Variable Number % Religion Orthodox 310 63.3 Muslim 98 20 Protestant 73 14.9 Catholic 9 1.8 Marital status Married 476 97.1 Single 10 2 Widowed 3 0.6 Divorced 1 0.2 Educational status No formal education 23 4.7 Primary education 179 36.5 Secondary education 209 42.7 Higher education 79 16.1 Occupational status House wife 254 51.8 Self employed 182 37.1 Government employed 49 10 Daily laborer 5 1 Age Age less than 35 379 77.3 35 and above 111 22.7 Parity Nulliparous 189 38.6 Parous 301 61.4 History of abortion Yes 127 36.9 No 217 63.1 History of still birth Yes 16 5.3 No 285 94.7 Number of pregnancy Single 466 95.1 Twin 23 4.7 Triplet 1 0.2 5.2. second and third trimester ultrasound scan results. As shown in table 2 below , the commonest organ system affected by congenital anomaly detected during third trimester scan was Central nervous system (CNS) 9 (30%), followed by Genito urinary system 8 (26.7%) and respiratory system 4 (13.3%). Cardiovascular system, musculoskeletal system, abdomen and face and neck each contribute for 2 (6.7%) anomalies per system. The single most common type of congenital anomaly was Urinary Tract Dilation (UTD) 6 (20%) followed by Chiari 2 malformation 4 (13.3%) and isolated ventriculomegaly 3(10%). Congenital Pulmonary Airway Malformation (CPAM), skeletal dysplasia, diaphragmatic hernia, multi cystic dysplastic kidney disease, abdominal cyst and cleft lip and palate each anomaly contributed for two cases. Besides, ventricular septal defect (VSD), left ventricular hypoplasia, omphalocele, dandy walker malformation and encephalocele each contributed for one (3.3%) anomaly. Of the 30 anomalies 20 (66.7%) of them were severe and 10 (33.3%) mild. The mild cases were: 4 (13.3%) UTDs, 2 (6.7%) cleft lip and palate, 2 (6.7%) intra-abdominal cyst and 2 (6.7%) ventriculomegaly. The 6 (20%) cases who were diagnosed in the 2nd trimester and managed expectantly include: 3 UTDs (10%), 2 CPAM 6.7%) and one (3.3%) cleft lip and palate. 3 (10%) fetuses had multiple congenital anomalies. The commonest organ involved in multiple malformation was CNS, where 2 out of the 3 cases of multiple malformation had CNS anomaly (enlarged cisterna magna). The other organs involved in multiple malformations were: cardio vascular system (VSD), skeletal system (upper limb hypoplasia), abdominal wall defect (omphalocele), respiratory system (diaphragmatic hernia) and cord cyst. Table 2: Frequency distribution of third trimester congenital anomaly by organ system, Y12HMC, Addis Ababa, 2024. Variable Number % Central nervous system Chiari 2 malformation 4 0.8 Ventriculomegaly 3 0.6 Encephalocele 1 0.2 Dandy walker malformation 1 0.2 Genitourinary system Urinary tract dilation 6 1.2 Multi cystic dysplastic kidney disease 2 0.4 Cardiovascular system Ventricular septal defect with cord cyst and enlarged cisterna magna 1 0.2 Left ventricle hypoplasia 1 0.2 Respiratory system Congenital pulmonary airway malformation 2 0.4 Diaphragmatic hernia 1 0.2 Diaphragmatic hernia with upper limb hypoplasia 1 0.2 Abdomen Intraabdominal cyst 2 0.4 Abdominal wall Omphalocele with enlarged cisterna magna 1 0.2 Musculoskeletal Skeletal dysplasia 2 0.4 Face and neck Cleft lip and palate 2 0.4 Total 30 6.1 5.3. factors associated with congenital anomaly As shown in table 3 below , eighteen (3.7%) mothers had history of chronic illness during pregnancy. The commonest chronic illness was hypertension 8 (1.6%), followed by diabetes 6 (1.2%) and asthma 4 (0.4%). 351 (71.6%) mothers had taken periconceptual folic acid. 7 (1.4%) pregnant mothers took unspecified medications early during pregnancy. 14 (2.9%) mothers gave history of alcohol consumption during pregnancy. 5 (1%) mothers had history of khat chewing during pregnancy. 12 (2.4%) mothers had history of herbal medication use during pregnancy, 6 (1.2%) mothers had history of pesticide exposure. 4 (0.8%) mothers had history of passive smoking exposure. 19 (3.9%) mothers used surface water has a source for drinking water. As shown in table 4 below, not taking folic acid periconception was associated with congenital anomaly (P value 0.001. Cramer's V 0.386 showing strong association). Medication use during pregnancy had association with congenital anomaly (P value 0.006. Cramer's V 0.184). Advanced maternal age (age 35 and above) was associated with congenital anomaly (P value 0.019, Cramer's V 0.106). Table 3: Frequency distribution of associated factors to congenital anomaly, Y12HMC, Addis Ababa, 2024. Variable Number % Folic acid use Yes 351 71.6 No 139 28.4 Medication use Yes 7 1.4 No 483 98.6 Chronic illness Yes 18 3.7 No 472 96.3 Type of chronic illness Hypertension 8 1.6 Diabetes 6 1.2 Asthma 2 0.4 Hyperthyroidism 1 0.2 Hypothyroidism 1 0.2 Alcohol consumption Yes 14 2.9 No 476 97.1 Khat chewing Yes 5 1 No 485 99 Herbal medication use Yes 12 2.4 No 478 97.6 Pesticide exposure Yes 6 1.2 No 484 98.8 Passive smoking Yes 4 0.8 No 486 99.2 Drinking water source Piped water 371 75.7 Protected well 56 11.4 Bottled water 44 9 Surface water 19 3.9 Table 4: Chi square test analysis of associated factors to congenital anomaly, Y12HMC Addis Ababa, 2024. Variable Congenital anomaly Total (%) P value Cramer’s V Yes (n=30) No(n=460) Folic acid use Yes 2 349 351(71.6) 0.001 0.368 No 28 111 139(28.4) Medication use Yes 3 4 7(1.4) 0.006 0.184 No 27 456 483(98.6) Chronic illness Yes 2 16 18(3.7) 0.303 0.041 No 28 444 472(96.3) Age ≥35yrs 12 99 111(22.7) 0.019 0.106 Below 35yrs 18 361 379(77.3) Parity Nulliparous 10 179 189(38.6) 0.543 0.027 Parous 20 281 301(61.4) Alcohol consumption Yes 2 12 14(2.9) 0.209 0.058 No 28 448 476(97.1) Khat chewing Yes 1 4 5(1) 0.272 0.059 No 29 456 485(99) Herbal medication use Yes 2 10 12(2.4) 0.163 0.07 No 28 450 478(97.6) Pesticide exposure Yes 1 5 6(1.2) 0.317 0.049 No 29 455 484(98.8) Passive smoking Yes 1 3 4(0.8) 0.224 0.071 No 29 457 486(99.2) History of abortion Yes 8 119 127(36.9) 0.956 0.003 No 14 203 217(63.1) History of stillbirth Yes 1 15 16(5.3) 1.00 0.007 No 20 265 285(94.7) Drinking water source Piped water 22 349 371(75.7) 0.286 0.088 Protected well 2 54 56(11.4) Bottled water 3 41 44(9) Surface water 3 16 19(3.9) 6. Discussion During the study period from July 1 to December 30, 20 24 at Y12HMC/AGH, a total of 490 third trimester ultrasound scans were performed. Thirty congenital anomalies detected during the 3rd trimester scan, making the incidence 6.1%. Of these. The prevalence of 3rd tri congenital anomaly is high when compared to studies done in different parts of Ethiopia. Studies done in Jimma, Bishoftu and north west Ethiopia found that the prevalence of congenital anomaly was 4.1%, 1% and 1.6% respectively [20] [22] [24]. This difference may be explained by Y12HMC is referral hospital with MFM unit where most of high-risk pregnancies and mothers with congenital anomaly fetuses are referred for management as well since the study is a hospital-based study it might have impact on overestimation of prevalence; besides most of the above studies determined prevalence by diagnosing overt anomaly at birth which might tend to miss internal anomalies that can be diagnosed by prenatal imaging. In addition, the prevalence by this study is still higher when it is compared to other African countries and worldwide ; prevalence in USA 3%, India 2.5%, UK 2 to3% and Japan 1% [25] [27] [26]. While a pooled prevalence in Africa 2.3% [18] [19]. The high prevalence of this study will be more remarkable when it is compared to studies which reported 3rd tri congenital anomaly separately as the pooled prevalence of 3rd trimester anomaly was found to be 0.3% from a systematic review study [16]. While a study done in kings’ college, UK from ultrasound done at 35 to 37weeks of gestation the prevalence of congenital anomalies was 1.9%. And for the 1st time diagnosed abnormalities in 3rd tri was 0.5% versus first time detected 3rd tri anomaly prevalence of 4.9% in this study [7]. All these variations in the prevalence of congenital anomaly can be explained by social, ecological, racial and economic influences. The commonest organ system affected by congenital anomaly detected during third trimester scan was Central nervous system (CNS) 9 (30%). This finding similar to other studies in North West Ethiopia, Jimma, Bishoftu, Amhara and Addis Ababa where the commonest organ system affected is CNS. CNS being the most common affected organ is in line with the fact that not taking periconceptual folic acid is associated with CNS malformations particularly neural tube defects which is shared finding of these studies [20] [21] [22] [24]. Though CNS is the commonest organ affected collectively; by third tri ultrasound detected specific congenital anomaly type, the single most common type of congenital anomaly identified was Urinary Tract Dilation (UTD) 6 (20%) followed by Chiari 2 malformation 4 (13.3%) and isolated ventriculomegaly 3 (10%). Congenital Pulmonary Airway Malformation (CPAM), skeletal dysplasia, diaphragmatic hernia, multi cystic dysplastic kidney disease, abdominal cyst and cleft lip and palate each anomaly contributed for two cases. Besides, ventricular septal defect (VSD), left ventricular hypoplasia, omphalocele, dandy walker malformation and encephalocele each contributed for one anomaly. The distribution and variety of specific congenital anomaly type detected in this study is comparable with the findings of other studies which were done on congenital anomaly detection by 3rd tri ultrasound scan; A systematic review of 13 studies found the commonest 3rd trimester anomaly type was urinary tract dilatation, ventriculomegaly and cardiac defects [16]. In another 3rd tri ultrasound scan study done in kings’ college, UK from ultrasound done at 35 to 37weeks of gestation the most common abnormalities diagnosed in the 3rd tri include: hydronephrosis (urinary tract dilation), ventriculomegaly, duplex kidney, ventricular septal defect, ovarian cyst (abdominal cyst), arachnoid cyst, hematocolpus and microcephaly [7]. The minor differences in type of detection might be attributed to the expertise level of the sonographer, the quality of ultrasound machine used and possibly patient characteristics. Three fetuses had multiple congenital anomalies. The commonest organ involved in multiple malformation was CNS (enlarged cisterna magna) in two out of the three cases. The other organs involved in multiple malformations were: cardio vascular system (VSD), skeletal system (upper limb hypoplasia), abdominal wall defect (omphalocele), respiratory system (diaphragmatic hernia) and cord cyst; by comparison the 3rd tri ultrasound scan study done in kings college identified more or less similar pattern of organs involved by multiple malformation: CNS, cardiovascular, skeletal dysplasia and genitourinary system [7]. Not taking folic acid periconception is associated with congenital anomaly (P value 0.001. Cramer's V 0.386 showing strong association) and Medication use during pregnancy had association with congenital anomaly (P value 0.006. Cramer's V 0.184 showing weak association) this finding is in line with studies done in South West Ethiopia, North West Ethiopia, Addis Ababa and Amhara region where all these studies found not taking folic acid and medication use early in pregnancy have significant association with congenital anomaly [20] [23] [24]. While a study done in Nigeria didn't find any association [18]. Advanced maternal age (age 35 and above) is associated with congenital anomaly (P value 0.019. Cramer's V 0.106 showing weak association). A study done in Bishoftu showed similar finding where advanced maternal age is associated with congenital anomaly [22]. In this study alcohol use, khat chewing, passive smoking, chronic illness, surface water use, history of abortion and history of still birth didn’t show association with congenital anomaly while a systematic review done in Africa showed chronic illness, alcohol use and khat chewing during pregnancy were associated with congenital anomaly [19], from a study in Southwest Ethiopia pesticide exposure, surface water use and passive smoking were associated with congenital anomaly [23]. These differences might arise from study population variation in terms of religious views, cultural norms, social customs and environmental exposures. 7. Strength and Limitations of the study 7.1 Strength 1) Data was collected prospectively which increases reliability of findings 2) 3rd tri ultrasound scan was done by highly qualified physicians: MFMF and abnormal findings were confirmed by MFM consultants. 3) taking the relatively rarity of congenital anomaly using chi square for analysis best suits for association detection. 7.2 Limitations of the study: 1) data was collected from referral hospital which might inflate prevalence. 2) study was done on a single hospital with small sample size which might not be representative. 3) since analysis was done by chi square test confounding variables cannot be controlled for associated factors. 8. Conclusion High prevalence of third trimester congenital anomaly detected in this study. CNS was the commonest organ affected by 3rd tri congenital anomaly while urinary tract dilation is the single most commonly identified type of congenital anomaly. Not using folic acid, medication use early during pregnancy and advanced maternal age are associated with congenital malformations. 9. Recommendation For clinicians and sonographers: emphasis shall be given for systematic evaluation of the fetal anatomy during routine third trimester scan for better antenatal detection of congenital anomalies . For policy makers and stake holders: further large-scale studies should be done to generate more information on the role of third trimester ultrasound scan in detection of congenital anomalies so that it might be included in the usual clinical practice. Abbreviations AIUM …………………………...American Institute of Ultrasound in Medicine. AGH………………………………Abebech Gobena Hospital ANC………………………………………………………………Antenatal Care ISUOG ………. International Society of Ultrasound in Obstetrics and Gynecology MFM ……………………………………………………. Maternal Fetal Medicine MFMF……………………………………………………. Maternal Fetal Medicine Fellow NIH…………………………………………………. National Institute of Health OBGYN…………………………………………… Obstetrician and Gynecologist SPSS…………………………………….…Statistical Software for Social Sciences TRI…………………………………………. Trimester UK ……………………………………………………………. United Kingdom US ……………………………………………………………………Ultrasound WHO …………………………………………………World Health Organization Y12HMC ………………………………………. Yekatit 12 Hospital Medical College CNS…………………………………….. Central Nervous System VSD……………………………………. Ventricular Septal defect UTD……………………………………. Urinary Tract Dilation CPAM………………………………….. Congenital Pulmonary Airway Malformations MCDKD………………………………. Multi cystic Dysplastic Kidney Disease Declarations Ethics approval and consent to participate: Ethical approval was obtained before the actual data collection in accordance with the Declaration of Helsinki from Yekatit 12 Hospital Medical College Institutional Review Board. Consent was taken from each participant after ascertaining their willingness to participate in the study. Consent for publication: Not applicable Availability of data and materials: The datasets used and/or analyzed during this study are available from the corresponding author on reasonable request. Competing interests: The authors declare that they have no competing interests. Funding: No funding to the study received Authors' contributions: TB: contributed on writing the proposal, data collection, doing analysis, result and discussion write up. EM: contributed on study design, sample size calculation, chi-square test analysis. BK: contributed on conceptual framework, objective development, and editing EG: contributed on data collection, operational definition, developing introduction, and abstract. KH: contributed on editing proposal and thesis, writing literature review, conclusion and recommendation. Acknowledgement I would like to express my appreciation to the department of Obstetrics and Gynecology of Abebech Gobena Maternity and Children Hospital for giving me an opportunity to research on my topic of interest. I want to extend my gratitude to my coauthors: 1. Dr. Ephrem Mamo, 2 Dr Birhanu Kebede, 3. Dr Eyob Gelan and 4. Kokeb Haile for their contribution in the development of this thesis. I am thankful to my family for their love, encouragement and support. I am also grateful to the study participants with out whom realization of the study would have been impossible. References "WHO recomendations on Antenatal Care for a Positive Pregnancy Experience," 2016. [Online]. Available: http://www.who.int. Z. A. V. B. e. a. Salmon L, "ISOUG Practice Guideline: performance the routine mid trimester ultrasound scan," Ultrasound Obstet Gynecol, vol. 59, pp. 840-856, 2022. S. M. J. Jabaz D, "Sonography , second trimester assessment, protocols and interpretation," Statpearls publishing, 2024, January. M. P. L. T. e. a. Canavan T, "AIUM Practice Parameter for Performance of Standard Diagnostic Obstetric ultrasound," J ultrasound Med, vol. 9999, pp. 1-13, 2024. J. A. L. L. e. a. Charles J, Creasy and Rensnik"s Maternal Fetal Medicine Principe and Practice, Philadelphia: Imprint of Elsevier Inc, 2024. L. M. V. A. e. a. Marry E, Callen"s Ultrasonography in Obstetrics and Gynecology, Philadelphia: Elsevier Inc, 2017. F. A. S. A. e. a. Nicolaides K, "Value of Routine Ultrasound Examination at 35 -37 weeks"s gestation in Diagnosis of Fetal Abnormalities," Ultrasound Obstet Gynecol, vol. 10, no. uog.20857, p. 1002, 2019. S. R. P. I. e. a. Butt F, "Pattern and Outcome of Congenital Anomalies and Maternal Risk Factors Associations," Biomedicia, vol. 29, pp. 234-240, 2013. V. B, "Preventing Congenital Anomalies in Developing Countries," Community Genet, vol. 5, pp. 61-69, 2002. "WHO congenital disorders," World Health Organization, 2023. [Online]. Available: http://www.who.int. E. A. I. L. e. a. Mohamed A, "Pattern of Congenital Anomalies," Pediatric Reports, vol. 5, no. 5, pp. 20-23, 2013. T. Z, "Prevalence and risk factors for congenital anomalies in Mosul city," The Iraqi Post Graduate Medical Journal, vol. 22, no. 2, pp. 140-146, 2012. S. A. A. A. e. a. Amany M, "Assessment of risk factors for fetal congenital anomalies at Cairo university Hospital," Journal of American Science, vol. 7, no. 12, pp. 899-908, 2011. K. Y. N. N. e. a. Naeimeh T, "the prevalence of congenital malformations and its correlation with consanguineous marriage," Oman Medical Journal, vol. 25, pp. 37-40, 2010. M. C. R. R. e. a. Vinceti M, "prevalence at birth for congenital anomalies in a population living around a modern municipal solid waste incinerator," Epidemology, vol. 17, no. 6, pp. 272-273, 2006. E. B. G. B. e. a. Drukker L, "how often do we identify fetal abnormalities during routine third trimester ultrasound? a systematic review and meta analysis," an International Journal Of Obstetrics and Gynecology, vol. 128, pp. 259-269, 2020. B. T. Mahela S, "prevalence of congenital abnormalities on routine ultrasound scan of second and third trimester pregnancy," International Journal of Reproduction, Contraception, vol. 5, pp. 182-185, 2016. I. A. Akinlabi e, "prevalence, risk factors and outcome of congenital anomalies among neonatal admissions in OGBOMOSO," BMC Pediatrics, vol. 19, p. 88, 2019. M. N, "congenital anomalies and risk factors in Africa a systematic review and metaanalysis," BMJ Pediatrics, vol. 7, no. 1, 2023. T. A. S. A. e. a. Bekalu G, "prevalenc of overt congenital anomalies and associated factors among newborns delivered at Jimma University Medical Center," international Journal of Africa Nursing Sciences, vol. 18, p. 100513, 2023. M. A. W. F. Molla T, "Factors associated with congenital anomalies in Addis Ababa and Amhara Region," BMC Pediatrics, vol. 18, p. 142, 2018. E. G. W. D. Samuel G, "congenital anomalies and associated factors among newborns in Bishoftu General Hospital," Hindawi journal of environmental and public health, vol. 2021, p. 6, 2021. G. G. D. A. e. a. Soressa A, "risk factors associated with congenital anomalies in South Western Ethiopia," PLoS ONE, vol. 16, p. e0245915, 2021. G. S. Fantahun A, "prevalence and associated factors of birth defects amongnewborns at referal hospital in north west Ethiopia," Ethiopian Journal of Health Development, vol. 32, pp. 00-000, 2018. C. M, "National Estimates and Race/Ethnicity specific variation of selected birth defects in the United States," Res A Clin Mol Teratol, vol. 76, no. 11, pp. 745-56, 2006. P. Z, "Birth Defects Surveillance Study," Indian J Pediatr, vol. 72, no. 6, pp. 489-91, 2005. B. P, "congenital anomaly surveillance in England ascertainment deficiencies in the national system," BMJ, vol. 330, no. 7481, pp. 27-31, 2005. Additional Declarations No competing interests reported. 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Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-6304485","acceptedTermsAndConditions":true,"allowDirectSubmit":false,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":452323266,"identity":"55bec967-4bc1-452b-a996-c52f0e358f1e","order_by":0,"name":"Tesfaye Bisenebit","email":"data:image/png;base64,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","orcid":"","institution":"Yekatit 12 Hospital Medical College, Adis Ababa","correspondingAuthor":true,"prefix":"","firstName":"Tesfaye","middleName":"","lastName":"Bisenebit","suffix":""},{"id":452323267,"identity":"f21d637a-d667-48a1-af80-654466b25ddd","order_by":1,"name":"Ephrem Mamo","email":"","orcid":"","institution":"Yekatit 12 Hospital Medical College, Adis Ababa","correspondingAuthor":false,"prefix":"","firstName":"Ephrem","middleName":"","lastName":"Mamo","suffix":""},{"id":452323268,"identity":"0aa9728f-3f1b-494f-9229-cae8ad6d5598","order_by":2,"name":"Birhanu Kebede","email":"","orcid":"","institution":"Yekatit 12 Hospital Medical College, Adis Ababa","correspondingAuthor":false,"prefix":"","firstName":"Birhanu","middleName":"","lastName":"Kebede","suffix":""},{"id":452323269,"identity":"1a613638-d3ac-4660-a3d1-506b6d571eeb","order_by":3,"name":"Eyob Gelan","email":"","orcid":"","institution":"Yekatit 12 Hospital Medical College, Adis Ababa","correspondingAuthor":false,"prefix":"","firstName":"Eyob","middleName":"","lastName":"Gelan","suffix":""},{"id":452323270,"identity":"0f65a7ab-6af9-431d-92aa-09f7ad0a83b4","order_by":4,"name":"Kokeb Haile","email":"","orcid":"","institution":"Menelik II Medical and Health Science College, Adis Ababa","correspondingAuthor":false,"prefix":"","firstName":"Kokeb","middleName":"","lastName":"Haile","suffix":""}],"badges":[],"createdAt":"2025-03-25 13:53:23","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-6304485/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-6304485/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":82308264,"identity":"5a1b6515-901c-4ec9-89d4-373443ee87c3","added_by":"auto","created_at":"2025-05-09 01:32:49","extension":"jpg","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":52932,"visible":true,"origin":"","legend":"\u003cp\u003econceptual framework for third trimester ultrasound scan for detection of congenital abnormalities and associated factors\u003c/p\u003e","description":"","filename":"1.jpg","url":"https://assets-eu.researchsquare.com/files/rs-6304485/v1/45830dbe3e905b62a5749a5f.jpg"},{"id":82308266,"identity":"adf32116-8d5a-463e-b60d-1b1c1b6a77c5","added_by":"auto","created_at":"2025-05-09 01:32:49","extension":"jpg","order_by":2,"title":"Figure 2","display":"","copyAsset":false,"role":"figure","size":23012,"visible":true,"origin":"","legend":"\u003cp\u003ethird tri ultrasound scan result, Y12HMC, 2024\u003c/p\u003e","description":"","filename":"2.jpg","url":"https://assets-eu.researchsquare.com/files/rs-6304485/v1/9814496da21a6bfb3027bcae.jpg"},{"id":82309740,"identity":"f5416ff4-04ed-478a-a7ab-1d5e054c0a35","added_by":"auto","created_at":"2025-05-09 01:48:50","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":1480320,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-6304485/v1/96d8bc4b-fe4b-49e6-8ed0-a29e77328598.pdf"},{"id":82308265,"identity":"6fe457bb-9993-436a-b72a-4e0c8522d82a","added_by":"auto","created_at":"2025-05-09 01:32:49","extension":"docx","order_by":1,"title":"","display":"","copyAsset":false,"role":"supplement","size":26592,"visible":true,"origin":"","legend":"","description":"","filename":"Annex12.docx","url":"https://assets-eu.researchsquare.com/files/rs-6304485/v1/dc565f0c2f6fb5e5bc99ea7e.docx"}],"financialInterests":"No competing interests reported.","formattedTitle":"\u003cp\u003eThird Trimester Ultrasound Scan for Detection of Congenital Abnormalities and Associated Factors, at Abebech Gobena MCH Hospital, a Cross Sectional Study\u003c/p\u003e","fulltext":[{"header":"1. Introduction","content":"\u003cdiv id=\"Sec2\" class=\"Section2\"\u003e \u003ch2\u003e1.1 Background Information\u003c/h2\u003e \u003cp\u003eOne of the essential components of antenatal care to a pregnant woman is ascertaining the normal development of the fetus while bearing in mind the aim of detecting congenital abnormalities, hence every pregnant woman should have at least one detailed ultrasound examination in the mid second trimester of pregnancy [1]. For detection of congenital abnormalities different professional associations recommend detailed ultrasound anatomic scanning with standardized criteria to be met during scanning by trained and skilled professional at first trimester from 11 to 14 weeks of gestation and second trimester from 18 to 24weeks [2] [3] [4]. Growing number of evidences also suggest that systematic evaluation of the fetal anatomy during 3rd trimester routine scan shall be done with additional goal of detecting congenital abnormalities that have been missed in earlier scans, occurred late in gestation or progressed from previous findings. The sensitivity of 2nd trimester ultrasound in detection of congenital abnormalities could be as high as 93%. Taking these facts in to consideration while disclosing a normal 2nd trimester anatomic scan, clients should be informed the inherent gap of the result and possibility of diagnosing congenital abnormalities in the third trimester, as 0.5 to 2% of anomalies might be diagnosed late in gestation among women who had a normal anatomic scan at 2nd trimester [5] [6] [7].\u003c/p\u003e \u003cp\u003eIntrauterine abnormal development may result from environmental factors, genetic factors or a combination of both that affect normal embryogenesis. These insults at the critical embryogenesis period causes altered cytogenesis, histogenesis and morphogenesis the final result being a birth defect also called congenital anomaly [8] [9]. Congenital anomaly is a structural or functional anomaly that occurs during intrauterine life that can be detected prenatally, at birth or later in life. These defects of prenatal origin result from defective embryogenesis or intrinsic abnormalities. Based on World health organization report annually, 240000 babies die within 4weeks of birth and 170000 children die with in 1month to 5years of age due to congenital anomaly worldwide [10].\u003c/p\u003e \u003cp\u003eCongenital anomaly is a major cause of health burden during childhood as well a significant cause of infant morbidity and mortality worldwide, particularly in developing countries [11] [12]. Affected pregnancies might end up in still birth, and those who are delivered alive almost two third of cases don\u0026rsquo;t make it past their 1st month. And most of the remaining live births need complicated post-natal care and multiple surgical interventions which has a significant psychosocial and economic burden. Despite interventions complete recovery may not be achieved resulting in variable degree of physical disabilities [13] [14] [15].\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec3\" class=\"Section2\"\u003e \u003ch2\u003e1.2 Statement of the problem\u003c/h2\u003e \u003cp\u003eThird trimester ultrasound scan is done for ascertaining the fetal wellbeing, presentation, localization of placenta, fetal growth assessment, prediction of preeclampsia besides systematic evaluation of the fetal anatomy helps to detect congenital abnormalities [5] [6] [7].\u003c/p\u003e \u003cp\u003eCongenital abnormalities detected at third trimester scan might be due to the evolving nature of pregnancy where some congenital malformations appearing late in third trimester; these malformations include: skeletal dysplasia like achondroplasia, central nervous system malformations: ventriculomegaly, megalencephally, polymicrogyria, renal malformations include: pyelectasis, polycystic kidney disease [7].\u003c/p\u003e \u003cp\u003eThe other reason for late detection of congenital malformations could be due to late occurring insults like congenital infections, hemorrhagic insults; missed malformations at second trimester routine scanning or technical factors affecting the detection accuracy of ultrasound: maternal body habitus, size of the fetus, fetal position [16] [17].\u003c/p\u003e \u003cp\u003eDetection for congenital abnormalities at third trimester might be distressing for the client as well as for the attending physician as it is a surprising news after a reassuring normal ultrasound report at second trimester scan. This has to be handled with vigilance without imposing blame in the accuracy of the second trimester scanner, as described above the new abnormality finding may not necessarily be failure of detection of 2nd trimester scan rather owing for multiple reasons. Knowing this avoids unnecessary distress to both client and attending physician and gives them opportunity to discuss about the implication of the findings, decide place of delivery, need of neonatal care and possible surgical management options in the post-natal period depending on the abnormality type [10] [18] [19].\u003c/p\u003e \u003cp\u003eDifferent studies revealed that congenital abnormalities are associated with different factors [20]. Having low socio-economic status, illiteracy, surface water source for drinking, pesticides exposure, drug use in the 1st and 2nd trimester, chronic illness like diabetes, having no ANC follow up, previous bad obstetric outcomes are associated with congenital abnormalities. While use of folic acid supplement was found to be protective [21] [22].\u003c/p\u003e \u003cp\u003eSo, knowing that there is a significant percentage of congenital abnormalities being diagnosed in the 3rd trimester helps while revealing a normal 2nd trimester scan result to the client, the potential risk of late appearing abnormalities in the index pregnancy. For those diagnosed at third trimester gives opportunity for psychosocial adjustment as well as planning a head the management of pregnancy. Identifying associated factors also provides physicians to educate their clients in terms of reducing exposure to potential risk factors and promote preventive factors [7] [23] [24].\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec4\" class=\"Section2\"\u003e \u003ch2\u003e1.3 Significance of the study\u003c/h2\u003e \u003cp\u003eAround 2 percent of pregnancies might have 3rd trimester diagnosed congenital abnormalities and having diagnosed congenital abnormalities in the 3rd trimester though it imposes a significant psychological distress to the unsuspecting parents as well as attending physicians, it has a benefit of giving time for psychosocial adjustment as well as helps to decide place of delivery, timing of delivery, post-natal care and planning a head for surgical interventions depending on the type of congenital abnormalities. So, this study with aim of determining the magnitude of congenital abnormalities and classifying the abnormalities based on affected organ involvement increases the awareness for the need of systematic anatomic evaluation of the fetus in the third trimester along with the routine 3rd trimester ultrasound scanning goals. Since there are no studies in the area regarding 3rd tri abnormalities the findings of the study would also serve as a baseline for further large-scale studies that could have impact on standardizing and integrating 3rd tri anatomic scanning in to the routine care of a pregnant woman.\u003c/p\u003e \u003c/div\u003e"},{"header":"2. Literature Review","content":"\u003cdiv id=\"Sec6\" class=\"Section2\"\u003e \u003ch2\u003e2.1 Prenatal ultrasound detection of anomaly and its burden on morbidity and mortality\u003c/h2\u003e \u003cp\u003eFor detection of congenital abnormalities different professional associations recommend detailed ultrasound anatomic scanning with standardized criteria to be met during scanning by trained and skilled professional at first trimester from 11 to 14 weeks of gestation and second trimester from 18 to 24weeks [2] [3] [4]. Growing number of evidences also suggest that systematic evaluation of the fetal anatomy during 3rd trimester routine scan shall be done with additional goal of detecting congenital abnormalities that have been missed in earlier scans, occurred late in gestation or progressed from previous findings. The sensitivity of 2nd trimester ultrasound in detection of congenital abnormalities could be as high as 93%. While disclosing a normal 2nd trimester anatomic scan, clients should be informed the possibility of diagnosing congenital abnormalities in the third trimester, as 0.5 to 2% of anomalies might be diagnosed late in gestation among women who had a normal anatomic scan at 2nd trimester [5] [6] [7].\u003c/p\u003e \u003cp\u003eCongenital anomaly is a structural or functional anomaly that occurs during intrauterine life that can be detected prenatally, at birth or later in life. These defects of prenatal origin result from defective embryogenesis or intrinsic abnormalities. Based on World health organization report annually, 240000 babies die within 4weeks of birth and 170000 children die with in 1month to 5years of age due to congenital anomaly worldwide [10].\u003c/p\u003e \u003cp\u003eCongenital anomaly is a major cause of health burden during childhood as well a significant cause of infant morbidity and mortality worldwide, particularly in developing countries [11] [12]. Affected pregnancies might end up in still birth, and those who are delivered alive almost two third of cases don\u0026rsquo;t make it past their 1st month. And most of the remaining live births need complicated post-natal care and multiple surgical interventions which has a significant psychosocial and economic burden. Despite interventions complete recovery may not be achieved resulting in variable degree of physical disabilities [13] [14] [15].\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec7\" class=\"Section2\"\u003e \u003ch2\u003e2.2 Magnitude of congenital anomaly\u003c/h2\u003e \u003cp\u003eThe prevalence of congenital anomaly in USA 3%, India 2.5%, UK 2 to3% and Japan 1% [25] [26] [27]. While a study in Nigeria 6.3% and pooled prevalence in Africa 2.3% [18] [19]. A systematic review of 13 studies were done and pooled prevalence of 3rd trimester anomaly was found to be 0.3% [16]. While a study done in kings\u0026rsquo; college, UK from ultrasound done at 35 to 37weeks of gestation the prevalence of congenital anomalies was 1.9%. And for the 1st time diagnosed abnormalities in 3rd tri was 0.5% [7]. Studies done in Jimma, Bishoftu and north west Ethiopia found that the prevalence of congenital anomaly was 4.1%, 1% and 1.6% respectively [20] [22] [24]. All these variations in the prevalence of congenital anomaly can be explained by social, ecological, racial and economic influences.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec8\" class=\"Section2\"\u003e \u003ch2\u003e2.3 Congenital anomaly types detected in 3rd trimester\u003c/h2\u003e \u003cp\u003eCongenital abnormalities detected at third trimester scan might be due to the evolving nature of pregnancy where some congenital malformations appearing late in third trimester; these malformations include: skeletal dysplasia like achondroplasia, central nervous system malformations: ventriculomegaly, megalencephally, polymicrogyria, renal malformations include: pyelectasis, polycystic kidney disease [7].\u003c/p\u003e \u003cp\u003eThe other reason for late detection of congenital malformations could be due to late occurring insults like congenital infections, hemorrhagic insults; missed malformations at second trimester routine scanning or technical factors affecting the detection accuracy of ultrasound: maternal body habitus, size of the fetus, fetal position [16] [17].\u003c/p\u003e \u003cp\u003eA systematic review of 13 studies were done and the commonest 3rd trimester anomaly was genitourinary system accounting 55% of which renal pelvis dilatation was the highest; the 2nd common was central nervous system anomaly 18% of which ventriculomegaly was the highest and the 3rd common was cardiac defects [16].\u003c/p\u003e \u003cp\u003eIn a study done in kings\u0026rsquo; college, UK from ultrasound done at 35 to 37weeks of gestation the most common abnormalities diagnosed in the 3rd tri include: hydronephrosis, ventriculomegaly, duplex kidney, ventricular septal defect, ovarian cyst, arachnoid cyst, hematocolpus and microcephaly [7].\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec9\" class=\"Section2\"\u003e \u003ch2\u003e2.4. Factors associated with congenital anomaly\u003c/h2\u003e \u003cp\u003eAs shown in Fig.\u0026nbsp;\u003cspan refid=\"Fig3\" class=\"InternalRef\"\u003e1\u003c/span\u003e below, using conceptual framework, congenital anomalies are affected by multiple factors including: sociodemographic, obstetric, environmental, genetic, chronic illness and exposure to different teratogens. A systematic review on studies done in Africa showed not taking folic acid, chronic illness, medication exposure, alcohol use and khat chewing during pregnancy were associated with congenital anomaly while a study done in Nigeria didn\u0026rsquo;t find any association in these factors with congenital anomaly [18] [19]. In a case control study in Addis Ababa and Amhara region: unidentified medication use, maternal alcohol use and chemical exposure during early pregnancy were found to be significantly associated with congenital abnormalities and folic acid use before and during pregnancy were found to be protective against congenital anomaly [21].\u003c/p\u003e \u003cp\u003eA study done in Jimma, chewing khat and having chronic illness during pregnancy were found to be associated with congenital abnormalities while taking folic acid supplement was protective [20]. A study done in Bishoftu, maternal age above 35, parity above 3, and low birth weight were found to be associated with congenital abnormalities and folic acid supplement was protective [22]. In a case control study in South West Ethiopia, unidentified drug use early in pregnancy, exposure to pesticides, surface water for drinking, passive smoking, having no ANC were associated with congenital abnormalities while folic acid use was found to be protective [23]. In a study in north west Ethiopia, absence of folic acid use, chronic illness, alcohol use and history of medication use during pregnancy were found to be associated with congenital abnormalities [24].\u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003c/div\u003e"},{"header":"3. Objectives","content":"\u003cp\u003e3.1 General objective: to assess the magnitude of congenital abnormalities and associated factors detected at third trimester ultrasound scan at AGH, Addis Ababa, Ethiopia.\u003c/p\u003e\u003cp\u003e3.2 Specific Objectives\u003c/p\u003e \u003cp\u003e1. To determine the magnitude of congenital abnormalities detected at third trimester ultrasound scan at AGH, Addis Ababa, Ethiopia.\u003c/p\u003e \u003cp\u003e2. To identify factors associated with congenital abnormalities detected at third trimester ultrasound scan at AGH, Addis Ababa, Ethiopia.\u003c/p\u003e "},{"header":"4. Methods","content":"\u003ch2\u003e4.1 Study design\u003c/h2\u003e\u003cp\u003eThis was a facility based cross-sectional study of third trimester ultrasound scan for detection of congenital abnormalities and associated factors.\u003c/p\u003e\u003ch2\u003e4.2 Study setting and period\u003c/h2\u003e\u003cp\u003eThe study was conducted between July 1, 2024 to December 30, 2024 at Yekatit 12 Hospital Medical College - Abebech Gobena MCH, one of the teaching hospitals under Addis Ababa city administration health bureau.\u003c/p\u003e\u003cp\u003eAbebech Gobena MCH is an affiliate of Yekatit 12 Hospital Medical College which was established in 2021 at Lemikura sub city, Addis Ababa. It is equipped with 400 beds, including 12 labor ward beds and NICU. Since its inauguration, on average 700 to 1000 monthly deliveries were attended in the MCH.\u003c/p\u003e\u003ch2\u003e4.3 Source population\u003c/h2\u003e\u003cp\u003eAll pregnant women having ANC at Yekatit 12 Hospital Medical College - Abebech Gobena MCH.\u003c/p\u003e\u003ch2\u003e4.4 Study population\u003c/h2\u003e\u003cp\u003eAll pregnant women who had third trimester ultrasound scan during the study period.\u003c/p\u003e\u003ch2\u003e4.4 Inclusion criteria\u003c/h2\u003e\u003cp\u003eAll pregnant women who had third trimester ultrasound scan from 28weeks to 42 weeks of gestation during the study period and were willing to participate in the study included.\u003c/p\u003e\u003ch2\u003e4.5 Exclusion Criteria\u003c/h2\u003e\u003cp\u003ePregnant women who did not have second trimester anatomic scan ultrasound were excluded.\u003c/p\u003e\u003cp\u003ePregnant women who had intra uterine fetal deaths were excluded.\u003c/p\u003e\u003ch2\u003e4.6 Sample size determination\u003c/h2\u003e\u003cp\u003eThe desired sample size was determined using single population proportion formula\u003c/p\u003e\u003cp\u003eN = [(z)2*p (1–p) /d2\u003c/p\u003e\u003cp\u003eZ = the value of the standard normal curve score corresponding to the given confidence interval = 1.96 (corresponding to 95% confidence level)\u003c/p\u003e\u003cp\u003eN = desired sample size\u003c/p\u003e\u003cp\u003eP = prevalence of congenital anomaly (major/ minor)\u003c/p\u003e\u003cp\u003ed = the permissible Margin of error 3%\u003c/p\u003e\u003cp\u003efrom the study conducted in UK the prevalence of congenital anomaly was found to be 1.9%; using this proportion the calculated sample size was 79.\u003c/p\u003e\u003cp\u003e \u003cb\u003eSample size calculated using associated factors\u003c/b\u003e \u003c/p\u003e\u003cdiv class=\"gridtable\"\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c7\" colnum=\"7\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c8\" colnum=\"8\"\u003e\u003c/div\u003e\u003ctable float=\"No\" id=\"Taba\" border=\"1\"\u003e\u003ccolgroup cols=\"8\"\u003e\u003c/colgroup\u003e\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eS.No\u003c/p\u003e \u003c/th\u003e\u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eFactors\u003c/p\u003e \u003c/th\u003e\u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003ePower\u003c/p\u003e \u003c/th\u003e\u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003e% of unexposed\u003c/p\u003e \u003c/th\u003e\u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003eRatio\u003c/p\u003e \u003c/th\u003e\u003cth align=\"left\" colname=\"c6\"\u003e \u003cp\u003eAOR\u003c/p\u003e \u003c/th\u003e\u003cth align=\"left\" colname=\"c7\"\u003e \u003cp\u003eCI\u003c/p\u003e \u003c/th\u003e\u003cth align=\"left\" colname=\"c8\"\u003e \u003cp\u003eSample\u003c/p\u003e \u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eANC visit\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e80\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e4%\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e1:1\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e3.2\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e95\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c8\"\u003e \u003cp\u003e426\u003c/p\u003e \u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e2\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eFolic acid use\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e80\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e5%\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e1:1\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e0.036\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e95\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c8\"\u003e \u003cp\u003e420\u003c/p\u003e \u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e3\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eMedication use\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e80\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e3.9%\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e1:1\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e4.6\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e95\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c8\"\u003e \u003cp\u003e230\u003c/p\u003e \u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e4\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eAlcohol use\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e80\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e8.7%\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e1:1\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e2.4\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e95\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c8\"\u003e \u003cp\u003e414\u003c/p\u003e \u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e5\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003ePesticide exposure\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e80\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.5%\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e1:1\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e11.48\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e95\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c8\"\u003e \u003cp\u003e446\u003c/p\u003e \u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e6\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eResidence\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e80\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e2.3%\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e1:1\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e4.2\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e95\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c8\"\u003e \u003cp\u003e430\u003c/p\u003e \u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/table\u003e\u003c/div\u003e\u003cp\u003eAmong the samples calculated the largest sample size 446 was taken and considering nonresponse rate of 10%, the desired sample size was 490.\u003c/p\u003e\u003ch2\u003e4.7 Sampling technique and procedure\u003c/h2\u003e\u003cp\u003eFrom the pattern for two months, weekly on average 25 third trimester ultrasound scans were made every week which gave a total of 600 scans over 6month period and the ratio to the sample size 490 was 1.2; hence, all study subjects who fulfilled the inclusion and exclusion criteria during the study period were included until the desired sample size was achieved.\u003c/p\u003e\u003ch2\u003e4.8 Data collection procedure\u003c/h2\u003e\u003cp\u003eData was collected using pre-tested \u0026amp; interviewer administered structured questionnaire ( annex 1) from the participants and electronic records. Two trained nurses filled the socio demographic, obstetric and clinical data \u0026amp; additional data was filled by the principal investigator from ultrasound examination findings which were done by Maternal Fetal Medicine Fellows at 28 to 42weeks and whenever there was a need for further scan on suspected abnormality, the scan was confirmed by Maternal Fetal Medicine Consultants.\u003c/p\u003e\u003ch2\u003e4.9 Study variables\u003c/h2\u003e\u003cp\u003eDependent variable: presence of third tri congenital abnormality.\u003c/p\u003e\u003cp\u003eIndependent variable:\u003c/p\u003e\u003cp\u003esocio demographic characteristics: age, literacy, economic status, marital status, religion, residence\u003c/p\u003e\u003cp\u003eObstetric factors: parity, abortion history, history of still birth, history of congenital malformation, number of ANC visit\u003c/p\u003e\u003cp\u003eMedical illness: diabetes, hypertension, asthma and other\u003c/p\u003e\u003cp\u003eDrug exposure, Radiation exposure, Pesticide exposure, Herbal medication\u003c/p\u003e\u003cp\u003eWater source\u003c/p\u003e\u003cp\u003eFolic acid supplement\u003c/p\u003e\u003cp\u003eCigarette smoking, Passive smoking, Alcohol use, Khat chewing.\u003c/p\u003e\u003ch2\u003e4.10 Data analysis\u003c/h2\u003e\u003cp\u003eData entered in to Epi Data version 4.6 \u0026amp; Statistical analysis made through SPSS version 29. Frequency tables and figures were used to describe the study finding.\u003c/p\u003e\u003cp\u003eAnalysis was made using chi-square test to see the presence of association between third trimester congenital anomaly and different obstetric, medical and environmental factors.\u003c/p\u003e\u003cp\u003ePearson Chi-square test was used if any of the cells during analysis has no count less than five and Fisher’s Exact test were used for analysis if any of the cells has count less than five. P value \u0026lt; 0.05 was used to show presence of statistically significant association. Cramer’s V was included to show strength of association.\u003c/p\u003e\u003ch2\u003e4.11 Data management / Data quality assurance\u003c/h2\u003e\u003cp\u003e5% of the filled data was checked for accuracy by the principal investigator. The principal investigator attended random record review sessions to monitor the data collection. Abnormal ultrasound findings were rescanned by a different scanner/ MFM consultants. Frequency output and sorting were used to check missing values and outliers. Data was checked for inconsistencies or ambiguities and data cleansing was performed.\u003c/p\u003e\u003ch2\u003e4.12 Dissemination of results\u003c/h2\u003e\u003cp\u003eFindings of the study will be presented to relevant stakeholders and will be published.\u003c/p\u003e\u003ch2\u003e4.13 Ethical consideration\u003c/h2\u003e\u003cp\u003e Before beginning data collection, ethical clearance was obtained from Yekatit 12 Hospital Medical College (Y12HMC) Institutional Review Board in accordance with the declaration of Helsinki. At the same time, written consent was taken from each pregnant woman during the data collection period, using information sheet and consent form (annex 2).\u003c/p\u003e\u003ch2\u003e4.14 Operational definitions\u003c/h2\u003e\u003cp\u003eCongenital anomaly – any form of structural fetal abnormality detected by prenatal ultrasound scan.\u003c/p\u003e\u003cp\u003eThird trimester ultrasound- systematic evaluation of the fetal anatomy at 28 to 42 weeks of gestation.\u003c/p\u003e\u003cp\u003eSevere congenital anomaly- an anomaly that can jeopardize extrauterine survival of the new born and those who survived might sustain physical and mental disability despite intervention.\u003c/p\u003e\u003cp\u003eMild congenital anomaly- an anomaly that doesn’t have impact on extrauterine survival and anomaly cold be corrected with intervention without having long standing mental or physical disability.\u003c/p\u003e\u003ch2\u003e4.15 Source of Support: Y12HMC.\u003c/h2\u003e\u003cp\u003eConflicts of Interest: None.\u003c/p\u003e"},{"header":"5. Result ","content":"\u003ch2\u003e5.1. prevalence, sociodemographic and obstetric characteristics.\u003c/h2\u003e\n\u003cp\u003e\u0026nbsp;As shown in figure 2 below , during the study period from July 1 to December 30, 2024 a total of 490 third trimester ultrasound scans were performed and thirty congenital anomalies detected during the 3rd trimester scan, making the prevalence 6.1%. Of these 30 anomalies 6 of them were diagnosed in the 2nd tri anatomic scan and pregnancy was managed expectantly, making the 1st time detected anomalies during the 3rd tri scan 4.9%.\u003c/p\u003e\n\u003cp\u003eAs shown in table 1 below : 189 (38.6%) pregnant women were nulliparous while 301(61.4%) were parous. Of 344 pregnant women who had more than one pregnancy 127 (36.9%) mothers had history of abortion. Of the 301 women who had one or more deliveries 16 (5.3%) of them had history of still birth.\u003c/p\u003e\n\u003cp\u003eOf the 490 pregnancies 466 (95.1%) were Singleton, 23 (4.7%) were twin pregnancies and there was one (0.2%) triplet pregnancy. Of the multiple gestations one of the twins had congenital anomaly. The rest 29 anomalies were among the singleton pregnancies.\u003c/p\u003e\n\u003cp\u003e476 (97.1%) pregnant mothers were married, 10 (2%) were single, 3 (0.6%) widowed and one (0.2%) divorced. 23 (4.7%) pregnant mothers had no formal education, 179 (36.5%) had primary education ,209 (42.7%) had secondary education and 79 (16.1%) had higher education. Majority of pregnant mothers 254 (51.8%) were house wives, 182 (37.1%) were self-employed ,49 (10%) were government employed and 5 (1%) were daily laborers. The mean per household monthly income was 7148 Eth Birr.\u003c/p\u003e\n\u003cp\u003eTable 1: Frequency distribution of sociodemographic characteristics of study subjects at Y12HMC, Addis Ababa, 2024.\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\" align=\"\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 32.9897%;\"\u003e\n \u003cp\u003e\u003cstrong\u003eVariable\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 34.0206%;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 18.5567%;\"\u003e\n \u003cp\u003e\u003cstrong\u003eNumber\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 14.433%;\"\u003e\n \u003cp\u003e\u003cstrong\u003e%\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 32.9897%;\"\u003e\n \u003cp\u003eReligion\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 34.0206%;\"\u003e\n \u003cp\u003eOrthodox\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 18.5567%;\"\u003e\n \u003cp\u003e310\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 14.433%;\"\u003e\n \u003cp\u003e63.3\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 32.9897%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 34.0206%;\"\u003e\n \u003cp\u003eMuslim\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 18.5567%;\"\u003e\n \u003cp\u003e98\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 14.433%;\"\u003e\n \u003cp\u003e20\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 32.9897%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 34.0206%;\"\u003e\n \u003cp\u003eProtestant\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 18.5567%;\"\u003e\n \u003cp\u003e73\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 14.433%;\"\u003e\n \u003cp\u003e14.9\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 32.9897%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 34.0206%;\"\u003e\n \u003cp\u003eCatholic\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 18.5567%;\"\u003e\n \u003cp\u003e9\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 14.433%;\"\u003e\n \u003cp\u003e1.8\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 32.9897%;\"\u003e\n \u003cp\u003eMarital status\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 34.0206%;\"\u003e\n \u003cp\u003eMarried\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 18.5567%;\"\u003e\n \u003cp\u003e476\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 14.433%;\"\u003e\n \u003cp\u003e97.1\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 32.9897%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 34.0206%;\"\u003e\n \u003cp\u003eSingle\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 18.5567%;\"\u003e\n \u003cp\u003e10\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 14.433%;\"\u003e\n \u003cp\u003e2\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 32.9897%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 34.0206%;\"\u003e\n \u003cp\u003eWidowed\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 18.5567%;\"\u003e\n \u003cp\u003e3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 14.433%;\"\u003e\n \u003cp\u003e0.6\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 32.9897%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 34.0206%;\"\u003e\n \u003cp\u003eDivorced\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 18.5567%;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 14.433%;\"\u003e\n \u003cp\u003e0.2\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 32.9897%;\"\u003e\n \u003cp\u003eEducational status\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 34.0206%;\"\u003e\n \u003cp\u003eNo formal education\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 18.5567%;\"\u003e\n \u003cp\u003e23\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 14.433%;\"\u003e\n \u003cp\u003e4.7\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 32.9897%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 34.0206%;\"\u003e\n \u003cp\u003ePrimary education\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 18.5567%;\"\u003e\n \u003cp\u003e179\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 14.433%;\"\u003e\n \u003cp\u003e36.5\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 32.9897%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 34.0206%;\"\u003e\n \u003cp\u003eSecondary education\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 18.5567%;\"\u003e\n \u003cp\u003e209\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 14.433%;\"\u003e\n \u003cp\u003e42.7\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 32.9897%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 34.0206%;\"\u003e\n \u003cp\u003eHigher education\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 18.5567%;\"\u003e\n \u003cp\u003e79\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 14.433%;\"\u003e\n \u003cp\u003e16.1\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 32.9897%;\"\u003e\n \u003cp\u003eOccupational status\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 34.0206%;\"\u003e\n \u003cp\u003eHouse wife\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 18.5567%;\"\u003e\n \u003cp\u003e254\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 14.433%;\"\u003e\n \u003cp\u003e51.8\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 32.9897%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 34.0206%;\"\u003e\n \u003cp\u003eSelf employed\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 18.5567%;\"\u003e\n \u003cp\u003e182\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 14.433%;\"\u003e\n \u003cp\u003e37.1\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 32.9897%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 34.0206%;\"\u003e\n \u003cp\u003eGovernment employed\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 18.5567%;\"\u003e\n \u003cp\u003e49\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 14.433%;\"\u003e\n \u003cp\u003e10\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 32.9897%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 34.0206%;\"\u003e\n \u003cp\u003eDaily laborer\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 18.5567%;\"\u003e\n \u003cp\u003e5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 14.433%;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 32.9897%;\"\u003e\n \u003cp\u003eAge\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 34.0206%;\"\u003e\n \u003cp\u003eAge less than 35\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 18.5567%;\"\u003e\n \u003cp\u003e379\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 14.433%;\"\u003e\n \u003cp\u003e77.3\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 32.9897%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 34.0206%;\"\u003e\n \u003cp\u003e35 and above\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 18.5567%;\"\u003e\n \u003cp\u003e111\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 14.433%;\"\u003e\n \u003cp\u003e22.7\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 32.9897%;\"\u003e\n \u003cp\u003eParity\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 34.0206%;\"\u003e\n \u003cp\u003eNulliparous\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 18.5567%;\"\u003e\n \u003cp\u003e189\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 14.433%;\"\u003e\n \u003cp\u003e38.6\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 32.9897%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 34.0206%;\"\u003e\n \u003cp\u003eParous\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 18.5567%;\"\u003e\n \u003cp\u003e301\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 14.433%;\"\u003e\n \u003cp\u003e61.4\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 32.9897%;\"\u003e\n \u003cp\u003eHistory of abortion\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 34.0206%;\"\u003e\n \u003cp\u003eYes\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 18.5567%;\"\u003e\n \u003cp\u003e127\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 14.433%;\"\u003e\n \u003cp\u003e36.9\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 32.9897%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 34.0206%;\"\u003e\n \u003cp\u003eNo\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 18.5567%;\"\u003e\n \u003cp\u003e217\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 14.433%;\"\u003e\n \u003cp\u003e63.1\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 32.9897%;\"\u003e\n \u003cp\u003eHistory of still birth\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 34.0206%;\"\u003e\n \u003cp\u003eYes\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 18.5567%;\"\u003e\n \u003cp\u003e16\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 14.433%;\"\u003e\n \u003cp\u003e5.3\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 32.9897%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 34.0206%;\"\u003e\n \u003cp\u003eNo\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 18.5567%;\"\u003e\n \u003cp\u003e285\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 14.433%;\"\u003e\n \u003cp\u003e94.7\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 32.9897%;\"\u003e\n \u003cp\u003eNumber of pregnancy\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 34.0206%;\"\u003e\n \u003cp\u003eSingle\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 18.5567%;\"\u003e\n \u003cp\u003e466\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 14.433%;\"\u003e\n \u003cp\u003e95.1\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 32.9897%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 34.0206%;\"\u003e\n \u003cp\u003eTwin\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 18.5567%;\"\u003e\n \u003cp\u003e23\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 14.433%;\"\u003e\n \u003cp\u003e4.7\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 32.9897%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 34.0206%;\"\u003e\n \u003cp\u003eTriplet\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 18.5567%;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 14.433%;\"\u003e\n \u003cp\u003e0.2\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp id=\"_Toc188532080\"\u003e5.2. second and third trimester ultrasound scan results.\u003c/p\u003e\n\u003cp\u003eAs shown in table 2 below , the commonest organ system affected by congenital anomaly detected during third trimester scan was Central nervous system (CNS) 9 (30%), followed by Genito urinary system 8 (26.7%) and respiratory system 4 (13.3%). Cardiovascular system, musculoskeletal system, abdomen and face and neck each contribute for 2 (6.7%) anomalies per system. The single most common type of congenital anomaly was Urinary Tract Dilation (UTD) 6 (20%) followed by Chiari 2 malformation 4 (13.3%) and isolated ventriculomegaly 3(10%). Congenital Pulmonary Airway Malformation (CPAM), skeletal dysplasia, diaphragmatic hernia, multi cystic dysplastic kidney disease, abdominal cyst and cleft lip and palate each anomaly contributed for two cases. Besides, ventricular septal defect (VSD), left ventricular hypoplasia, omphalocele, dandy walker malformation and encephalocele each contributed for one (3.3%) anomaly.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eOf the 30 anomalies 20 (66.7%) of them were severe and 10 (33.3%) mild. The mild cases were: 4 (13.3%) UTDs, 2 (6.7%) cleft lip and palate, 2 (6.7%) intra-abdominal cyst and 2 (6.7%) ventriculomegaly. The 6 (20%) cases who were diagnosed in the 2nd trimester and managed expectantly include: 3 UTDs (10%), 2 CPAM 6.7%) and one (3.3%) cleft lip and palate. 3 (10%) fetuses had multiple congenital anomalies. The commonest organ involved in multiple malformation was CNS, where 2 out of the 3 cases of multiple malformation had CNS anomaly (enlarged cisterna magna). The other organs involved in multiple malformations were: cardio vascular system (VSD), skeletal system (upper limb hypoplasia), abdominal wall defect (omphalocele), respiratory system (diaphragmatic hernia) and cord cyst.\u003c/p\u003e\n\u003cp id=\"_Toc193460455\"\u003eTable 2: Frequency distribution of third trimester congenital anomaly by organ system, Y12HMC, Addis Ababa, 2024.\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\" align=\"\" width=\"636\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 27.673%;\"\u003e\n \u003cp\u003e\u003cstrong\u003eVariable\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 50.9434%;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 14.1509%;\"\u003e\n \u003cp\u003e\u003cstrong\u003eNumber\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 7.2327%;\"\u003e\n \u003cp\u003e\u003cstrong\u003e%\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 27.673%;\"\u003e\n \u003cp\u003eCentral nervous system\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 50.9434%;\"\u003e\n \u003cp\u003eChiari 2 malformation\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 14.1509%;\"\u003e\n \u003cp\u003e4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 7.2327%;\"\u003e\n \u003cp\u003e0.8\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 27.673%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 50.9434%;\"\u003e\n \u003cp\u003eVentriculomegaly\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 14.1509%;\"\u003e\n \u003cp\u003e3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 7.2327%;\"\u003e\n \u003cp\u003e0.6\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 27.673%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 50.9434%;\"\u003e\n \u003cp\u003eEncephalocele\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 14.1509%;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 7.2327%;\"\u003e\n \u003cp\u003e0.2\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 27.673%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 50.9434%;\"\u003e\n \u003cp\u003eDandy walker malformation\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 14.1509%;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 7.2327%;\"\u003e\n \u003cp\u003e0.2\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 27.673%;\"\u003e\n \u003cp\u003eGenitourinary system\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 50.9434%;\"\u003e\n \u003cp\u003eUrinary tract dilation\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 14.1509%;\"\u003e\n \u003cp\u003e6\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 7.2327%;\"\u003e\n \u003cp\u003e1.2\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 27.673%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 50.9434%;\"\u003e\n \u003cp\u003eMulti cystic dysplastic kidney disease\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 14.1509%;\"\u003e\n \u003cp\u003e2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 7.2327%;\"\u003e\n \u003cp\u003e0.4\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 27.673%;\"\u003e\n \u003cp\u003eCardiovascular system\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 50.9434%;\"\u003e\n \u003cp\u003eVentricular septal defect with cord cyst and enlarged cisterna magna\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 14.1509%;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 7.2327%;\"\u003e\n \u003cp\u003e0.2\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 27.673%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 50.9434%;\"\u003e\n \u003cp\u003eLeft ventricle hypoplasia\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 14.1509%;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 7.2327%;\"\u003e\n \u003cp\u003e0.2\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 27.673%;\"\u003e\n \u003cp\u003eRespiratory system\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 50.9434%;\"\u003e\n \u003cp\u003eCongenital pulmonary airway malformation\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 14.1509%;\"\u003e\n \u003cp\u003e2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 7.2327%;\"\u003e\n \u003cp\u003e0.4\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 27.673%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 50.9434%;\"\u003e\n \u003cp\u003eDiaphragmatic hernia\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 14.1509%;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 7.2327%;\"\u003e\n \u003cp\u003e0.2\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 27.673%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 50.9434%;\"\u003e\n \u003cp\u003eDiaphragmatic hernia with upper limb hypoplasia\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 14.1509%;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 7.2327%;\"\u003e\n \u003cp\u003e0.2\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 27.673%;\"\u003e\n \u003cp\u003eAbdomen\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 50.9434%;\"\u003e\n \u003cp\u003eIntraabdominal cyst\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 14.1509%;\"\u003e\n \u003cp\u003e2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 7.2327%;\"\u003e\n \u003cp\u003e0.4\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 27.673%;\"\u003e\n \u003cp\u003eAbdominal wall\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 50.9434%;\"\u003e\n \u003cp\u003eOmphalocele with enlarged cisterna magna\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 14.1509%;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 7.2327%;\"\u003e\n \u003cp\u003e0.2\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 27.673%;\"\u003e\n \u003cp\u003eMusculoskeletal\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 50.9434%;\"\u003e\n \u003cp\u003eSkeletal dysplasia\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 14.1509%;\"\u003e\n \u003cp\u003e2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 7.2327%;\"\u003e\n \u003cp\u003e0.4\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 27.673%;\"\u003e\n \u003cp\u003eFace and neck\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 50.9434%;\"\u003e\n \u003cp\u003eCleft lip and palate\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 14.1509%;\"\u003e\n \u003cp\u003e2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 7.2327%;\"\u003e\n \u003cp\u003e0.4\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 27.673%;\"\u003e\n \u003cp\u003eTotal\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 50.9434%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 14.1509%;\"\u003e\n \u003cp\u003e30\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 7.2327%;\"\u003e\n \u003cp\u003e6.1\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003ch2 id=\"_Toc188532081\"\u003e5.3. factors associated with congenital anomaly\u003c/h2\u003e\n\u003cp\u003eAs shown in table 3 below , eighteen (3.7%) mothers had history of chronic illness during pregnancy. The commonest chronic illness was hypertension 8 (1.6%), followed by diabetes 6 (1.2%) and asthma 4 (0.4%). \u0026nbsp;351 (71.6%) mothers had taken periconceptual folic acid. 7 (1.4%) pregnant mothers took unspecified medications early during pregnancy. 14 (2.9%) mothers gave history of alcohol consumption during pregnancy. 5 (1%) mothers had history of khat chewing during pregnancy. 12 (2.4%) mothers had history of herbal medication use during pregnancy, 6 (1.2%) mothers had history of pesticide exposure. \u0026nbsp;4 (0.8%) mothers had history of passive smoking exposure. 19 (3.9%) mothers used surface water has a source for drinking water.\u003c/p\u003e\n\u003cp\u003eAs shown in table 4 below, not taking folic acid periconception was associated with congenital anomaly (P value 0.001. Cramer\u0026apos;s V 0.386 showing strong association). Medication use during pregnancy had association with congenital anomaly (P value 0.006. Cramer\u0026apos;s V 0.184). Advanced maternal age (age 35 and above) was associated with congenital anomaly (P value 0.019, Cramer\u0026apos;s V 0.106).\u003c/p\u003e\n\u003cp\u003eTable 3: Frequency distribution of associated factors to congenital anomaly, Y12HMC, Addis Ababa, 2024.\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\" align=\"\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 41.7582%;\"\u003e\n \u003cp\u003e\u003cstrong\u003eVariable\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 28.5714%;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 17.5824%;\"\u003e\n \u003cp\u003e\u003cstrong\u003eNumber\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 12.0879%;\"\u003e\n \u003cp\u003e\u003cstrong\u003e%\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 41.7582%;\"\u003e\n \u003cp\u003eFolic acid use\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 28.5714%;\"\u003e\n \u003cp\u003eYes\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 17.5824%;\"\u003e\n \u003cp\u003e351\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 12.0879%;\"\u003e\n \u003cp\u003e71.6\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 41.7582%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 28.5714%;\"\u003e\n \u003cp\u003eNo\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 17.5824%;\"\u003e\n \u003cp\u003e139\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 12.0879%;\"\u003e\n \u003cp\u003e28.4\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 41.7582%;\"\u003e\n \u003cp\u003eMedication use\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 28.5714%;\"\u003e\n \u003cp\u003eYes\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 17.5824%;\"\u003e\n \u003cp\u003e7\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 12.0879%;\"\u003e\n \u003cp\u003e1.4\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 41.7582%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 28.5714%;\"\u003e\n \u003cp\u003eNo\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 17.5824%;\"\u003e\n \u003cp\u003e483\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 12.0879%;\"\u003e\n \u003cp\u003e98.6\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 41.7582%;\"\u003e\n \u003cp\u003eChronic illness\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 28.5714%;\"\u003e\n \u003cp\u003eYes\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 17.5824%;\"\u003e\n \u003cp\u003e18\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 12.0879%;\"\u003e\n \u003cp\u003e3.7\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 41.7582%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 28.5714%;\"\u003e\n \u003cp\u003eNo\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 17.5824%;\"\u003e\n \u003cp\u003e472\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 12.0879%;\"\u003e\n \u003cp\u003e96.3\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 41.7582%;\"\u003e\n \u003cp\u003eType of chronic illness\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 28.5714%;\"\u003e\n \u003cp\u003eHypertension\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 17.5824%;\"\u003e\n \u003cp\u003e8\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 12.0879%;\"\u003e\n \u003cp\u003e1.6\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 41.7582%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 28.5714%;\"\u003e\n \u003cp\u003eDiabetes\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 17.5824%;\"\u003e\n \u003cp\u003e6\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 12.0879%;\"\u003e\n \u003cp\u003e1.2\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 41.7582%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 28.5714%;\"\u003e\n \u003cp\u003eAsthma\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 17.5824%;\"\u003e\n \u003cp\u003e2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 12.0879%;\"\u003e\n \u003cp\u003e0.4\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 41.7582%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 28.5714%;\"\u003e\n \u003cp\u003eHyperthyroidism\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 17.5824%;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 12.0879%;\"\u003e\n \u003cp\u003e0.2\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 41.7582%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 28.5714%;\"\u003e\n \u003cp\u003eHypothyroidism\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 17.5824%;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 12.0879%;\"\u003e\n \u003cp\u003e0.2\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 41.7582%;\"\u003e\n \u003cp\u003eAlcohol consumption\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 28.5714%;\"\u003e\n \u003cp\u003eYes\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 17.5824%;\"\u003e\n \u003cp\u003e14\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 12.0879%;\"\u003e\n \u003cp\u003e2.9\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 41.7582%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 28.5714%;\"\u003e\n \u003cp\u003eNo\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 17.5824%;\"\u003e\n \u003cp\u003e476\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 12.0879%;\"\u003e\n \u003cp\u003e97.1\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 41.7582%;\"\u003e\n \u003cp\u003eKhat chewing\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 28.5714%;\"\u003e\n \u003cp\u003eYes\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 17.5824%;\"\u003e\n \u003cp\u003e5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 12.0879%;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 41.7582%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 28.5714%;\"\u003e\n \u003cp\u003eNo\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 17.5824%;\"\u003e\n \u003cp\u003e485\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 12.0879%;\"\u003e\n \u003cp\u003e99\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 41.7582%;\"\u003e\n \u003cp\u003eHerbal medication use\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 28.5714%;\"\u003e\n \u003cp\u003eYes\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 17.5824%;\"\u003e\n \u003cp\u003e12\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 12.0879%;\"\u003e\n \u003cp\u003e2.4\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 41.7582%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 28.5714%;\"\u003e\n \u003cp\u003eNo\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 17.5824%;\"\u003e\n \u003cp\u003e478\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 12.0879%;\"\u003e\n \u003cp\u003e97.6\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 41.7582%;\"\u003e\n \u003cp\u003ePesticide exposure\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 28.5714%;\"\u003e\n \u003cp\u003eYes\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 17.5824%;\"\u003e\n \u003cp\u003e6\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 12.0879%;\"\u003e\n \u003cp\u003e1.2\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 41.7582%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 28.5714%;\"\u003e\n \u003cp\u003eNo\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 17.5824%;\"\u003e\n \u003cp\u003e484\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 12.0879%;\"\u003e\n \u003cp\u003e98.8\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 41.7582%;\"\u003e\n \u003cp\u003ePassive smoking\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 28.5714%;\"\u003e\n \u003cp\u003eYes\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 17.5824%;\"\u003e\n \u003cp\u003e4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 12.0879%;\"\u003e\n \u003cp\u003e0.8\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 41.7582%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 28.5714%;\"\u003e\n \u003cp\u003eNo\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 17.5824%;\"\u003e\n \u003cp\u003e486\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 12.0879%;\"\u003e\n \u003cp\u003e99.2\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 41.7582%;\"\u003e\n \u003cp\u003eDrinking water source\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 28.5714%;\"\u003e\n \u003cp\u003ePiped water\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 17.5824%;\"\u003e\n \u003cp\u003e371\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 12.0879%;\"\u003e\n \u003cp\u003e75.7\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 41.7582%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 28.5714%;\"\u003e\n \u003cp\u003eProtected well\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 17.5824%;\"\u003e\n \u003cp\u003e56\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 12.0879%;\"\u003e\n \u003cp\u003e11.4\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 41.7582%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 28.5714%;\"\u003e\n \u003cp\u003eBottled water\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 17.5824%;\"\u003e\n \u003cp\u003e44\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 12.0879%;\"\u003e\n \u003cp\u003e9\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 41.7582%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 28.5714%;\"\u003e\n \u003cp\u003eSurface water\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 17.5824%;\"\u003e\n \u003cp\u003e19\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 12.0879%;\"\u003e\n \u003cp\u003e3.9\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003eTable 4: Chi square test analysis of associated factors to congenital anomaly, Y12HMC Addis Ababa, 2024.\u0026nbsp;\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\" align=\"\" width=\"750\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 21.6%;\"\u003e\u003cstrong\u003e\u003cbr\u003e\u0026nbsp;\u003c/strong\u003e\u0026nbsp;\u003cp\u003e\u003cstrong\u003eVariable\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 14.4%;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" valign=\"top\" style=\"width: 29.6%;\"\u003e\n \u003cp\u003e\u003cstrong\u003eCongenital anomaly\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 10.4%;\"\u003e\n \u003cp\u003e\u003cstrong\u003eTotal (%)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 8.8%;\"\u003e\n \u003cp\u003e\u003cstrong\u003eP value\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 15.2%;\"\u003e\n \u003cp\u003e\u003cstrong\u003eCramer\u0026rsquo;s V\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 21.6%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 14.4%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 13.6%;\"\u003e\n \u003cp\u003e\u003cstrong\u003eYes (n=30)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 16%;\"\u003e\n \u003cp\u003e\u003cstrong\u003eNo(n=460)\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 10.4%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 8.8%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 15.2%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 21.6%;\"\u003e\n \u003cp\u003eFolic acid use\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 14.4%;\"\u003e\n \u003cp\u003eYes\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 13.6%;\"\u003e\n \u003cp\u003e2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 16%;\"\u003e\n \u003cp\u003e349\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 10.4%;\"\u003e\n \u003cp\u003e351(71.6)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 8.8%;\"\u003e\n \u003cp\u003e0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 15.2%;\"\u003e\n \u003cp\u003e0.368\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 21.6%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 14.4%;\"\u003e\n \u003cp\u003eNo\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 13.6%;\"\u003e\n \u003cp\u003e28\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 16%;\"\u003e\n \u003cp\u003e111\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 10.4%;\"\u003e\n \u003cp\u003e139(28.4)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 8.8%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 15.2%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 21.6%;\"\u003e\n \u003cp\u003eMedication use\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 14.4%;\"\u003e\n \u003cp\u003eYes\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 13.6%;\"\u003e\n \u003cp\u003e3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 16%;\"\u003e\n \u003cp\u003e4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 10.4%;\"\u003e\n \u003cp\u003e7(1.4)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 8.8%;\"\u003e\n \u003cp\u003e0.006\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 15.2%;\"\u003e\n \u003cp\u003e0.184\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 21.6%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 14.4%;\"\u003e\n \u003cp\u003eNo\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 13.6%;\"\u003e\n \u003cp\u003e27\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 16%;\"\u003e\n \u003cp\u003e456\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 10.4%;\"\u003e\n \u003cp\u003e483(98.6)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 8.8%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 15.2%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 21.6%;\"\u003e\n \u003cp\u003eChronic illness\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 14.4%;\"\u003e\n \u003cp\u003eYes\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 13.6%;\"\u003e\n \u003cp\u003e2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 16%;\"\u003e\n \u003cp\u003e16\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 10.4%;\"\u003e\n \u003cp\u003e18(3.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 8.8%;\"\u003e\n \u003cp\u003e0.303\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 15.2%;\"\u003e\n \u003cp\u003e0.041\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 21.6%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 14.4%;\"\u003e\n \u003cp\u003eNo\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 13.6%;\"\u003e\n \u003cp\u003e28\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 16%;\"\u003e\n \u003cp\u003e444\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 10.4%;\"\u003e\n \u003cp\u003e472(96.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 8.8%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 15.2%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 21.6%;\"\u003e\n \u003cp\u003eAge\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 14.4%;\"\u003e\n \u003cp\u003e\u0026ge;35yrs\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 13.6%;\"\u003e\n \u003cp\u003e12\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 16%;\"\u003e\n \u003cp\u003e99\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 10.4%;\"\u003e\n \u003cp\u003e111(22.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 8.8%;\"\u003e\n \u003cp\u003e0.019\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 15.2%;\"\u003e\n \u003cp\u003e0.106\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 21.6%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 14.4%;\"\u003e\n \u003cp\u003eBelow 35yrs\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 13.6%;\"\u003e\n \u003cp\u003e18\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 16%;\"\u003e\n \u003cp\u003e361\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 10.4%;\"\u003e\n \u003cp\u003e379(77.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 8.8%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 15.2%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 21.6%;\"\u003e\n \u003cp\u003eParity\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 14.4%;\"\u003e\n \u003cp\u003eNulliparous\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 13.6%;\"\u003e\n \u003cp\u003e10\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 16%;\"\u003e\n \u003cp\u003e179\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 10.4%;\"\u003e\n \u003cp\u003e189(38.6)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 8.8%;\"\u003e\n \u003cp\u003e0.543\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 15.2%;\"\u003e\n \u003cp\u003e0.027\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 21.6%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 14.4%;\"\u003e\n \u003cp\u003eParous \u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 13.6%;\"\u003e\n \u003cp\u003e20\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 16%;\"\u003e\n \u003cp\u003e281\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 10.4%;\"\u003e\n \u003cp\u003e301(61.4)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 8.8%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 15.2%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 21.6%;\"\u003e\n \u003cp\u003eAlcohol consumption\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 14.4%;\"\u003e\n \u003cp\u003eYes\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 13.6%;\"\u003e\n \u003cp\u003e2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 16%;\"\u003e\n \u003cp\u003e12\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 10.4%;\"\u003e\n \u003cp\u003e14(2.9)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 8.8%;\"\u003e\n \u003cp\u003e0.209\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 15.2%;\"\u003e\n \u003cp\u003e0.058\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 21.6%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 14.4%;\"\u003e\n \u003cp\u003eNo\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 13.6%;\"\u003e\n \u003cp\u003e28\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 16%;\"\u003e\n \u003cp\u003e448\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 10.4%;\"\u003e\n \u003cp\u003e476(97.1)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 8.8%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 15.2%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 21.6%;\"\u003e\n \u003cp\u003eKhat chewing\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 14.4%;\"\u003e\n \u003cp\u003eYes\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 13.6%;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 16%;\"\u003e\n \u003cp\u003e4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 10.4%;\"\u003e\n \u003cp\u003e5(1)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 8.8%;\"\u003e\n \u003cp\u003e0.272\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 15.2%;\"\u003e\n \u003cp\u003e0.059\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 21.6%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 14.4%;\"\u003e\n \u003cp\u003eNo\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 13.6%;\"\u003e\n \u003cp\u003e29\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 16%;\"\u003e\n \u003cp\u003e456\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 10.4%;\"\u003e\n \u003cp\u003e485(99)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 8.8%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 15.2%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 21.6%;\"\u003e\n \u003cp\u003eHerbal medication use\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 14.4%;\"\u003e\n \u003cp\u003eYes\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 13.6%;\"\u003e\n \u003cp\u003e2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 16%;\"\u003e\n \u003cp\u003e10\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 10.4%;\"\u003e\n \u003cp\u003e12(2.4)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 8.8%;\"\u003e\n \u003cp\u003e0.163\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 15.2%;\"\u003e\n \u003cp\u003e0.07\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 21.6%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 14.4%;\"\u003e\n \u003cp\u003eNo\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 13.6%;\"\u003e\n \u003cp\u003e28\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 16%;\"\u003e\n \u003cp\u003e450\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 10.4%;\"\u003e\n \u003cp\u003e478(97.6)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 8.8%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 15.2%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 21.6%;\"\u003e\n \u003cp\u003ePesticide exposure\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 14.4%;\"\u003e\n \u003cp\u003eYes\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 13.6%;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 16%;\"\u003e\n \u003cp\u003e5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 10.4%;\"\u003e\n \u003cp\u003e6(1.2)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 8.8%;\"\u003e\n \u003cp\u003e0.317\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 15.2%;\"\u003e\n \u003cp\u003e0.049\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 21.6%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 14.4%;\"\u003e\n \u003cp\u003eNo\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 13.6%;\"\u003e\n \u003cp\u003e29\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 16%;\"\u003e\n \u003cp\u003e455\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 10.4%;\"\u003e\n \u003cp\u003e484(98.8)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 8.8%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 15.2%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 21.6%;\"\u003e\n \u003cp\u003ePassive smoking\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 14.4%;\"\u003e\n \u003cp\u003eYes\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 13.6%;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 16%;\"\u003e\n \u003cp\u003e3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 10.4%;\"\u003e\n \u003cp\u003e4(0.8)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 8.8%;\"\u003e\n \u003cp\u003e0.224\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 15.2%;\"\u003e\n \u003cp\u003e0.071\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 21.6%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 14.4%;\"\u003e\n \u003cp\u003eNo\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 13.6%;\"\u003e\n \u003cp\u003e29\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 16%;\"\u003e\n \u003cp\u003e457\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 10.4%;\"\u003e\n \u003cp\u003e486(99.2)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 8.8%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 15.2%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 21.6%;\"\u003e\n \u003cp\u003eHistory of abortion\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 14.4%;\"\u003e\n \u003cp\u003eYes\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 13.6%;\"\u003e\n \u003cp\u003e8\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 16%;\"\u003e\n \u003cp\u003e119\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 10.4%;\"\u003e\n \u003cp\u003e127(36.9)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 8.8%;\"\u003e\n \u003cp\u003e0.956\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 15.2%;\"\u003e\n \u003cp\u003e0.003\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 21.6%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 14.4%;\"\u003e\n \u003cp\u003eNo\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 13.6%;\"\u003e\n \u003cp\u003e14\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 16%;\"\u003e\n \u003cp\u003e203\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 10.4%;\"\u003e\n \u003cp\u003e217(63.1)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 8.8%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 15.2%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 21.6%;\"\u003e\n \u003cp\u003eHistory of stillbirth\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 14.4%;\"\u003e\n \u003cp\u003eYes\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 13.6%;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 16%;\"\u003e\n \u003cp\u003e15\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 10.4%;\"\u003e\n \u003cp\u003e16(5.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 8.8%;\"\u003e\n \u003cp\u003e1.00\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 15.2%;\"\u003e\n \u003cp\u003e0.007\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 21.6%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 14.4%;\"\u003e\n \u003cp\u003eNo\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 13.6%;\"\u003e\n \u003cp\u003e20\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 16%;\"\u003e\n \u003cp\u003e265\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 10.4%;\"\u003e\n \u003cp\u003e285(94.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 8.8%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 15.2%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 21.6%;\"\u003e\n \u003cp\u003eDrinking water source\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 14.4%;\"\u003e\n \u003cp\u003ePiped water\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 13.6%;\"\u003e\n \u003cp\u003e22\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 16%;\"\u003e\n \u003cp\u003e349\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 10.4%;\"\u003e\n \u003cp\u003e371(75.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 8.8%;\"\u003e\n \u003cp\u003e0.286\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 15.2%;\"\u003e\n \u003cp\u003e0.088\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 21.6%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 14.4%;\"\u003e\n \u003cp\u003eProtected well\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 13.6%;\"\u003e\n \u003cp\u003e2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 16%;\"\u003e\n \u003cp\u003e54\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 10.4%;\"\u003e\n \u003cp\u003e56(11.4)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 8.8%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 15.2%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 21.6%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 14.4%;\"\u003e\n \u003cp\u003eBottled water\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 13.6%;\"\u003e\n \u003cp\u003e3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 16%;\"\u003e\n \u003cp\u003e41\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 10.4%;\"\u003e\n \u003cp\u003e44(9)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 8.8%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 15.2%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 21.6%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 14.4%;\"\u003e\n \u003cp\u003eSurface water\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 13.6%;\"\u003e\n \u003cp\u003e3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 16%;\"\u003e\n \u003cp\u003e16\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 10.4%;\"\u003e\n \u003cp\u003e19(3.9)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 8.8%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 15.2%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e"},{"header":"6. Discussion ","content":"\u003cp\u003eDuring the study period from July 1 to December 30, 20 24 at Y12HMC/AGH, a total of 490 third trimester ultrasound scans were performed. Thirty congenital anomalies detected during the 3rd trimester scan, making the incidence 6.1%. Of these. The prevalence of 3rd tri congenital anomaly is high when compared to studies done in different parts of Ethiopia. \u0026nbsp;Studies done in \u0026nbsp; Jimma, Bishoftu and north west Ethiopia found that the prevalence of congenital anomaly was 4.1%, 1% and 1.6% respectively [20]\u0026nbsp;[22]\u0026nbsp;[24]. This difference may be explained by Y12HMC is referral hospital with MFM unit where most of high-risk pregnancies and mothers with congenital anomaly fetuses are referred for management as well since the study is a hospital-based study it might have impact on overestimation of prevalence; besides most of the above studies determined prevalence by diagnosing overt anomaly at birth which might tend to miss internal anomalies that can be diagnosed by prenatal imaging.\u003c/p\u003e\n\u003cp\u003eIn addition, the prevalence by this study is still higher when it is compared to other African countries and worldwide ; prevalence in \u0026nbsp; USA 3%, India 2.5%, UK 2 to3% and Japan 1%\u0026nbsp;[25]\u0026nbsp;[27]\u0026nbsp;[26]. While a pooled prevalence in Africa 2.3%\u0026nbsp;[18] [19].\u003c/p\u003e\n\u003cp\u003e\u0026nbsp;The high prevalence of this study will be more remarkable when it is compared to studies which reported 3rd tri congenital anomaly separately as the pooled prevalence of 3rd trimester anomaly was found to be 0.3% from a systematic review study\u0026nbsp;[16]. \u0026nbsp;While a study done in kings\u0026rsquo; college, UK from ultrasound done at 35 to 37weeks of gestation the prevalence of congenital anomalies was 1.9%. And for the 1st time diagnosed abnormalities in 3rd tri was 0.5% versus first time detected 3rd tri anomaly prevalence of 4.9% in this study [7]. All these variations in the prevalence of congenital anomaly can be explained by social, ecological, racial and economic influences.\u003c/p\u003e\n\u003cp\u003eThe commonest organ system affected by congenital anomaly detected during third trimester scan was Central nervous system (CNS) 9 (30%). \u0026nbsp; This finding similar to other studies in North West Ethiopia, Jimma, Bishoftu, Amhara and Addis Ababa where the commonest organ system affected is CNS. CNS being the most common affected organ is in line with the fact that not taking periconceptual folic acid is associated with CNS malformations particularly neural tube defects which is shared finding of these studies\u0026nbsp;[20] [21] [22] [24].\u003c/p\u003e\n\u003cp\u003eThough CNS is the commonest organ affected collectively; by third tri ultrasound detected specific congenital anomaly type, the single most common type of congenital anomaly identified was Urinary Tract Dilation (UTD) 6 (20%) followed by Chiari 2 malformation 4 (13.3%) and isolated ventriculomegaly 3 (10%). Congenital Pulmonary Airway Malformation (CPAM), skeletal dysplasia, diaphragmatic hernia, multi cystic dysplastic kidney disease, abdominal cyst and cleft lip and palate each anomaly contributed for two cases. Besides, ventricular septal defect (VSD), left ventricular hypoplasia, omphalocele, dandy walker malformation and encephalocele each contributed for one anomaly. The distribution and variety of specific congenital anomaly type detected in this study is comparable with the findings of other studies which were done on congenital anomaly detection by 3rd tri ultrasound scan; A systematic review of 13 studies found the commonest 3rd trimester anomaly type was urinary tract dilatation, ventriculomegaly and cardiac defects\u0026nbsp;[16]. In another 3rd tri ultrasound scan study done in kings\u0026rsquo; college, UK from ultrasound done at 35 to 37weeks of gestation the most common abnormalities diagnosed in the 3rd tri include: hydronephrosis (urinary tract dilation), ventriculomegaly, duplex kidney, ventricular septal defect, ovarian cyst (abdominal cyst), arachnoid cyst, hematocolpus and microcephaly\u0026nbsp;[7]. The minor differences in type of detection might be attributed to the expertise level of the sonographer, the quality of ultrasound machine used and possibly patient characteristics.\u003c/p\u003e\n\u003cp\u003e\u0026nbsp;Three fetuses had multiple congenital anomalies. The commonest organ involved in multiple malformation was CNS (enlarged cisterna magna) in two out of the three cases. The other organs involved in multiple malformations were: cardio vascular system (VSD), skeletal system (upper limb hypoplasia), abdominal wall defect (omphalocele), respiratory system (diaphragmatic hernia) and cord cyst; by comparison the 3rd tri ultrasound scan study done \u0026nbsp;in kings college identified more or less similar pattern of organs involved by multiple malformation: CNS, cardiovascular, skeletal dysplasia and genitourinary system\u0026nbsp;[7].\u003c/p\u003e\n\u003cp\u003eNot taking folic acid periconception is associated with congenital anomaly (P value 0.001. Cramer\u0026apos;s V 0.386 showing strong association) and Medication use during pregnancy had association with congenital anomaly (P value 0.006. Cramer\u0026apos;s V 0.184 showing weak association) this finding is in line with studies done in South West Ethiopia, North West Ethiopia, Addis Ababa and Amhara region where all these studies found \u0026nbsp;not taking folic acid and medication use early in pregnancy have significant association with congenital anomaly\u0026nbsp;[20] [23] [24]. While a study done in Nigeria didn\u0026apos;t find any association [18]. Advanced maternal age (age 35 and above) is associated with congenital anomaly (P value 0.019. Cramer\u0026apos;s V 0.106 showing weak association). \u0026nbsp;A study done in Bishoftu showed similar finding where advanced maternal age is associated with congenital anomaly\u0026nbsp;[22].\u003c/p\u003e\n\u003cp\u003eIn this study alcohol use, \u0026nbsp;khat chewing, passive smoking, chronic illness, surface water use, history of abortion and history of still birth didn\u0026rsquo;t show association with congenital anomaly while a systematic review done in \u0026nbsp;Africa showed chronic illness, \u0026nbsp;alcohol use and khat chewing during pregnancy were associated with congenital anomaly [19], from a study in Southwest Ethiopia pesticide exposure, surface water use and passive smoking were associated with congenital anomaly [23]. These differences might arise from study population variation in terms of religious views, cultural norms, social customs and environmental exposures.\u003c/p\u003e"},{"header":"7. Strength and Limitations of the study","content":"\u003cp\u003e7.1 Strength\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e1) Data was collected prospectively which increases reliability of findings\u003c/p\u003e\n\u003cp\u003e2) 3rd tri ultrasound scan was done by highly qualified physicians: MFMF and abnormal findings were confirmed by MFM consultants.\u003c/p\u003e\n\u003cp\u003e3) taking the relatively rarity of congenital anomaly using chi square for analysis best suits for association detection.\u003c/p\u003e\n\u003cp\u003e7.2 Limitations of the study:\u003c/p\u003e\n\u003cp\u003e1) data was collected from referral hospital which might inflate prevalence.\u003c/p\u003e\n\u003cp\u003e2) study was done on a single hospital with small sample size which might not be representative.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e3) since analysis was done by chi square test confounding variables cannot be controlled for associated factors.\u003c/p\u003e"},{"header":"8. Conclusion","content":"\u003cp\u003eHigh prevalence of third trimester congenital anomaly detected in this study. CNS was the commonest organ affected by 3rd tri congenital anomaly while urinary tract dilation is the single most commonly identified type of congenital anomaly. Not using folic acid, medication use early during pregnancy and advanced maternal age are associated with congenital malformations.\u003c/p\u003e"},{"header":"9. Recommendation","content":"\u003cp\u003eFor clinicians and sonographers: emphasis shall be given for\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003esystematic evaluation of the fetal anatomy during routine third trimester scan for better antenatal detection of congenital anomalies\u003cstrong\u003e.\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eFor policy makers and stake holders: further large-scale studies should be done to generate more information on the role of third trimester ultrasound scan in detection of congenital anomalies so that it might be included in the usual clinical practice.\u003c/p\u003e"},{"header":"Abbreviations","content":"\u003cp\u003eAIUM \u0026hellip;\u0026hellip;\u0026hellip;\u0026hellip;\u0026hellip;\u0026hellip;\u0026hellip;\u0026hellip;\u0026hellip;\u0026hellip;...American Institute of Ultrasound in Medicine.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eAGH\u0026hellip;\u0026hellip;\u0026hellip;\u0026hellip;\u0026hellip;\u0026hellip;\u0026hellip;\u0026hellip;\u0026hellip;\u0026hellip;\u0026hellip;\u0026hellip;Abebech Gobena Hospital\u003c/p\u003e\n\u003cp\u003eANC\u0026hellip;\u0026hellip;\u0026hellip;\u0026hellip;\u0026hellip;\u0026hellip;\u0026hellip;\u0026hellip;\u0026hellip;\u0026hellip;\u0026hellip;\u0026hellip;\u0026hellip;\u0026hellip;\u0026hellip;\u0026hellip;\u0026hellip;\u0026hellip;\u0026hellip;\u0026hellip;\u0026hellip;\u0026hellip;\u0026hellip;\u0026hellip;Antenatal Care\u003c/p\u003e\n\u003cp\u003eISUOG \u0026hellip;\u0026hellip;\u0026hellip;. International Society of Ultrasound in Obstetrics and Gynecology\u003c/p\u003e\n\u003cp\u003eMFM \u0026hellip;\u0026hellip;\u0026hellip;\u0026hellip;\u0026hellip;\u0026hellip;\u0026hellip;\u0026hellip;\u0026hellip;\u0026hellip;\u0026hellip;\u0026hellip;\u0026hellip;\u0026hellip;\u0026hellip;\u0026hellip;\u0026hellip;\u0026hellip;\u0026hellip;\u0026hellip;. Maternal Fetal Medicine\u003c/p\u003e\n\u003cp\u003eMFMF\u0026hellip;\u0026hellip;\u0026hellip;\u0026hellip;\u0026hellip;\u0026hellip;\u0026hellip;\u0026hellip;\u0026hellip;\u0026hellip;\u0026hellip;\u0026hellip;\u0026hellip;\u0026hellip;\u0026hellip;\u0026hellip;\u0026hellip;\u0026hellip;\u0026hellip;\u0026hellip;. Maternal Fetal Medicine Fellow\u003c/p\u003e\n\u003cp\u003eNIH\u0026hellip;\u0026hellip;\u0026hellip;\u0026hellip;\u0026hellip;\u0026hellip;\u0026hellip;\u0026hellip;\u0026hellip;\u0026hellip;\u0026hellip;\u0026hellip;\u0026hellip;\u0026hellip;\u0026hellip;\u0026hellip;\u0026hellip;\u0026hellip;\u0026hellip;. National Institute of Health\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eOBGYN\u0026hellip;\u0026hellip;\u0026hellip;\u0026hellip;\u0026hellip;\u0026hellip;\u0026hellip;\u0026hellip;\u0026hellip;\u0026hellip;\u0026hellip;\u0026hellip;\u0026hellip;\u0026hellip;\u0026hellip;\u0026hellip;\u0026hellip; Obstetrician and Gynecologist\u003c/p\u003e\n\u003cp\u003eSPSS\u0026hellip;\u0026hellip;\u0026hellip;\u0026hellip;\u0026hellip;\u0026hellip;\u0026hellip;\u0026hellip;\u0026hellip;\u0026hellip;\u0026hellip;\u0026hellip;\u0026hellip;\u0026hellip;.\u0026hellip;Statistical Software for Social Sciences\u003c/p\u003e\n\u003cp\u003eTRI\u0026hellip;\u0026hellip;\u0026hellip;\u0026hellip;\u0026hellip;\u0026hellip;\u0026hellip;\u0026hellip;\u0026hellip;\u0026hellip;\u0026hellip;\u0026hellip;\u0026hellip;\u0026hellip;\u0026hellip;\u0026hellip;. Trimester\u003c/p\u003e\n\u003cp\u003eUK \u0026hellip;\u0026hellip;\u0026hellip;\u0026hellip;\u0026hellip;\u0026hellip;\u0026hellip;\u0026hellip;\u0026hellip;\u0026hellip;\u0026hellip;\u0026hellip;\u0026hellip;\u0026hellip;\u0026hellip;\u0026hellip;\u0026hellip;\u0026hellip;\u0026hellip;\u0026hellip;\u0026hellip;\u0026hellip;\u0026hellip;. United Kingdom\u003c/p\u003e\n\u003cp\u003eUS \u0026hellip;\u0026hellip;\u0026hellip;\u0026hellip;\u0026hellip;\u0026hellip;\u0026hellip;\u0026hellip;\u0026hellip;\u0026hellip;\u0026hellip;\u0026hellip;\u0026hellip;\u0026hellip;\u0026hellip;\u0026hellip;\u0026hellip;\u0026hellip;\u0026hellip;\u0026hellip;\u0026hellip;\u0026hellip;\u0026hellip;\u0026hellip;\u0026hellip;\u0026hellip;Ultrasound\u003c/p\u003e\n\u003cp\u003eWHO \u0026hellip;\u0026hellip;\u0026hellip;\u0026hellip;\u0026hellip;\u0026hellip;\u0026hellip;\u0026hellip;\u0026hellip;\u0026hellip;\u0026hellip;\u0026hellip;\u0026hellip;\u0026hellip;\u0026hellip;\u0026hellip;\u0026hellip;\u0026hellip;\u0026hellip;World Health Organization\u003c/p\u003e\n\u003cp\u003eY12HMC \u0026hellip;\u0026hellip;\u0026hellip;\u0026hellip;\u0026hellip;\u0026hellip;\u0026hellip;\u0026hellip;\u0026hellip;\u0026hellip;\u0026hellip;\u0026hellip;\u0026hellip;\u0026hellip;\u0026hellip;. \u0026nbsp;Yekatit 12 Hospital Medical College\u003c/p\u003e\n\u003cp\u003eCNS\u0026hellip;\u0026hellip;\u0026hellip;\u0026hellip;\u0026hellip;\u0026hellip;\u0026hellip;\u0026hellip;\u0026hellip;\u0026hellip;\u0026hellip;\u0026hellip;\u0026hellip;\u0026hellip;.. Central Nervous System\u003c/p\u003e\n\u003cp\u003eVSD\u0026hellip;\u0026hellip;\u0026hellip;\u0026hellip;\u0026hellip;\u0026hellip;\u0026hellip;\u0026hellip;\u0026hellip;\u0026hellip;\u0026hellip;\u0026hellip;\u0026hellip;\u0026hellip;. Ventricular Septal defect\u003c/p\u003e\n\u003cp\u003eUTD\u0026hellip;\u0026hellip;\u0026hellip;\u0026hellip;\u0026hellip;\u0026hellip;\u0026hellip;\u0026hellip;\u0026hellip;\u0026hellip;\u0026hellip;\u0026hellip;\u0026hellip;\u0026hellip;. Urinary Tract Dilation\u003c/p\u003e\n\u003cp\u003eCPAM\u0026hellip;\u0026hellip;\u0026hellip;\u0026hellip;\u0026hellip;\u0026hellip;\u0026hellip;\u0026hellip;\u0026hellip;\u0026hellip;\u0026hellip;\u0026hellip;\u0026hellip;.. Congenital Pulmonary Airway Malformations\u003c/p\u003e\n\u003cp\u003eMCDKD\u0026hellip;\u0026hellip;\u0026hellip;\u0026hellip;\u0026hellip;\u0026hellip;\u0026hellip;\u0026hellip;\u0026hellip;\u0026hellip;\u0026hellip;\u0026hellip;. Multi cystic Dysplastic Kidney Disease\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eEthics approval and consent to participate:\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eEthical approval was obtained before the actual data collection in accordance with the Declaration of Helsinki from Yekatit 12 Hospital Medical College Institutional Review Board. Consent was taken from each participant after ascertaining their willingness to participate in the study.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConsent for publication:\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNot applicable\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAvailability of data and materials:\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe datasets used and/or analyzed during this study are available from the corresponding author on reasonable request.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eCompeting interests:\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe authors declare that they have no competing interests.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFunding:\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNo funding to the study received\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthors\u0026apos; contributions:\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTB:\u0026nbsp;\u003c/strong\u003econtributed on writing the proposal, data collection, doing analysis, result and discussion write up.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eEM:\u0026nbsp;\u003c/strong\u003econtributed on study design, sample size calculation, chi-square test analysis.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eBK:\u0026nbsp;\u003c/strong\u003econtributed on conceptual framework, objective development, and editing\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eEG:\u003c/strong\u003e contributed on data collection, operational definition, developing introduction, and abstract.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eKH:\u0026nbsp;\u003c/strong\u003econtributed on editing proposal and thesis, writing literature review, conclusion and recommendation.\u003c/p\u003e\n\u003ch2\u003eAcknowledgement\u003c/h2\u003e\n\u003cp\u003eI would like to express my appreciation to the department of Obstetrics and Gynecology of Abebech Gobena Maternity and Children Hospital for giving me an opportunity to research on my topic of interest.\u003c/p\u003e\n\u003cp\u003eI want to extend my gratitude to my coauthors: 1. Dr. Ephrem Mamo, 2 Dr Birhanu Kebede, 3. Dr Eyob Gelan and 4. Kokeb Haile for their contribution in the development of this thesis.\u003c/p\u003e\n\u003cp\u003eI am thankful to my family for their love, encouragement and support.\u003c/p\u003e\n\u003cp\u003eI am also grateful to the study participants with out whom realization of the study would have been impossible.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\n\u003cli\u003e\u0026quot;WHO recomendations on Antenatal Care for a Positive Pregnancy Experience,\u0026quot; 2016. [Online]. Available: http://www.who.int.\u003c/li\u003e\n\u003cli\u003eZ. A. V. B. e. a. Salmon L, \u0026quot;ISOUG Practice Guideline: performance the routine mid trimester ultrasound scan,\u0026quot; Ultrasound Obstet Gynecol, vol. 59, pp. 840-856, 2022. \u003c/li\u003e\n\u003cli\u003eS. M. J. Jabaz D, \u0026quot;Sonography , second trimester assessment, protocols and interpretation,\u0026quot; Statpearls publishing, 2024, January. \u003c/li\u003e\n\u003cli\u003eM. P. L. T. e. a. Canavan T, \u0026quot;AIUM Practice Parameter for Performance of Standard Diagnostic Obstetric ultrasound,\u0026quot; J ultrasound Med, vol. 9999, pp. 1-13, 2024. \u003c/li\u003e\n\u003cli\u003eJ. A. L. L. e. a. Charles J, Creasy and Rensnik\u0026quot;s Maternal Fetal Medicine Principe and Practice, Philadelphia: Imprint of Elsevier Inc, 2024. \u003c/li\u003e\n\u003cli\u003eL. M. V. A. e. a. Marry E, Callen\u0026quot;s Ultrasonography in Obstetrics and Gynecology, Philadelphia: Elsevier Inc, 2017. \u003c/li\u003e\n\u003cli\u003eF. A. S. A. e. a. Nicolaides K, \u0026quot;Value of Routine Ultrasound Examination at 35 -37 weeks\u0026quot;s gestation in Diagnosis of Fetal Abnormalities,\u0026quot; Ultrasound Obstet Gynecol, vol. 10, no. uog.20857, p. 1002, 2019. \u003c/li\u003e\n\u003cli\u003eS. R. P. I. e. a. Butt F, \u0026quot;Pattern and Outcome of Congenital Anomalies and Maternal Risk Factors Associations,\u0026quot; Biomedicia, vol. 29, pp. 234-240, 2013. \u003c/li\u003e\n\u003cli\u003eV. B, \u0026quot;Preventing Congenital Anomalies in Developing Countries,\u0026quot; Community Genet, vol. 5, pp. 61-69, 2002. \u003c/li\u003e\n\u003cli\u003e\u0026quot;WHO congenital disorders,\u0026quot; World Health Organization, 2023. [Online]. Available: http://www.who.int.\u003c/li\u003e\n\u003cli\u003eE. A. I. L. e. a. Mohamed A, \u0026quot;Pattern of Congenital Anomalies,\u0026quot; Pediatric Reports, vol. 5, no. 5, pp. 20-23, 2013. \u003c/li\u003e\n\u003cli\u003eT. Z, \u0026quot;Prevalence and risk factors for congenital anomalies in Mosul city,\u0026quot; The Iraqi Post Graduate Medical Journal, vol. 22, no. 2, pp. 140-146, 2012. \u003c/li\u003e\n\u003cli\u003eS. A. A. A. e. a. Amany M, \u0026quot;Assessment of risk factors for fetal congenital anomalies at Cairo university Hospital,\u0026quot; Journal of American Science, vol. 7, no. 12, pp. 899-908, 2011. \u003c/li\u003e\n\u003cli\u003eK. Y. N. N. e. a. Naeimeh T, \u0026quot;the prevalence of congenital malformations and its correlation with consanguineous marriage,\u0026quot; Oman Medical Journal, vol. 25, pp. 37-40, 2010. \u003c/li\u003e\n\u003cli\u003eM. C. R. R. e. a. Vinceti M, \u0026quot;prevalence at birth for congenital anomalies in a population living around a modern municipal solid waste incinerator,\u0026quot; Epidemology, vol. 17, no. 6, pp. 272-273, 2006. \u003c/li\u003e\n\u003cli\u003eE. B. G. B. e. a. Drukker L, \u0026quot;how often do we identify fetal abnormalities during routine third trimester ultrasound? a systematic review and meta analysis,\u0026quot; an International Journal Of Obstetrics and Gynecology, vol. 128, pp. 259-269, 2020. \u003c/li\u003e\n\u003cli\u003eB. T. Mahela S, \u0026quot;prevalence of congenital abnormalities on routine ultrasound scan of second and third trimester pregnancy,\u0026quot; International Journal of Reproduction, Contraception, vol. 5, pp. 182-185, 2016. \u003c/li\u003e\n\u003cli\u003eI. A. Akinlabi e, \u0026quot;prevalence, risk factors and outcome of congenital anomalies among neonatal admissions in OGBOMOSO,\u0026quot; BMC Pediatrics, vol. 19, p. 88, 2019. \u003c/li\u003e\n\u003cli\u003eM. N, \u0026quot;congenital anomalies and risk factors in Africa a systematic review and metaanalysis,\u0026quot; BMJ Pediatrics, vol. 7, no. 1, 2023. \u003c/li\u003e\n\u003cli\u003eT. A. S. A. e. a. Bekalu G, \u0026quot;prevalenc of overt congenital anomalies and associated factors among newborns delivered at Jimma University Medical Center,\u0026quot; international Journal of Africa Nursing Sciences, vol. 18, p. 100513, 2023. \u003c/li\u003e\n\u003cli\u003eM. A. W. F. Molla T, \u0026quot;Factors associated with congenital anomalies in Addis Ababa and Amhara Region,\u0026quot; BMC Pediatrics, vol. 18, p. 142, 2018. \u003c/li\u003e\n\u003cli\u003eE. G. W. D. Samuel G, \u0026quot;congenital anomalies and associated factors among newborns in Bishoftu General Hospital,\u0026quot; Hindawi journal of environmental and public health, vol. 2021, p. 6, 2021. \u003c/li\u003e\n\u003cli\u003eG. G. D. A. e. a. Soressa A, \u0026quot;risk factors associated with congenital anomalies in South Western Ethiopia,\u0026quot; PLoS ONE, vol. 16, p. e0245915, 2021. \u003c/li\u003e\n\u003cli\u003eG. S. Fantahun A, \u0026quot;prevalence and associated factors of birth defects amongnewborns at referal hospital in north west Ethiopia,\u0026quot; Ethiopian Journal of Health Development, vol. 32, pp. 00-000, 2018. \u003c/li\u003e\n\u003cli\u003eC. M, \u0026quot;National Estimates and Race/Ethnicity specific variation of selected birth defects in the United States,\u0026quot; Res A Clin Mol Teratol, vol. 76, no. 11, pp. 745-56, 2006. \u003c/li\u003e\n\u003cli\u003eP. Z, \u0026quot;Birth Defects Surveillance Study,\u0026quot; Indian J Pediatr, vol. 72, no. 6, pp. 489-91, 2005. \u003c/li\u003e\n\u003cli\u003eB. P, \u0026quot;congenital anomaly surveillance in England ascertainment deficiencies in the national system,\u0026quot; BMJ, vol. 330, no. 7481, pp. 27-31, 2005. \u003c/li\u003e\n\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"bmc-pregnancy-and-childbirth","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"prch","sideBox":"Learn more about [BMC Pregnancy and Childbirth](http://bmcpregnancychildbirth.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/prch/default.aspx","title":"BMC Pregnancy and Childbirth","twitterHandle":"@BMC_series","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true},"keywords":"Congenital anomaly, Third trimester ultrasound, Anatomic scan ","lastPublishedDoi":"10.21203/rs.3.rs-6304485/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-6304485/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003e\u003cstrong\u003eBackground: \u003c/strong\u003eCongenital anomaly is a structural or functional anomaly that occurs during intrauterine life. Growing number of evidences suggest that systematic evaluation of the fetal anatomy during 3rd trimester routine scan increases detection of congenital abnormalities that have been missed in earlier scans, occurred late in gestation or progressed from previous findings.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eObjective: \u003c/strong\u003eto find out the magnitude of congenital abnormalities and associated factors detected at third trimester ultrasound scan.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eMethods: \u003c/strong\u003eThis was a facility based cross-sectional study. Data was collected for a sample size of 490 pregnant mother using pre-tested structured questionnaire from the participants and electronic records; by two trained nurses and principal investigator. Ultrasound examinations were done by Maternal Fetal Medicine (MFM) Fellows at third trimester and suspected abnormality cases were confirmed by MFM Consultants.\u003c/p\u003e\n\u003cp\u003eData entered in to Epi Data version 4.6 \u0026amp; Statistical analysis made through SPSS version 29. Descriptive statistics and tables used to describe the study finding. Analysis was made using chi-square test. P value \u0026lt;0.05 was used to show presence of statistically significant association.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eResults: \u003c/strong\u003eDuring the study period 490 3rd tri ultrasound scans were performed at Y12HMC/AGH. 30 congenital anomalies detected, making the prevalence 6.1%. Of these 30 anomalies 6 of them were diagnosed in the 2nd tri anatomic scan; hence, 1st time detected anomalies during the 3rd tri scan was 4.9%. The commonest organ affected by congenital anomaly detected during 3rd tri scan was Central nervous system (CNS) 9 (30%). The single most common type of congenital anomaly was Urinary Tract Dilation (UTD) 6 (20%). Congenital Pulmonary Airway Malformation (CPAM), skeletal dysplasia, diaphragmatic hernia, multi cystic dysplastic kidney disease, abdominal cyst and cleft lip and palate each contributed for two cases. Ventricular septal defect (VSD), left ventricular hypoplasia, omphalocele, dandy walker malformation and encephalocele each contributed for one anomaly. Not taking folic acid periconception (P value 0.001), medication use during early pregnancy (P value 0.006) and advanced maternal age (P value 0.019) are associated with congenital malformation.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConclusion: \u003c/strong\u003ehigh prevalence of 3rd tri congenital anomaly detected in this study; CNS was the commonest organ affected by 3rd tri congenital anomaly. Not using folic acid, medication use early during pregnancy and advanced maternal age are associated with congenital malformations.\u003c/p\u003e","manuscriptTitle":"Third Trimester Ultrasound Scan for Detection of Congenital Abnormalities and Associated Factors, at Abebech Gobena MCH Hospital, a Cross Sectional Study","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2025-05-09 01:32:45","doi":"10.21203/rs.3.rs-6304485/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"decision","content":"Revision requested","date":"2026-03-13T17:48:52+00:00","index":"","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2025-05-19T10:12:54+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2025-05-15T02:39:12+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"236945795812635770275094160041597912660","date":"2025-05-11T12:48:45+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2025-05-10T15:22:17+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"3761426389584491172808212323807808216","date":"2025-05-06T00:55:40+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"142185335869135300986452265730636951023","date":"2025-05-02T09:33:55+00:00","index":"hide","fulltext":""},{"type":"reviewersInvited","content":"","date":"2025-05-02T05:53:40+00:00","index":"","fulltext":""},{"type":"editorInvited","content":"","date":"2025-04-01T09:50:25+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2025-03-31T10:08:56+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2025-03-31T10:08:20+00:00","index":"","fulltext":""},{"type":"submitted","content":"BMC Pregnancy and Childbirth","date":"2025-03-25T13:51:00+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"bmc-pregnancy-and-childbirth","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"prch","sideBox":"Learn more about [BMC Pregnancy and Childbirth](http://bmcpregnancychildbirth.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/prch/default.aspx","title":"BMC Pregnancy and Childbirth","twitterHandle":"@BMC_series","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"9407abc1-f162-47be-b5a4-53da451b7c15","owner":[],"postedDate":"May 9th, 2025","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"under-review","subjectAreas":[],"tags":[],"updatedAt":"2026-04-19T12:08:21+00:00","versionOfRecord":[],"versionCreatedAt":"2025-05-09 01:32:45","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-6304485","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-6304485","identity":"rs-6304485","version":["v1"]},"buildId":"8U1c8b4HqxoKbykW_rLl7","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}