Is That Obstetric Ultrasound Scan Necessary?

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Apparently failure to blindly follow orders leads to being bullied and talked down to so I said fine, cancel it all. With this form of scan it is not as necessary for the mother to have a full bladder.

It was nice to have the assurance that the baby looked okay, but what I really wanted was to find out the sex and see a picture. It's wonderful to see a little blob with a heartbeat that will become your baby.

Ultrasound QLD & NSW

What is a low carb diet, really? When can a low carb diet be beneficial? Should everyone follow a low carb diet? Or, can a low carb diet ruin your health? It is not a blanket condemnation of ultrasound, nor is it a judgment of women who choose routine ultrasound during their pregnancy. It is not an argument against using ultrasound to investigate suspected problems, or to detect potential abnormalities, provided the woman is adequately informed. This was going to be a very long article, so I decided to split it into two parts. In part A I will discuss the use of ultrasound in clinical practice and examine whether it improves birth outcomes. In part B, I will review studies on the safety of ultrasound as it is used today, and make recommendations for expecting mothers. History of ultrasound and use in clinical practice Ultrasound was originally developed in WWII to detect enemy submarines. After the war in 1955, a surgeon in Glasgow named Ian Donald began to experiment with it for medical uses. He quickly realized the potential of ultrasound for examining a growing baby in utero. Initially, ultrasound was used only to investigate possible problems. For example, if there was bleeding in early pregnancy, it would be used to determine whether miscarriage was inevitable. Later in pregnancy, if breech or twins were suspected, ultrasound would be used to confirm that suspicion. In these cases, ultrasound can be very useful for a woman and her caregivers. However, over the years ultrasound has come to be used as routine scan at 18-20 weeks for all women. It involves scanning all pregnant women — whether a problem is suspected or not — in the hope of improving birth outcomes. As often happens in medicine, techniques which may be of value to a small percentage of people slowly become adopted for routine use without prior study of benefits. The problem with this approach, of course, is that when we perform a procedure or administer a treatment to a segment of the population without properly testing it beforehand, we are essentially conducting an uncontrolled scientific experiment on that population — often without their understanding and consent. And in this case, we are performing that uncontrolled experiment on two of the most vulnerable populations: pregnant women and babies in the womb. Some physicians and researchers have been questioning the wisdom of performing such an experiment for decades. In 1987, : The casual observer might be forgiven for wondering why the medical profession is now involved in the wholesale examination of pregnant patients with machines emanating vastly different powers of energy which is not proven to be harmless to obtain information which is not proven to be of any clinical value by operators who are not certified as competent to perform the operations. More recently, in 2010, the prestigious Cochrane Collaboration on routine prenatal ultrasound RPU and concluded: Existing evidence does not provide conclusive evidence that the use of routine umbilical artery Doppler ultrasound, or combination of umbilical and uterine artery Doppler ultrasound in low-risk or unselected populations benefits either mother or baby. In order to answer that question, we have to distinguish between different uses of ultrasound. As I said earlier, ultrasound scanning can be a useful diagnostic tool when abnormalities are suspected. I have no argument with using it in this manner. The presence of prenatal testing and monitoring shifts the balance towards having to prove the health or normality of a fetus. Does it improve specific birth outcomes like perinatal mortality or morbidity? Routine prenatal ultrasound is not recommended by researchers and major organizations In general, RPU is accurate for predicting birth date when scans are performed in the early stages of pregnancy. The estimated due date EDD calculated by a scan at 7-8 weeks will be accurate to plus or minus 3-4 days. What about detecting abnormalities? Studies show that RPU % of the 1 in 50 babies that have significant abnormalities at birth. The larger centers with better trained sonographers have rates toward the higher end of the scale, but even major centers. Heart and kidney problems are unlikely to be picked up, as are some markers for Down syndrome. Cerebral palsy, autism, and other markers of intellectual disability are impossible to detect. A showed that for 1 in 200 babies aborted for supposed major abnormalities, the diagnosis on post-mortem was less severe than predicted by ultrasound, and the termination was probably unjustified. In the same survey, 2. Two other studies have shown false positive results in diagnosed with structural abnormalities. And in some cases, the abnormalities without intervention. In addition to false positives, there are also cases that are difficult to interpret, and the outcome for the baby is unknown. This uncertainty can cause considerable stress and anxiety for the mother, which in turn adversely affects the developing baby. In one study involving women at higher risk, a full. And in that same study, mothers with uncertain diagnoses were still anxious three months after the birth of their baby. Ultrasound scanning for placenta previa is mostly accurate, but almost all women who test positive for it on a scan will be unnecessarily worried. Studies show that the placenta will move up and not cause problems during birth for , and that detection of placenta previa by RPU. All of this might explain why organizations like the American College of Obstetricians and Gynecologists , including uncertain due dates and fetal assessment, and advises that routine prenatal scans are cost-effective only when done by ultrasound technicians working in high-level centers. In Canada, recommend only a single midpregnancy scan and stress that information on risks and benefits must be provided and informed consent obtained. Routine prenatal ultrasound does not improve birth outcomes Studies on RPU over the years have consistently shown that it does not improve birth outcomes as measured by clinical endpoints such as perinatal mortality and morbidity. A of all randomized trials prior to that date covering 16,000 births showed no improvement in the condition of babies measured by APGAR score when ultrasound was used compared to those who did not have it. There was a slight reduction in perinatal mortality in this study. However, this happened because these babies were aborted during pregnancy — not because their lives were saved. There was no increase in the number of live, healthy births from RPU. The authors of this study concluded: Routine ultrasound scanning does not improve the outcome of pregnancy in terms of an increased number of live births or of reduced perinatal morbidity. Routine ultrasound scanning may be effective and useful as a screening for malformation. Its use for this purpose, however, should be made explicit and take into account the risk of false positive diagnosis in addition to ethical issues. The rates of induced abortion, amniocentesis, tests of fetal well-being, external version, induction, and cesarean section and the distribution of total hospital days were similar in the two groups. They concluded: Screening ultrasonography resulted in no clinically significant benefit. In the same year 1993 , the World Health Organization WHO issued a letter reviewing the studies performed on routine ultrasound to date and concluded : It is fair to say that at the moment the best research shows no benefit from routine ultrasound scanning and the real possibility of serious risk. Thanks for your support! This absolutely infuriates me. As someone who was just recently diagnosed with vasa previa, an extremely rare 1 in 3000 placenta related issue that occurs during pregnancy and can ONLY be diagnosed with an ultrasound, articles like this make me livid. If my condition went undiagnosed and most of them do, the risk of fetal death baby dying during birth due to a burst blood vessel is 95%! Please, everyone, do not miss any of your scheduled ultrasounds. Make sure you DEMAND a vaginal ultrasound at 20 weeks, as often times vasa previa is totally missed without one. If it can happen to me, it can happen to you. Hi Chris I am expecting twins at 16 weeks. Now there is more medical pressure than ever. I want to know if the 20 week scan is any more useful or necessary for twins than with singletons. Thanks During the past two years research, I compiled a new bibliography of ultrasound exposure studies. These are human studies, high-tech laboratory studies, that observed the results of ultrasound exposure to a total of 2,700 women-fetus pairs. These are approximately 50 studies over a 23 year period. Ultrasound appears to be much higher risk than commonly publicized. See Any ulyrasound you will have in future will effect your unborn babies. Utrasound heats up the tissue and cause damage. There are over 50 studies done in China on aborted foetuses in all stages of ptegnancy and all of them proved dangers of ultrasound. I bet i will be just fine. I have irregular cycles and we had an ultrasound that was supposed to be at 12 weeks but turned out to be just at 6 wks! That was because their dating based on last cycle was a month and a halve off. I am faced with a serious problem. Can you please help cause i am confused and worried. My oldest daughter is approximately 10 weeks pregnant and has already had three ultrasounds. Two were performed at the college where she is in school to become a dental assistant. At the school she has had two of the three sounds performed for fun. The other sound was performed at her first prenatal doctor appt which I attended with her. The PA advised my daughter to limit anymore ultrasounds and her face showed a face of disapproval that my daughter had already had two sounds. I teach my students, and our pregnant volunteers, that there are no KNOWN risks but that we have guidelines set forth by our governing bodies and our Code of Ethics. Certainly concentrating that much sound on such a small area a 10 week fetus is obviously MUCH smaller than a 39 week fetus is not advisable multiple times unless there are clinical symptoms indicating possible problems. How does a woman know if she has a high risk pregnancy? Does carrying twins warrant a high risk pregnancy treatment and again without ultrasound scan it could not be known whether woman is carrying twins or not for sure? I am not yet pregnant but trying to be, before reading this article I had never ever given any thought to ultrasound scan sand thought of it as a normal necessary procedure for all pregnant woman. Thanks Chris, you shared quite useful information, which would allow women to make an informed choice. Yes, carrying twins is considered a high risk pregnancy. Age can be high risk, whether below or above certain ages. Family history can be high risk. I do not believe most of us look at it as assuming things are wrong until proven otherwise. I believe in preventative medicine, just like immunizations. An ultrasound at around 20 weeks gestation can confirm that things are progressing as expected and desired. It can also reveal if there are any abnormalities that might prevent a safe vaginal delivery BEFORE the mother spends hours in unnecessary labor. Further, it can reveal abnormalities that warrant a plan of delivery in a hospital with a NICU neonatal ICU for immediate attention. Yes, while few babies are born with diaphragmatic hernias, or omphaloceles, or gastroschisis, or a host of other issues, there are still quite a few who are and whose lives have been saved to go on and lead normal, productive lives because of prenatal ultrasound. Without the prenatal ultrasound, these would not have been discovered, planned for appropriately, and turned out in a positive outcome. If there is bleeding, high-blood pressure or diabetes diagnosed you can be considered high-risk. This is for your doctor to diagnose. I come from a family of doctors and BS nurses. I fine it strange that only the man race has to depend on science that says it is ok to use these machines which are not proven to be safe. Put your trust in the divine not man! I am due in May and at my 19 week scan I was just anxious to find out where my placenta was because I was planning a hbac. I am so disappointed to and distraught to find out I do indeed have a partial previa. The high risk ob mentioned possible accretia because I my prior csections. Now I just read your article and feel a little better that the previa may resolve itself. A little worse because this scan was more in depth of any I ever had and they want to do more :. There were colors on the screen so I assume it was MRI like? They want to recheck the previa in a month around 24 weeks. I am wondering if I should just politely refuse until closer to my due date. I of course came home an googled partial previa and accretia and was so upset and crying for days.. This has caused me much anxiety indeed!!!!!! I am one of many women who have gone through a missed miscarriage. My first prenatal visit was at 8 weeks. Sure enough I arrived a week later to an ultrasound where the baby no longer had a heartbeat. There was real emotional shock and anxiety and having a wand up inside me while I was being told things are over was a bit cold and devastating. I am still months later a bit traumatized from that. I opted for the latter, feeling completely adverse to emotionally handling weeks of waiting. There were no good answers because it overall feels awful. I am not alone. There are millions of women who go through that every day. It left me feeling powerless. I will not be looking at the screen and not be looking at the technician. I will dread it every time i may have to go in. The whole process was pretty expensive. Even with good insurance, the whole thing ended up costing me over a thousand dollars at the end of the day for all the medical bills just for one miscarriage. I just hate the whole process. My first pregnancy had complications not picke up at the first 12 week scan but at the 20 week scan. This was then followed by lots of other scans and a grave outlook. I knew my son would be ok and he is — although I think very mildly in the spectrum. My second pregnancy proved the same. Early scan fine, abnormalities at second scan. I would have liked to have miscarried naturally. Especially since my last miscarriage also resulted in PID and a hospital stay. Got pregnant first try despite being wrongly told years ago that I have pcos. Another US diagnosis that resolved itself. If this one makes it we will be over the moon. I think it will. If not then so be it. We will try again. I wish you all the best! There is a key point about ultrasound safety studies that I would like to bring up. While there have been several studies that claim no correlation between adverse health effects following any number of ultrasound scans, there is a logical fallacy buried within this argument. The number of ultrasound scans IS NOT dose,.. Each scan is different, and each practitioner has a different method. This is probably the most important part because consider that WHERE the ultrasound penetrates is the tissue that is affected. If ultrasound were to be linked to autism or other developmental disorders, it would likely be attributed to exposure of a sensitive organ or tissue such as the brain, or hormone regulatory gland to ultrasound. Yet, those with excessive brain exposure would be lumped into the same category as people with very light elbow exposures because the number of scans is really all that is considered. Dose measurement and subsequent risk assessment is much more complex than our studies today are able to effectively investigate… it matters where the ultrasound penetrates, and no safety studies I have found take this into consideration. For example, ultrasound is used in physical therapy and agriculture, microbiology to promote growth. However, many autists upwards of 70-80%? When a sonographer is getting a flush facial picture, that ultrasound is penetrating first through the prefrontal cortex on its way through the brain. Further, there have been studies on rats showing that ultrasound exposure to gonads can alter testosterone levels. Coincidentally, there are studies being carried out by Dr. This would explain the 4:1 boy:girl ratio. At the end of the day, although I cannot prove that ultrasound is directly linked to autism with a single clean cut scientific study, there is sufficient evidence to be concerned and further research is well warranted. I believe that regulatory changes are needed to ensure the safety of modern practice. In the face of these dangers, considering we are exposing nearly every child in the modern industrialized world to ultrasound, it would be irrevocably self serving and …downright evil, frankly, to put profit above patient safety. I started a petition at change. This is a very biased article. The referenced studies show no difference in outcome between scanned and non scanned groups. You report this as evidence not to be scanned yet it basically says that there are no adverse effects from being scanned. The 2010 Chochrane study actually states long term follow up of children reveal no developmental or psychological problems. Citing that study as evidence against safety of routine scans is misleading. While I would agree that most women receive far too many ultrasounds and the doppler monitors! I was planning a home water birth with well-respected midwives when I was pregnant with my daughter. An ultrasound at 19 weeks showed the placenta was just barely covering the cervix. I had complete placenta previa. Only then did I try acupuncture and TCM to shift it away from the cervix. It did not move and I ended up with a c-section at 37w1d gestation the furthest the OBs would let me push it. My daughter and I might not be here today. So if a person has a single scan during pregnancy, should this be around 18-20 weeks? Based on how much development has occurred, I thought that perhaps one around 8 weeks would be more useful and less risky and would also be more accurate for verifying due date. The scan is recommended mid-pregnancy because most organs are developed by that point, plus the fetus is large enough for good viewing, but not so large that parts might be obstructed. At 8 weeks, it is possible to see the heart beating, but development of organs is really not that far along. There are ultrasound photos online you can Google to see the difference. We can see the organs at around 20 weeks. At 8 weeks, we can really only see the heart beat and the measurement for due date. Plus, the sound waves are concentrated in a much smaller area than when the fetus is larger, which actually tends to be less advisable when we are talking about risk. Of course if there are clinical indications for a scan that early, then risks versus benefits are items for discussion between the patient and doctor. I see one commenter about talking about being told she was putting her baby at risk by refusing an ultrasound in 1978. Certainly my OB never suggested I have one done, and so I never did. By the time her second and third kids came along it was starting to seem more routine. Thank you for the article! Unfortunately the main part of present Dr. We need to be more conscious before ourselves and our children! I had difficulty getting pregnant and there were a lot of issues including very early twin loss in the early days of In Vitro Fertilization , so I was very COMFORTED with frequent ultrasounds to see that the baby was OK. Each US allowed me to relax and not worry so much because I could see for myself that she was fine. It was never checked again to see if it had resolved itself until a few days before my delivery date when I woke in a puddle of blood! It all came out OK, but there were several hours of terror until the hospital could get an ultrasonographer in to see what was going on. I admit the outcome was the same a perfect. The meta-analysis you site is from 1993. Ultrasound technology has grown in leaps and bounds since then. I am a sonographer at a large hospital. I have myself discovered many major heart defects, in completely routine scans. I have discovered lung tumors,fetal teratomas, diaphragmatic hernias and many other defects in routine scans which lead to the baby being delivered with the proper team of physicians and surgeons in a hospital equipped to care for these cases. I recently discovered a rather subtle heart defect which would have progressed a fatal outcome. The fetus had in utero surgery which saved its life. These are the sorts of things that are possible now. They were not possible in 1993. That baby is alive because of ultrasound and surgical technology. Not all defects can be fixed in utero, of course, and yes — there are a lot of false positives which cause anxiety. But if it were my fetus with the huge CCAM or hypoplastic left heart? I think everyone should have that option. Yes, the technology has changed. Scanning intensities used today are much higher than in 1979-1981. In fact, outputs have been estimated to have between 1991-1995 alone. This makes it even more likely that routine prenatal ultrasound — as it is performed today — may cause harm. Hi Chris, I am currently pregnant and reading these articles with great interest. I feel that you provide enough evidence to show that there are risks to routine ultrasounds and these studies you link to show that there is no improvement in outcomes and based on that, I would avoid all rutine ultrasounds. I generally would trust the results of these multiple large trials, however I am still puzzled. How do you explain these commenters experiences? For example, do you think that had the baby been born without any ultrasounds, the defect would have been caught at birth and then the same intervention would have been possible, so an ultrasound would not have have changed anything in the final outcome which is what these studies measure? Some commenters describe defects that would not have been seen externally and potentially would have caused some damage by the time they were discovered post-birth. I am really torn as I figure out what to do for this pregnancy. We are planning a birth at Mid-wife Birthing Center and some of these commenters suggest that knowing about a defect may result in needing a hospital birth and not doing an ultrasound in this case, puts the baby at higher risk. Can you please comment on how you would explain these anecdotal stories that seem to contradict the results of the studies? In every article I find similar to this, I always find a few comments of this nature. Thank you for a great article and I hope you will respond. We are murders if we choose to decline pricey procedures and then were called responsible if we have an abortion because of defects or just because! I agree with Joann. My nephew was diagnosed with a serious Congenital Diaphragmatic Hernia on a routine ultrasound at 18 weeks. I refused an ultrasound in 1978 when pregnant with my second baby … I knew the due date exactly husband only home a few days. I ended up with a low lying placenta, which should have been detected by other means. We lived in Northern Alberta and he was routinely sending all pregnant women to Edmonton for the test usually 3x a pregnancy. I did manage a natural birth, without medication I will add. I am not sure what I would do, if given the same situation again. I suspect go with the ultrasound … but at the time they were very new and I felt unnecessary for the reasons given above. Thanks for the article, Chris. I got diagnosed with gestational diabetes. They hit me over the head with that horrid glucose tolerance test. They wanted to do another one, but I said hell no. The monitoring of my glucose levels was just fine if I ate the right things. But, volunteering to be labeled as a diabetic dragged me into the monthly ultrasound protocol. At one of my sessions, I said to the Dr. I continued with the ultrasonic monitoring. My baby is just fine, but, I had the medicalized pregnancy of which you speak. This is the rose colored glasses approach to child birth. When my child was dead in-utero, I sure did want that ultrasound. Also, incompetent cervix is the number one leading cause of premature birth currently in this country. How much does an ultrasound cost again? Maybe ultrasounds are used for the wrong reasons. Definitely they need to be used better for some cases, such as incompetent cervix. But to throw the baby out with the bath water seems ridiculous. Where do you get the stat that the leading cause of preterm birth is incompetent cervix…or that knowing in advance that the cervix is incompentent would improve outcomes? You put in to words what my gut was telling me eight years ago. Now, granted, I did end up having an ultrasound—at 36 weeks, when there was confusion of the position of the baby. I was carrying twins! Once I found out, the medical community started treating me like a sick person high-risk pregnancy, yadda, yadda, yadda. She reported to me that she scanned her own baby her 6th almost every night when on duty, just for fun. Her baby was small for gestational age SGA or possibly intrauterine growth retarded IUGR though she never noticed this with her repeated scans. I, however, noted prenatally, that her baby felt much smaller than her other 5 children, using my hands to palpate her baby. The outcome was good, though the baby needed some resuscitation at the time of birth. I have always wondered if all those scans hundreds of them! My nephew now 12 must have been subjected to more ultrasonic waves before birth than most people are in their entire lives. Even at the time, I questioned him about how safe this was, and in typical MD fashion dismissed my concerns.

Further, there have been studies on rats showing that ultrasound exposure to gonads can alter testosterone levels. Factors women delay they drive exactly when they come - even down to the day. Instead, you will be offered a ultrasound. Interesting to note, both of my children hid from the doppler. Wishing you a happy, healthy pregnancy. The middle way may be to get just a single ultrasound mid-pregnancy, and leave it at that.