The first-trimester (11 to 13 + 6 weeks) ultrasound examination offers an opportunity to detect fetal abnormalities and contributes to the first-trimester aneuploidy screening. The scan conducted according to standardized protocol can maximize its value. Here, we aim to develop the First Trimester Ultrasound Quality-control System (FUQS) for assessing the first-trimester ultrasound scans and further apply it for quality control practice in Liaoning Province, China. To develop and test FUQS, 41,968 images from 7251 pregnancies was collected. The system achieved high consistency with experts on view scoring (ICC 0.957, p < 0.001). In quality audit practice among the randomly selected 35 hospitals, the overall completion rate was 65.85% and the overall median score was 58.50. Tier 3 hospitals outperformed Tier 2 hospitals, while specialized hospitals outperformed general hospitals. Among the required standard views, the transventricular axial view showed best performance. In contrast, abdominal cord insertion view performed worst.
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