Liao Y, Wen H, Ouyang S, et al. - In view of a recent systematic review establishing the use of a standardized anatomical protocol as the most crucial factor in improving the sensitivity of first-trimester ultrasound screening for anomalies, researchers here investigated the performance of routine first trimester scans using a standardized anatomical protocol for identifying structural abnormalities in China. They conducted a large retrospective study including 59,063 sequentially unselected pregnancies. From October 2008 to December 2015, 53,349 pregnant women underwent first trimester scans with available outcome. Of these, 1,578 (3%) pregnancies presented with at least one fetal structural abnormality. The detection rate of 43·1% was reported for first-trimester screening. During routine first trimester scans, a robust high detection rate was achieved for anencephaly, exencephaly, cephalocele, holoprosencephalys, exomphalos, gastroschisis, pentalogy of Cantrell, sirenomelia and Body stalk anomaly. Based on findings, they advise a standardized anatomical protocol when routine first-trimester ultrasound screening is performed. Extension of screening for severe structural abnormalities to the first trimester is recommended.