In healthcare systems where NIPT has become the first-tier screening test, the role of early detailed ultrasound risks being underestimated, potentially delaying the detection of structural fetal anomalies to the second trimester. This reduces the time available for investigations and diagnostic work up and may result in later termination of pregnancy, which is associated with increased maternal risks (UOG 1). The IMITAS cohort study by Bronsgeest et al. strongly reinforces the importance of the first-trimester anomaly scan (FTAS) as a key assessment of fetal anatomy, complementing NIPT screening. Rather than competing tools, FTAS and NIPT should be considered complementary components of modern prenatal screening, assessing phenotype and genotype, and women undergoing NIPT as a primary test should also receive an FTAS, as recommended by ISUOG (UOG 2). The IMITAS study confirms FTAS as a major advance in prenatal care, providing rare national real-world evidence that it improves early detection even where cfDNA screening is universal, with potentially greater benefits in settings where cfDNA is not. Following FTAS implementation in the Netherlands, the number of abnormal diagnostic scans increased substantially, demonstrating a clear rise in early identification of fetal anomalies. Importantly, this increase occurred with only a minimal increase in time to final diagnosis. Earlier identification of severe conditions offers parents greater diagnostic certainty, earlier counselling and referral, improved care planning and more time for informed decision-making, an outcome highly meaningful for families facing complex choices. However, the study highlights an important nuance: earlier detection does not always translate into faster diagnostic conclusions. FTAS broadens the spectrum of anomalies identified, increasing detection of uncertain or transient findings, such as nuchal oedema, as well as complex conditions like congenital heart disease and spina bifida that require follow-up imaging, genetic testing and multidisciplinary care. Consequently, more families enter the diagnostic pathway earlier, creating opportunities for fetal treatment when available but, for some, prolonging evaluation and the emotional journey of decision-making. The nationwide rollout of FTAS in the Netherlands functions as a natural experiment, providing valuable real-world evidence consistent with findings from other settings. Although comparisons between the pre- and post-implementation periods required statistical adjustments and cannot prove causality, similar studies are essential to understand how screening policies perform in routine clinical practice. The Dutch experience offers important lessons. National first-trimester anatomy screening appears feasible and improves early detection, but it also shifts workload and requires robust counselling services and multidisciplinary collaboration. Moreover, FTAS does more than move detection earlier; it reshapes the entire pathway of fetal medicine and parental decision-making. As early screening expands, it is essential that earlier detection is matched by equally strong systems of support. Finally, the 12–13 week scan should be recognised as a unique opportunity extending beyond anomaly detection, including screening for preeclampsia (UOG 3), prediction of preterm birth and emerging outcomes such as, for instance, labour onset and intrapartum events (AJOG 4). The author has nothing to report. The author has nothing to report. The author declares no conflicts of interest. The author has nothing to report.
Paolo Ivo Cavoretto (Tue,) studied this question.