UK Midwifery Archives
These archives contain posts from the UK Midwives and Consumers email list, a discussion group for people interested in midwifery in the UK. All are welcome to join the group. Posts in these archives express the views of the individual authors, and not those of the Association of Radical Midwives.
- Scans for bonding and reassurance
- Is it safe?
- Intra-Uterine Growth Restriction
- Links to other sources of information
I am a sonographer who works part-time in a very busy hospital and who is very unhappy about the time and treatment given to the vast majority of women who come through our department. Over two years ago I set up a private ultrasound service under the guidance of a consultant obstetrician. – to offer women the opportunity to have a scan just for them and to promote bonding between the parent and siblings. Well-documented evidence shows how seeing a baby on the screen promotes bonding and offers reassurance.
Sexing the baby which is controversial in some hospitals we feel is the mothers right to choose and again helps with the bonding by giving the child an identity.
We are now recommended by midwives all over the country who offer our service to their patients and we have a good relationship by helping them deal with the frustrations passed back to the midwives about the treatment in ultrasound departments.
I feel I would like to promote our service and make more midwives aware that our service now exists. Our site is BabyBond (www.babybond.com)
I taught a couple who were so unhappy with their (hospital scanning) experience that they went to BabyBond and were deliriously happy with it. It seemed a bit churlish of me to point out the worries about repeat scanning as they had already done it by the time I saw them.
I visited the website and was not impressed. I know it can be useful in a few problem cases, but if mother’s can’t bond with their babies without seeing them on the screen, how did the human race get this far? Also, did you ever hear such rubbish as the statement that, “it is the mother’s right to choose to have a scan for sexing the baby, and that it helps with the bonding by giving the child an identity”. I wonder how my kids managed to get an identity – ultrasound scanning wasn’t available when I was pregnant in the 1950s!
Another worry is all those midwives referring women to her service. I sometimes despair. Don’t those midwives ever read professional journals, research studies, and are they unaware of the advice of DoH that ultrasound scanning should only be done when the information is absolutely necessary and cannot be obtained in any other way?
I’d like to know if BabyBond informs the women and their families of this official advice, and that ultrasound scanning has not yet been proved to be safe. Probably not, because after all, they’re running a business and their profits would slump if women decided not to have the scan after all
Somehow I wonder if we should set up a SPPW (Society for the Protection of Pregnant Women) – the poor things seem to be the target for anyone wanting to make a quick profit.
Would you mind if I offer a different view point……. I actually didn’t bond with this baby until I had a scan….. I hoped many times for it all to go away.. not now, I love him and want him dearly. I’m not ‘for’ scans, tests or intervention…. I don’t like all this medicalisation of birth etc… and I don’t usually have scans. BUT this time because of my situation and this very unplanned baby. I had problems ‘acknowledging’ him and even thought about termination.
I needed a scan for possible gallstones so I had a full renal scan and a pregnancy scan at the same time. It cut through all my, “Is this right for me” and, “should I really be doing this”…. Yes, it did help me to immediately bond and come to terms with the fact that I was actually having a baby and this is him
It really helped me. While I would not have gone out of my way to have or ask for a scan, it was positive for me in this pregnancy.
Please don’t condemn us all for using a one-off scan as some sort of bonding exercise.
I hear what you are saying, and sympathise with the situation you were in. Many women have these feelings when they first realise they are pregnant, not all babies are planned! I can also understand that seeing the scan helped you to bond with your unplanned and unwelcome baby. You can’t be sure that you would not have grown to accept and love him without seeing the scan. If, as you indicate, it was seeing the scan that turned you away from the idea of a termination, then I accept that in your case the scan was a good thing, for you at least.
I do not, and never intended to, condemn anyone, least of all the women themselves. My concern is that this company (BabyBond) is making money by taking advantage of pregnant women, who are probably unaware of the possible risks to their growing fetus. I do not believe that so-called ‘bonding’ by scan is essential for most women.
I stand by my initial comments, that the jury is still out on the safety or otherwise of scans in pregnancy, and until they are proved safe then they should be used only where they are absolutely necessary. I also believe that midwives have a moral and professional duty to give this information to their clients, who will then be able to make informed choices.
I feel there should be more counselling to go with a scan – a reminder that things might not all be ‘bonding’ and ‘roses’. Yes, in most cases, it provides reassurance – but not always.
This thread reminds me on an experience I had in a hospital antenatal clinic when I was a student. In the middle of one those busy crazy factory sessions a bloke came up to me and asked if he could have a word. We went to one side and he pulled out his wallet and offered me £100 if I could organise a scan for his then 28 week pregnant partner. The doctor she had seen told her she didn’t need one. Apparently, she was in the car crying because of this and her partner wanted to fix things up. I was really taken aback and just said no I’m sure that was not possible and then he went away.
I think I would do a very different thing if it happened again but it still wouldn’t be arranging a scan to boost the xmas party funds!
I disliked the three scans (dating/amnio/post-amnio) I had in my second pregnancy – if anything I found them distancing, compared with watching and feeling my child move inside me. I felt it was somehow intrusive to be looking at parts of my baby I would not normally see such as heart, bladder, brain. And the two in my first pregnancy (dating and bleeding/?breech at 38 weeks) did not have the effect on me that so many men and women describe – my partner and I found it interesting, but not really moving.
That said, I know many women in my area who are unhappy that the one routine scan that is offered is the 12 week dating scan and would prefer to have one later scan instead.
There could be a place for this kind of service – but I very much suspect that it isn’t intended for or accessible to those who would genuinely benefit from it.
I can appreciate S’s experience – even if the bonding came later, maybe not until some time after birth, even if counselling could have had the same effect, perhaps she was saved a good deal of anxiety about whether it would ever happen – for her baby it was a life threatening situation of a kind. I am mindful of the great comfort my friends had from their scan photographs and in particular videos (they took the videos themselves – fortunately they were at places which allow this – only some of these were done after the babies’ ultimate survival was in serious doubt) – the only way they can see their stillborn twin alive. A photograph and footprints of a dead baby are not quite the same.
As someone has already said, the emphasis is put on reassurance, rather than diagnosis. Perhaps the reason I didn’t relish scanning was because I see tests as looking for something wrong.
No one seems to question the rights and wrongs of these scans and I just accepted that it was part of pregnancy. If I had another baby, however, I would decline this early scan as it seems to serve no real purpose, particularly as I have always been sure of my dates. In fact, with my third pregnancy the scan simply caused problems as there was a dark patch on the placenta. I was sent for several scans up until 29 weeks, but nothing untoward was ever discovered. All it did was cause unnecessary worry, not that there was actually something wrong, but that this might be used to prevent me from having a home birth.
Today I saw a woman who was off to London for a 4-D ultrasound scan – she showed me the article in Pregnancy & Birth Magazine. This is a woman who can ill afford £220 plus her rail fare, is having a normal pregnancy and is keen for a home birth and has had two reassuring scans already. She says she can’t afford it really but just wants to see the baby to reassure her all is OK for a home birth. I wanted to shake her and hug her at the same time!!! Why do we want to see, watch, know, photograph and video our babies in utero? The amazing magic surrounding birth seems to be vanishing,as live a society that cannot wait for events to unfold, we must know it and control it all now. The web site for more info is http://www.createhealth.org
She says she .. just wants to see the baby to reassure her all is OK for a home birth
Oh dear… what on earth does she think a scan will tell her that will reassure her all is OK for a home birth?
As she has had two scans already, it sounds almost as if she is looking for a reason not to have the baby at home – do you think a home birth is what she really wants? After all, most of the things which might affect one’s decision to have a home birth will not be diagnosable by a scan, but by antenatal checks conducted by a midwife. This makes me wonder if she has really thought through the eventualities which might result in a transfer to hospital. It would be interesting to hear what exactly she was worried about. Does she just want to know if the baby is head-down? Presumably she knows the placental location from previous scans. Sometimes people are just convinced that something will go wrong, and will keep having test after test until they get a result to confirm their belief. Perhaps the “Checking everything is OK for a home birth” is just a way of giving herself permission to have another look at the baby, just for fun. Maybe this mother’s reasons are entirely different – I don’t know her and shouldn’t make assumptions, but it is important to think about people’s reasons for choosing a particular treatment/pathway, just in case there are better ways of fulfilling their needs.
The other factor to consider, of course, is that a clear scan is not a guarantee that “everything” will be OK. It can reassure you about a range of visible foetal anomalies, but not much else. So of people feel they need a scan before they can relax and enjoy the pregnancy – are they lulled into a false sense of security? If the scan does not really have the power to tell you that you will avoid the major complications of pregnancy, then why so much anxiety about not having one? It would seem perfectly rational for it to provide *some* reassurance – a clear scan certainly reduces the odds that your baby has certain abnormalities – but it seems unrealistic for it to be *the* major factor in whether a woman feels relaxed about her pregnancy or not.
I can’t help thinking of Anna, who used to write so heart-rendingly about her elective caesarean which ended in a hysterectomy. That all happened because she had a scan at 36 weeks “to check everything was OK for a home birth”. Anna’s story is at http://www.radmid.demon.co.uk/csanna.htm .
Why go looking for problems when there is no reason to suspect any? Ultrasound scans are not neutral procedures – they remind me of that thing about quantum mechanics, where just by observing something, you change it. Even if all of the concerns about effects on the foetus come to nothing, it is still an intervention which can have serious consequences in terms of false positive results, increased stress for the mother.
A friend smoked and drank through all four of her pregnancies, but the most harm any of her babies suffered during pregnancy and birth (to our knowledge) was not caused by this, but by a late scan “just to check all was well” at 36 weeks, which resulted in a misdiagnosis and elective caesarean the next day, of a baby who suffered from being preterm. I’m not saying that smoking and drinking in pregnancy is harmless and nothing to worry about, but I feel it is noteworthy that in our family, and surely in others too, the ‘harmless’ scan has led to so much more trouble than these ‘high-risk’ factors.
You might argue that problems with misdiagnosis and false positives are not the fault of scans per se, but of unskilled sonographers. However, we have to consider how ultrasound is administered in the real world – the actual effect of the scans that women are offered out there in hospitals everywhere, now, not the theoretical effect of the ‘ideal’ scan.
Angela Horn Home Birth Reference Site
Before screening was introduced many babies with anomalies would have miscarried or not survived birth. Certainly a small number of parents would be faced at birth with hard choices of life with a less than perfect baby. Allowing nature to take its course and having one’s baby die from a lethal anomaly versus having to decide whether to have it killed is what many parents are faced with now. Counselling is not a cure all for these parents either, as the risk of depression is known to be high in parents who choose ‘therapeutic’ terminations.
If the US results were at all accurate it would perhaps be more acceptable but they aren’t, by a very long shot. For example, nuchal scans have a false positive rate of 86% according to the latest study I read in Ultrasound Journal. All large trials of the value of US have found soft marker results are equally inaccurate. If the aim is to dispose of imperfect babies as early as possible at what costs to all those perfect babies. And at what cost to peace of mind for thousands of parents of perfectly normal misdiagnosed babies?
The stress is not easy for pregnant parents. I was interested to read a study last week that showed that 5% of mothers miscarry after a false positive Down’s test compared with less than 1% rate of miscarriages in those with negative results. How much stress does it take for a woman to miscarry a perfectly healthy baby? How much stress did the other 95% of parents with false positives go through? Certainly many had terminated their healthy pregnancies before the final results were out.
No screening test is benign. They are all wolves in sheep’s clothing, because the false positives mean misery for much very large numbers. An ultrasound is only reassuring to those with so-called good results, but the numbers of parents exposed to false positive soft marker results are in the tens of thousands and pregnancy has become such a miserable experience for so many women. It is yet another FUD ( Fear Uncertainty and Doubt) marketing ploy introduced by obstetrics that women have swallowed hook line and sinker.
On the question of bonding maybe women are supposed to be a little indifferent to their pregnancies. I still remember the exquisite pain I experienced alone in an hospital corridor after an ultrasound during my near miscarriage with my third baby. I know that if I had lost her before that ultrasound the pain would have been different from the pain if I had lost her afterwards. I felt so raw and I knew with a clarity I cannot explain now that my previous ignorance was a sort of protection and it had been stripped from me.
There is conflict… ultrasound may be harmful (though the evidence is far from concrete) and therefore, according to the scientific principle, is not necessarily a good thing. On the other hand, many women really want a scan, they find it reassuring and a positive experience. This goes for many aspects of childbirth, and life… so what takes priority? Science… in which case we need to accept that we are not necessarily thinking of the woman as central, or, maybe the woman will be central, sacrificing some of our ‘science’.
I don’t know if there is an answer to this conflict. It’s something I find difficult to deal with, particularly when working with PND women, for whom the situation can be even more complex. I know I often forgo ‘optimal’ obstetric stuff for the sake of their mental health, which in turn has implications for their infant’s and child’s development.
Don’t get me wrong, I am anything but a pro-medical interventionist, but I also feel strongly about presenting realism to mothers. I’ve certainly found that maternal ‘choice’ has had its downside for the mums I work with… “I chose the homebirth/hospital etc. and planned X, so it’s my fault and I was the failure because it went wrong” is something I hear daily, and I then wonder if promoting these things is the right thing to do …. but maybe that’s because I don’t see the happy and satisfied ones!
I’d be interested to know how everyone else deals with such conflict..
At one hospital in London I was told there was no point at all in having a 20 week scan, if I wouldn’t have a termination; all the scan was meant to do was find out abnormalities, and for parents who wouldn’t terminate, they didn’t recommend it.
The midwife didn’t actually call it a termination scan, but an “anomaly” one, but since she thought I wasn’t a candidate for a termination, she said there was no point.
I realise that other places may offer scans for other reasons, but I was told there, by that midwife, not to have the scan if I was against termination. Which I was. So I didn’t : )
But I have had scans in other hospitals; I appreciate they may have other uses. I missed a 20 week scan once (same hospital) , and had a late scan (to check on growth) at 38 weeks, and was told rudely by the scanner that ” there can be lots of defects we can’t check at this age; there could be anything wrong with this baby”. Huh.
I’ve never heard it called a ‘termination’ scan before, but some people do see it in those terms i.e. anomaly scans are so you can find out if there is something wrong and terminate if there is – an attitude which seems to be at least as prevalent amongst those who are opposed to termination on the grounds of abnormality.
However, let’s not forget that some of the anomalies detected at scan are those where ‘nature’ has made life cheap i.e. the baby is not going to live whatever ‘we’ do.
I have had lots of scans during both my pregnancies (I’d been having some cancer treatment) and despite the above I found them reassuring in terms of seeing baby was alive… though I was always wondering as soon as the scan was over. I had the anomaly checks but was really uncomfortable with it, especially seeing baby’s heart etc., it did feel intrusive. I never had any intention of having a termination, but wanted to know if there were going to be any obvious problems.
And on the subject of consumerism… at least those scans are done by some sort of professional. One of my work colleagues bought one of those self monitor heartbeat things with headphones and listened to it all day through her pregnancy. If the baby kicked or moved we had panic stations until it was repositioned!
I had a weird experience at a scan …
I had one anomaly scan apiece – around 20 weeks – for my first and third babies, which I was perfectly happy with – there are things I’d rather know about before the baby was born, and I found it quite amazing.
In my second pregnancy, I had a bit of bleeding early on, and (for other reasons too) was very paranoid about the pregnancy, so much so that at my booking-in appointment, my midwife arranged for an earlier scan to ‘reassure’ me.
When I had the scan (15 weeks) the baby looked fine, BUT they could also see another ‘baby’ outside my uterus. It seemed to be some kind of ‘reflection’, but the scope of the US was not wide enough to be able to see both at once to check that the two images were the same baby. They tried a vaginal doppler as well, but didn’t get any more information that way.
They were pretty sure it was some mechanical weird glitch, but not sure enough to let me go home (I had the last appointment of the day, and was in there for about an hour). Unfortunately, I was actually on holiday with my parents at the time, but not too far from home, so my mum and I had come back for the scan, leaving my dad and husband with my just-turned-one daughter. So there I was, stuck in the hospital, not being able to get in touch with my partner, crying about not being with my still-breastfeeding daughter, even more worried about the baby, given bad food, etc etc.
First thing in the morning, scanned again, everything fine, but they were definite that I had to come back for the anomaly scan, which I’d been leaning towards not bothering with.
Has anyone else heard of anything like this happening?
All three anomaly scans that I’ve had, I’ve had to justify wanting them, because I’d turned down the AFP (?) tests.
I struggle with the concept that a ‘professional’ can know the gender of the baby but the parents do not have the right to this information in most areas. I live on the border of two health authorities – at the anomaly scan one will tell the parents the sex of their baby, the other will not.
I never wanted to know the sex of my babies at scans (I had one for each) but it made me really cross that they wouldn’t tell me if I had wanted to know. This makes a mockery of women’s choice. Scanning is yet another control issue. They decide what they’ll tell you and what they won’t; the hoops you have to jump through to get what you want!
The idea of seeing your baby on screen is very seductive so perhaps they milk it for all its worth.
Given that anomaly scans are on offer I am shocked that they might be offered only on the condition that the woman will have a termination if an anomaly is found. To choose screening and not a termination if something generally considered grounds for a termination is found is a perfectly legitimate parental choice. We are not in the business of eugenics. Are we? sometimes I wonder.
I think this business of making the scan conditional is to protect the staff from psychological discomfort (like a number of other practices). Although one could always say one would have a TOP and then not – no one can force it.
Margaret mentioned control over the information which is given. I think this is a really good point, and that it also needs to be said that interpretation of a scan is not objective.
I’ve been very interested in this thread as it’s something that has come up for me professionally too
I work as a PND researcher, and on all of the studies I have been involved in, the scan has been one of the most important experiences of a pregnancy to women. A quick/rushed scan leads to anxiety, a post bleed scan gives the utmost reassurance. Fathers often report it as the beginning of the bond with their baby.
I am very aware, and concerned about the physiological effects of scans… I had 7 in the first few weeks of my last pregnancy (I had every ‘complication’ going!) and this worried me greatly, especially with the lack of positive research evidence, and I also take on board the point about women bonding well with their babies before scans were around…though I would argue the experience of pregnancy is very different for women now, in terms of expectations and reality.
I am a researcher, and I believe in the importance of research in our practice, but I also think we need to think carefully about what we are measuring, and what our definitions are. Health, as defined by WHO etc, takes into account both physiological and psychological well being, and (without wanting to start a row here)..the ‘positive’ psychological effects of scans may counterbalance the ‘negative’ physiological ones, at least for some women. While I am always alarmed at the consumerism associated with childbirth these days, I also take some of their ‘blurb’ on board!
I have been listening to the discussion on later scans and i am now wondering what to do about my current situation, I am about 8w and have spoken to the midwife saying that i’m not keen on having a 17w scan as the only benifit I can see is to check the position of the placenta and i don’t want any other checks done which seem to come as a package. she has suggested a scan next week at the doctors just to get an idea of size as i am breastfeeding and am unsure of dates, then a 36w scan to check the placenta. any comments?
The scan next week would be used for dating your pregnancy, going by foetal development (not just size at this point). It would be more accurate for dating the pregnancy than a later scan – how important is that for you? In other words, does certainty about your dates matter to you particularly? How do you feel about the possibility of the due-date being changed to reflect the scan findings? The fact that you’re breastfeeding shouldn’t have any impact on whether you have a scan.
The 36-week scan – again, it depends on how you feel about it. How was the placenta with your previous babies? If there were no concerns, why is the 36-week scan being suggested now?
I have tried to put my own thoughts on scans in this post.I think that if you are asking for information and advice you have come to the right place and hopefully there will be enough different opinions expresssed for you to truly make informed consent. So, below is my 2p-
If you are unsure of your dates then ‘they ‘ will want to know more than your guesstimate.You could try having someone do a bimanual (internal) to assess the size of your uterus as an 8-9 week uterus can be felt differently from a 6-7 week or a 10-11 week uterus.- however this is a midwifey /obstetric skill thatnot every one will feel confident at whilst even an amateur ultrasonographer can tell at the the earliest scan the dates of conception plus or minus a week.
After 12 weeks the scans are only plus or minus two weeks and by 3rd trimester they can be out a whopping 3 weeks(EVEN WITH THE TOP ULTRASONOGRAPHER IN THE COUNTRY!)
The only reason to get a dates scan is for the simple reason that you are unsure yourself and, what if you are wrong by two weeks ? If you have no scan early on and you go 2 weeks over the dates you gave then there will be alarm that you are postdates and you will be asked to come in for a biophysical profile every three days to check that you are not postdates. What if you are wrong two weeks the other way and it makes the differece between anticipating a 34 week or 36 week baby. 34 weeks for example rules out a home birth , 36 weeks no-one bats an eyelid!!
If the placenta is located at or near the os and you get any bleeding you can also assume that a scan will be pushed and it may be comforting to know that information – but if you reach 36 weeks with no bleeding you may want to ask why they need to know where the placenta is. (rhetorical question!)
So what I’m saying is that if you go for the earliest scan possible it may avoid future ”issues” unless something out of ‘normal ‘ happens then another one may be requested. Unless of course you read the literature on scans and decide that you definately do not want one at all whatever the circumstances. Try ‘Ultrasound , Unsound?” published by AIMS.
It is important to remember that any ultrasound suggested for any indication at any stage in pregnancy always has the potential to find anything else and as such start a cascade of events that you may have been attempting to avoid. Ultrasound is the ultimate screening test and as such probably has greater potential for medicalising your pregnancy than any other thing…this is important to realise.
Many women happily choose ultrasound and if this is an informed decision that is fine, but if you have decided for whatever reasons that you do not want to have an anomoly scan then any ultrasound suggested for any reason (dating, growth, placental site etc etc etc……) always will check for structural anomalies in the fetus or anything else for that matter and has the potential to find problems real or otherwise unrelated to the original “indication” for ultrasound.
It has been noted by J Proud (who has written a lot about obstetric ultrasound) how often a woman who declines ultrasound will be encouraged by health professionals to have one for some other reason; many seem very uncomfortable with anyone who has not had an ultrasound (whatever happened to clinical skills.? How on earth did women manage to have babies 30 years ago before ultrasound was so universal?). I think you maybe discovering this known phenomenon.
It is also known that there is no evidence of the benefit of routine ultrasound (Cochrane review). So by all means have an ultrasound if you want one but not because other people want you to!
Scans just to check placental location?
Some people refuse anomaly screening but choose to have an ultrasound scan at the end of pregnancy just to check the placental site.
I did that in a couple of pregnancies. The hospital were fine about it. Have had two friends who got to 40 weeks (one was in labour) with undiagnosed placenta previa, so I would be (for myself, I realise everyone is different) wary of not having any scans at all, and just hoping I didn’t have placenta previa. (They both had CSs, one in a bit a blood-ridden emergency!)
(Regarding the friend with an emergency CS for placenta praevia) As soon as she started having mild contractions, she started spurting blood during each contraction; and got to hospital asap in an ambulance. Apart from the fact it was all a bit frightening, she was fine. Don’t think she needed a blood transfusion. She had an emergency CS.
She had had a scan at 20 weeks. . . dunno if they missed the low placenta or if it moved.
I did this, but at about 39-40 weeks. Third baby, unstable lie, & the midwife suggested it was possible that it was due to a low-lying placenta (he got into a head-down position several times but didn’t stay there – or anywhere else – for very long). It seemed to me to be a sensible precaution, especially given that I was planning a homebirth. I had a scan which lasted no more than 90 seconds, was assured that the placenta was nice & high up on the uterine wall, & no more was said about it. Baby eventually moved into a head-down position & stayed there at about 41 weeks & was born with no problems at 42+1.
OK I accept that they will not always check for them if you specifically ask them not to (if the person going for the scan is well enough informed to ask them not to – which most people wouldn’t be). That is not really the point – to a trained eye there is always the possibility they will notice structural anomalies in the fetus (at least this is what J Proud says and she is a midwife ultrasonographer so I guess she knows more than most of us) – and even if you have an untrained eye you may notice some. Although you are obviously less likely to find them if you are not looking for them! So basically you have to not look at the screen yourself and ask the ultrasonograher not to tell you or take any action if they notice any anomaly which is certainly something of an ethical dilemma at the very least and goes against how most health professionals act i.e. we may be OK at not looking for a problem but if we find one to ask us not to inform or act may be a little hard (professional code of conduct….?). Some may be happy with that but I think many if put to the test would find it a real dilemma. Some may have positive experiences of this- which is great but I can also cite examples of times women have gone for scans and a problem has been found or suggested unrelated to the original indication for the scan and it can be very distressing as the woman thought the scan would just get the date “right” or whatever. We don’t know what any individual ultrasonographer would do if they did find a problem and it may be that the experience was positive because there was not anything negative to find (which of course is usually the case anyway).
Of course we may be making an assumption as to why anyone may not want to have ultrasound and basically it doesn’t really matter why not. If there is no evidence that routine ultrasound is beneficial then you need to be convinced that in your particular situation the benefits outweigh any possible disadvantages. Why does anyone need to know where the placenta is anyway? we are all talking like a load of obstetricians assuming that if you don’t know you must have grade IV placenta praevia. I would be interested to know how many women have placenta praevia without any bleeding in their pregnancy – which would be an indication for ultrasound. I guess we wouldn’t know nowadays as it is ultrasound which discovers the “low lying placenta” in early pregnancy and is then followed up by further scans etc etc – most of which are not placenta praevia anyway by which time you have had appointments with Obs, maybe a touch of bleeding, hospital admission etc etc (all jolly fine if that is what you want but not if that was what you were hoping to avoid). The point is if you have any intervention (and ultrasound is an intervention) the consequences may not always be what you want and one intervention has a habit of leading to another.
I think the discussion is fascinating, though, because it seems that just about no-one seems to get through pregnancy without ultrasound these days – one way or another – which was exactly the point I was making. This aspect of the medicalisation of childbirth is rarely questioned even by those who would rant and rave about other aspects of intervention and medicalisation of childbirth. At the end of the day it is fine to make an informed choice to have ultrasound but also fine to just say no.
Once you have done some ultrasound training there are certain anomolies that you can’t miss. Missing organs, for example.
In order to assess biophysical profile or low lying placenta you have to look at the whole picture and I think it is dreadfully unfair to ask an ultrasonographer to do a scan and not be able to mention it to anyone else if they see an obvious problem.The poor person who sees an anomoly which they know will mean the baby needs a transport to another hospital or would be better off being born in the hospital and not at home…and ethically they cant tell the pregnant woman nor any of her caregivers .The care givers will also be faced with an emergency upon birth as oppossed to an anticipated problem and this ulktrasonographer would be asked to disregard his /her own colluegues situation.If I were this ultrasonographer this would cause me sleepless nights.
I think it’s selfish , frankly, to ask anyone to do this, and yet another example of how some technology is being appplied without the thorough discussion of medical ethics.
There is an ultrasound list on obgyn.net , which , like this list, has some of the finest in the world (albeit that , naturally their bent is technomedical). I will try and access that list again as this topic really is interesting.
With my own daughter, I really wanted to know if she was a boy or a girl as I am Jewish and the thought of only having 8 days to tell my family that my baby boy was NOT getting circumscised was making me anxious in pregnancy…so I went in at 34 weeks and thank G-d she was a girl.I stopped worrying for the rest of the pregnancy .
I knew that if there was a problem it would be seen but I asked that nothing be said unless there was a problem. I would not have done an ultrasound just to know about anomolies as the risk of there being a problem was not high enough IMO to warrant it.However the risk of having a boy was 50%!! Once I already involving my body and baby in the use of ultrasound technology, I decided I would rather know whether my baby would need immediate transport to a hospital, whether the problem could wait after birth or whether the baby was incompatible with life. Reason being that if all are prepared in a home birth for the baby dying soon after birth then not only do you have time to adjust but you avoid all the horrible transport and diagnosis immmediately postpartum.
The type of clients I usually dealt with in the USA either had ultrasounds done because they wanted to know everything or they refused them point blank. Before a biophysical profile was done I did fetal wellbeing tests (with a fetoscope!) and only sent for a biophysical once woman hit 42 weeks , which with the bag of tricks we had was not that often.That woman knew that thew only way she could get her clinic birth was to proove to the authorities through biophysical profile that the baby and placenta was OK.
I have never heard of doing ultrasound at the end of pregnancy just to rule out placenta praevia. If it hasn’t bled during pregnancy then its unlikely to be complete praevia and if its partial then I’d rather not have a situation in Britain where that ‘neccessitates’ a c-section before a trial of labour.. IMO partial previa warrants expectant management. Usually, according to the midwives I have asked about this, it gets compressed with the descending head. You may see some bleeding in labour as cervix dilates but the placenta is born with a ‘dead’ part on the side as the blood supply got cut off. Of course, the 500ml blood loss limit before panic sets in has to be disregarded!! Think more like 1000ml. The likelihood of the bleeding being so bad that it would be a disaster to have a half hour wait till diagnosois, transport from home and c-section set up is minimal. I think we are talking about a risk as big as any other in a home birth.
Of coures the above is not from my own personal experience but from talking with other home birth midwives about this – it is not something that comes up as often as, let’s say, emergency twins or breech or even prolapsed cord. please will the person who posted about the terrible hemorhage caused by the praevia write some more details about how much blood was lost etc. as it’s the first story I have heard of something serious actually happening.
A 17 week scan to determine the position of the placenta is a complete waste of time. May I suggest that you draw your midwife’s attention to the large randomised controlled trial by Sari-Kemppainen et al, 1990, Ultrasound screening and perinatal mortality controlled trial of systematic one-stage screening in pregnancy, The Lancet, Vol 336, pp387-391.
4,000 women were scanned at 16-20 weeks and 250 were diagnosed as having placenta praevia. When it cam to delivery there were only 4 placenta praevias – and one of those had not been diagnosed. In the control group (where the women were not scanned) there were also 4 cases of placenta praevia. All the women had caesarean sections and no babies died. But one presumes that 246 women spent most of their pregnancies unnecessarily worrying about a forthcoming caesarean section!
Comments on this study and others can be found in Ultrasound Unsound, available from AIMS.
I was told at a 9week scan (after bleeding)that I wasn’t pregnant, but carrying a ‘degenerating cell’….that degenerating cell is now a beautiful 7yr old boy
…even now I sometimes think I might send them a photo
Reading this has made me feel very upset. The same thing happened to me, but I had a D&C. That was seven years ago and I have never forgiven myself for not questioning the scan or not asking for another one later. It is something I will always wonder about and I can never forget my baby that couldn’t be.
Ok, I’m not a scan pusher… but isn’t it true that ‘occasionally’ these scans can prepare the parents and or staff to a problem that can be corrected ASAP after the birth? Like some heart conditions? I know that false positive/negative results are found too…. but maybe sometimes preparation is a good thing? emotionally as well as ready for surgery etc..?
Yes, Sal, that would be great but consider the maths of false positives. Rates are in the 80%s.
Take 1000 mums, anxious to different degrees for reassurance. 900 are told the baby is healthy. About three of these mums give birth to babies with unexpected problems because of false negative results.
10 are told there are problems: 8 of those babies would be normal, a false positive result.
Two mums of healthy babies terminate because they cannot face dealing with a disabled baby.
One mum miscarries a healthy baby from the stress.
One mum terminates a baby with a condition incompatible with life and develops post partum depression.
Six mums carry to term having told family and friends that they are carrying a disabled baby.
One mum gives birth to a baby which dies shortly after birth and is grateful she was prepared.
Five mums have a story to tell of all the pain they went through for a false positive result.
Could you cite a reference for these figures?
I don’t know where to start. Just out of curiosity last week I started reading all the journals for the last 10 years on prenatal diagnosis and obstetric ultrasonography. The figures relating to soft markers and their accuracy are pretty astounding. Essential the problems relate to specificity and sensitivity. Every issue contained studies with similar figures for accuracy – roughly half the babies with a particular problem are detected ( I don’t know if that sort of sensitivity would attract me) while 80-95% of the babies suspected were normal.The specificity of US for soft markers is poor.
In a large study published in the Lancet in 1998 by Boyd, Chamberlain and Hicks, out of 396 babies suspected of anomalies, 174 were found to be normal at birth. Of those normal babies 92% were suspected of abnormality because of identification of US soft markers. Over the duration of the study the popularity of soft markers led to a very small increase in detection of malformations while the rate of false positives increased 12 fold. Interestingly several years earlier these same authors found much higher accuracy in relation to normal babies born because the ultrasonogrphers were looking for only for gross anomalies.
Since BMJ is available online I include these links which discuss US screening of massive numbers of normal pregnancies and its implications.
There is an interesting letter to which I have also linked: http://www.bmj.com/cgi/content/full/314/7085/918?ijkey=AEPRqWYKmXUiI
Just out of curiosity last week I started reading all the journals for the last 10 years on prenatal diagnosis and obstetric ultrasonography. The figures relating to soft markers and their accuracy are pretty astounding.
Essentially, the problems relate to specificity and sensitivity. Every issue contained studies with similar figures for accuracy: roughly half the babies with a particular problem are detected ( I don’t know if that sort of sensitivity would attract me) while 80-95% of the babies suspected were normal.The specificity of US for soft markers is poor.
In a large study published in the Lancet in 1998 by Boyd, Chamberlain and Hicks, out of 396 babies suspected of anomalies, 174 were found to be normal at birth. Of those normal babies 92% were suspected of abnormality because of identification of US soft markers. Over the duration of the study the popularity of soft markers led to a very small increase in detection of malformations while the rate of false positives increased 12 fold. Interestingly several years earlier these same authors found much higher accuracy in relation to normal babies born because the ultrasonogrphers were looking for only for gross anomalies.
The RADIUS Study found that mass screenings for anomalies did not improve outcomes over selective ultrasound given as a result of medical indications:
‘Effect of prenatal ultrasound screening on perinatal outcome’
Bernard G Ewigman, James P Crane, Fredric D Frigoletto, Michael L LeFevre, Raymond P Bain and Donald McNellis for The RADIUS Study Group
An RCT involving 15,151 pregnant women at low risk for perinatal problems; aimed to determine whether ultrasound screening decreased the frequency of adverse perinatal outcomes. The women randomly assigned to the ultrasound-screening group had one scan at 15 to 22 weeks of gestation and another at 31 to 35 weeks. The women in the control group had a scan only for medical indications. Adverse perinatal outcome was defined as fetal death, neonatal death, or neonatal morbidity such as intraventricular haemorrhage. Results: The mean numbers of scans in the ultrasound-screening group was 2.2 and in the control groups it was 0.6. The rate of adverse perinatal outcome was 5% in the ultrasound-screening group and 4.9% in the control group. The rates of preterm delivery and the distribution of birth weights were nearly identical in the two groups. The ultrasonographic detection of congenital anomalies had no effect on perinatal outcome. There were no significant differences between the groups in perinatal outcome in the subgroups of women with post-date pregnancies, multiple-gestation pregnancies, or infants who were small for gestational age.
Conclusions: Screening ultrasonography did not improve perinatal outcome as compared with the selective use of ultrasonography on the basis of clinician judgment.
Finally, a study of the effects of reassuring results that were in error:
BMJ 2000 Feb 12;320(7232):407-12 >Psychological consequences for parents of false negative results on prenatal screening for Down’s syndrome: retrospective interview study.
Hall S, Bobrow M, Marteau TM.
Psychology and Genetics Research Group, Guy’s, King’s College, and St Thomas’s School of Medicine, Thomas Guy House, Guy’s Campus, London SE1 9RT.
OBJECTIVE: To determine the psychological consequences for parents of children with Down’s syndrome of having received a false negative result on prenatal screening. DESIGN: Comparison of adjustment of parents who received a false negative result with that of parents not offered a test and those who declined a test. SETTING: Parents were interviewed in their own homes. PARTICIPANTS: Parents of 179 children with Down’s syndrome (mean age 4 (range 2-6) years). MAIN OUTCOME MEASURES: Anxiety, depression, parenting stress, attitudes towards the child, and attributions of blame for the birth of the affected child.
RESULTS: Overall, regardless of screening history, parents adjusted well to having a child with Down’s syndrome. Compared with mothers who declined a test, mothers in the false negative group had higher parenting stress (mean score 81.2 v 71.8, P=0.016, 95% confidence interval for the difference 1.8 to 17.0) and more negative attitudes towards their children (124.9 v 134.2, P=0. 009, -16.2 to -2.4). Fathers in the false negative group had higher parenting stress test scores (77.8 v 70.0, P=0.046, 1.5 to 14.2) than fathers not offered a test. Mothers in the false negative group were more likely to blame others for the outcome than mothers who had not been offered the test (28% v 13%, P=0.032, 3% to 27%). Mothers and fathers in the false negative group were more likely to blame others for this outcome than parents who had declined a test (mothers 28% v 0%, P=0.001, 19% to 37%; fathers 27% v 0%, P=0.004, 17% to 38%). Blaming others was associated with poorer adjustment for mothers and fathers.
CONCLUSIONS: A false negative result on prenatal screening seems to have a small adverse effect on parental adjustment evident two to six years after the birth of an affected child.
We had a false positive scan with baby no. 7; he was showing soft markers for Down’s syndrome, and I found the way it was dealt with by the doctors and scanner just horrific. They wouldn’t give me any real information, the scan lady wouldn’t give me any information at all. She wrote lots of things in ‘code’ on the results form, and just refused to tell me what any of it meant. I eventually found out via the internet, and challenged the doctor, who was very unwilling to dicuss it.
The doctors wanted me to keep going back for repeat scans to see if things had changed or worsened, but my midwife said not to bother if I didn’t want to.
The baby was born safe and well, but the anguish we went through was not funny; wondering if our child would live or be handicapped. The lack of information or counselling didn’t help.
So yes, a ‘clear’ scan is reassuring, but at bad result is hideous too, and in our case it was all for no reason.
I don’t know if anyone else has seen this but I read an article from a weekly magazine (Either That’s Life or Take a Break – not sure which). It was a heartbreaking true account of a woman’s experience of scanning. To cut a long tale short – this lady had a scan at eight weeks which showed twins. From then on it seems that she had several scans (not sure why) which appeared to show both babies growing normally. She was told that she was expecting a baoy and a girl and was delighted. She already had two boys and had longed for a little girl and was so pleased when the scan showed one of each.
At 33 weeks she had a scan as she had bled and yes – you’ve guessed it no sign of a second twin. A boy floating about happily but no girl. It transpired that there probably never had been a girl. The sonographer had been measuring and looking at the same baby for weeks. Probably the only time there were two babies was at the first eight week scan. The poor woman then had all the emotional problems of bereavement for her baby girl who may never have been plus resentment that this boy was living and then guilt when she initially rejected him at birth. Fortunately she managed to overcome these feelings and is now a happy mum of three boys. But who knows what the long term damage may be.
It was such a sad tale I had to share it and see if anyone else read it. So sad that we don’t think about the implications of scanning a bit more isn’t it?
For further reading on the possible downside of scans, I would recommend Beverley Beech’s paper, Ultrasound – weighing the propaganda agains the facts
(www.aims.org.uk/ultrasound.htm). In the other corner, Ob-Ultrasound.net is a very thorough site which defends the safety of ultrasound (www.ob-ultrasound.net)
Ultrasound scans linked to brain damage in babies
By Robert Matthews, Science Correspondent, Daily Telegraph
EVIDENCE suggesting that ultrasound scans on pregnant women cause brain damage in their unborn babies has been uncovered by scientists.
In the most comprehensive study yet on the effect of the scanning, doctors have found that men born to mothers who underwent scanning were more likely to show signs of subtle brain damage.
The implications of the study are to be raised at an international meeting of scientists being held this week in Edinburgh. There have been calls for urgent further research.
During the 1990s, a number of studies hinted that ultrasound scanning affected unborn babies. Research has suggested that subtle brain damage can cause people who ought genetically to be right-handed to become left-handed. In addition, these people face a higher risk of conditions ranging from learning difficulties to epilepsy.
Now a team of Swedish scientists has confirmed the earlier reports on the effects of ultrasound with the most compelling evidence yet that unborn babies are affected by the scanning. They compared almost 7,000 men whose mothers underwent scanning in the 1970s with 170,000 men whose mothers did not, looking for differences in the rates of left- and right-handedness.
The team found that men whose mothers had scans were significantly more likely to be left-handed than normal, pointing to a higher rate of brain damage while in the womb. Crucially, the biggest difference was found among those born after 1975, when doctors introduced a second scan later in pregnancy. Such men were 32 per cent more likely to be left-handed than those in the control group.
Reporting their findings in the journal Epidemiology, the researchers warned that scans in late pregnancy were now routine in many countries. “The present results suggest a 30 per cent increase in risk of left-handedness among boys pre-natally exposed to ultrasound,” they say. “If this association reflects brain injury, this means as many as one in 50 male foetuses pre-natally exposed to ultrasound are affected.”
Prof Juni Palmgren, of the Karolinska Institute in Stockholm, a member of the team, told The Sunday Telegraph: “I would urge people not to refuse to have ultrasound scanning, as the risk of brain damage is only a possibility – but this is an interesting finding and needs to be taken seriously.”
Other doctors and scientists caution that until further studies are carried out, scanning should still be regarded as safe by mothers-to-be. If confirmed, however, the findings would mean that ultrasound scans are causing slight brain damage in thousands of babies in Britain each year.
Ultrasound scans, which were introduced in the 1960s, have long been regarded as a safe means of checking on the health of unborn children. The scanners use high-frequency sound waves to give X-ray-like images of the inside of the womb, but without using radiation, which carries a risk of causing cancer. Between the 1960s and today, the number of pregnant women having scans in western Europe has increased from a handful to virtually all of them.
Normally, left-handedness is genetic: the likelihood of two left-handed parents having a left-handed child is 35 per cent, while for two right-handed parents, it is only nine per cent. It is when the incidence of left-handedness begins to rise above these normal rates that scientists become concerned that brain damage of some kind could be a factor.
Other surveys have shown that premature babies are five times more likely than normal to be left-handed. According to the Swedish researchers, the human brain undergoes critical development until relatively late in pregnancy, making it vulnerable to damage. In addition, the male brain is especially at risk, as it continues to develop later than the female brain.
The growing evidence that ultrasound affects unborn babies may cast new light on the puzzling rise in left-handedness over recent years.
In Britain, the rate has more than doubled, from five per cent in the 1920s to 11 per cent today. Researchers have estimated that only 20 per cent of this rise can be put down to the suppression of left-handedness among the older generation.
Dr Francis Duck of the British Medical Ultrasound Society will chair a discussion of the results at the international meeting of ultrasound experts being held this week in Edinburgh. “When the first study suggesting a link came out, it was possible to ignore it, but now this is the third,” he said. “What it demonstrates is the need to investigate the link further, and to look at possible mechanisms.”
Dr Duck cautioned, however, that ultrasound scanning has saved the lives of countless babies: “This research must be seen in context, and it should not deter anyone from having an antenatal scan.”
Beverley Beech, the chairman of the Association for Improvements in Maternity Services, criticised doctors for insisting for years that ultrasound was totally safe.
“I am not sure at all that the benefits of ultrasound scans outweigh the downsides,” said Ms Beech. “We should be advising women to think very, very carefully before they have scans at all.”
MedscapeWire – Greater Risk of Lung Damage From Ultrasound Than Previously Thought
September 7, 2001
New York – Pumping more energy into a beam of diagnostic ultrasound could produce a better image – and therefore a better diagnosis – but studies at the University of Illinois at Champaign suggest the risk of ultrasound-induced lung damage is greater than many scientists previously believed.
While there has been no evidence that clinical use of ultrasound has had any adverse effects in humans, safety concerns were raised recently when scientists discovered that diagnostic treatment levels could produce acute lung hemorrhages in laboratory animals. The researchers presented their latest findings this week at the 17th International Congress on Acoustics in Rome, Italy.
“The big question is whether human lungs can be damaged by diagnostic ultrasound, and if so, under what exposure conditions,” said William O’Brien Jr, a UI professor of electrical and computer engineering and the director of the Bioacoustics Research Laboratory at the university’s Beckman Institute for Advanced Science and Technology.
In experiments performed on mice, rats, rabbits and pigs, O’Brien and colleagues found similar patches of lung damage, independent of animal size or species.
“What’s common in all of these animals is the thickness of the air-blood barrier near the surface of the lung,” said James F. Zachary, a UI professor of veterinary pathology and interim department head of veterinary pathobiology. “This barrier is of similar thickness in humans, also – so people may be just as susceptible to this type of lung damage.”
The air-blood barrier is very thin, and may be the principal target for ultrasound-induced lung damage.
“The cause of the damage appears to be mechanical in nature,” O’Brien said. “A sound wave has momentum and imparts a force. A beam of sound focused at an air-water interface, for example, can shoot water into the air – like the cold steam produced by ultrasonic humidifiers. We think the sound waves push against the lung tissue hard enough to create small rips, which cause bleeding.”
Acoustic forces, acting on the air-blood barrier, “could initiate a lesion that could grow through alveolar hemorrhage and propagate into deeper lung tissue,” Zachary said. “The lesion would stop growing only when the hemorrhage becomes large enough to effectively dissipate the acoustic energy.”
In their work, the researchers found that lung damage appears to be dependent upon ultrasound beamwidth, pulse duration, and exposure duration. In an age-dependent study performed on pigs, the researchers also found that older animals were most sensitive to lung damage.
“One possible explanation is that the lung membrane becomes less pliable with age, and rips more easily when exposed to sound waves,” O’Brien said.
Read this story on Medscape (www.medscape.com/MedscapeWire/2001/09/medwire.0907.Greater.html)
ULTRASOUND SCANS can stop cells from dividing and make them commit suicide.
A research team in Ireland say this is the first evidence that routine scans, which have let doctors peek at fetuses and internal organs for the past 40 years, affect the normal cell cycle.
A team led by Patrick Brennan of University College Dublin gave 12 mice an 8-megahertz scan lasting for 15 minutes. Hospital scans, which reflect inaudible sound waves off soft tissue to produce images on a monitor, use frequencies of between 3 and 10 megahertz and can last for up to an hour
The researchers detected two significant changes in the cells of the small intestine in scanned mice compared to the mice that hadn’t been scanned. Four and a half hours after exposure, there was a 22 per cent reduction in the rate of cell division, while the rate of programmed cell death or “apoptosis” had approximately doubled.
Brennan believes there will be similar effects in humans. “It has been assumed for a long time that ultrasound has no effect on cells,” he says. “We now have grounds to question that assumption.”
Brennan stresses, however, that the implications for human health are uncertain. “There are changes happening, but we couldn’t say whether they are harmful or harmless,” he explains. The intestine is a very adaptable organ that can compensate for alterations in the cell cycle, says Brennan.
It is possible that the sound waves damage the DNA in cells, delaying cell division and repair. Brennan suggests that ultrasound might be switching on the p53 gene which controls cell deaths. This gene, dubbed “the guardian of the genome”, produces a protein that helps cells recognise DNA damage and then either self-destruct or stop dividing.
Studies in the early 1990s by researchers at the University of Rochester in New York and the Batelle Pacific Northwest Laboratories in Richland, Washington, showed that tissue heating due to ultrasound can cause bleeding in mouse intestines. Ultrasonographers now tune the power of scans to reduce such heating.
But Brennan’s work is the first evidence that scans create changes in cells. “Our results are preliminary and need further investigation,” he says. The team presented their results at the Radiology 1999 conference in Birmingham last month and are now preparing them for submission to a peer-reviewed journal.
Alex Elliott, a researcher in clinical physics at the University of Glasgow, thinks that Brennan’s results are important and should be followed with further studies. “If the conditions of his experiments really compare to the clinical use of ultrasound,” he says, “we may have to review the current safety limits.”
From New Scientist, 12 June 1999
Ultrasound Scans May Harm Unborn Babies
By Robert Uhlig, Technology Correspondent, New Scientist
New research has raised doubts over the safety of ultrasound scans used to view fetuses in the womb. Scientists have called for further research to determine whether safety limits should be reviewed for the tests, which are also used to check internal organs in children and adults. Since the early 1990s, when American researchers showed that ultrasound tissue heating can cause bleeding in mouse intestines, ultrasonographers tune the power of scans to reduce heating. The latest discovery, by scientists at University College Dublin, is the first to find that scans create changes in cells. Patrick Brennan, who led the research, said: “It has been assumed for a long time that ultrasound has no effect on cells. We now have grounds to question that assumption.”
The researchers gave 12 mice an eight megahertz scan lasting for 15 minutes. Hospital scans can last for up to an hour, using frequencies of between three and 10 megahertz. According to today’s New Scientist, two significant changes in the cells of the small intestine were detected in scanned mice compared with unscanned mice. Four and a half hours after exposure, the rate of cell division had reduced by 22 per cent and the rate of programmed cell death had approximately doubled. Mr. Brennan believes there will be similar effects in humans.
COMMENT: It would certainly seem prudent to avoid all routine absolutely unnecessary ultrasound scans for fetal observation. There appears to be more than enough evidence to warrant this recommendation. Pregnancy complications are another issue and one would have to weigh all the factors individually when attempting to determine the benefit/risk ratio.
New Scientist ISSUE 1476 Thursday 10 June 1999
Comment from GLORIA LEMAY, Vancouver, BC. : The above item and comment came from Healthy News You Can Use, a weekly on line health newsletter by Dr. Mercola, and the comments are Dr. Mercola’s.
I believe the statement above that this is the first study showing cell changes from ultrasound is incorrect. Dr. D. Liebeskind of Albert Einstein University published findings of cell changes as a result of ultrasound in l982 in the British Journal of Cancer. Her study was duplicated by 4 other reputable labs but ll others could not duplicate the results. Therefore, her work was essentially thrown out. The heating effect of ultrasound has also been proven before. Good scientists have tried to alert the public about the danger to a baby’s brain of having ultrasound scans. Because the head is bowl shaped, the radiation is magnified and can result in parts of the brain being subjected to extra high intensities. (ref. “A Prudent Approach to Ultrasound Imaging of the Fetus and Newborn. Kenneth J.W. Taylor, M.D., Ph.D., Birth 17:4 Dec l990) Dr. Taylor, who is Professor of Diagnostic Radiology and Chief of the Ultrasound Section at Yale University School of Medicine, New Haven, Connecticut, makes the statement in this article “I would not let anybody get near my infant’s head with a transducer unless I knew what the output was.” How many parents could make an informed choice about this matter?
Another article with information about brain heating by ultrasound is Tissue Heating Effect of Pulsed Doppler Ultrasound in the Live Fetal Lamb Brain. Fetal Diagnostic Therapy l992;7:26-30.
One of the promises held out by antenatal scanning is that obstetricians will be able to identify the baby with problems and do something to help it and great attention is paid to whether the baby is growing normally.. A German study from Wiesbaden hospital (Jahn A et al, 1998) found that out of 2,378 pregnancies only 58 of 183 growth retarded babies were diagnosed before birth. Forty-five fetuses were wrongly diagnosed as being growth retarded when they were not. Only 28 of the 72 severely growth-retarded babies were detected before birth despite the mothers having an average of 4.7 scans.
The babies diagnosed as small were much more likely to be delivered by elective caesarean – 44.3% compared with 17.4% for babies who were not small for dates. If the baby actually had intrauterine growth retardation (IUGR) the section rate varied hugely according to whether it was diagnosed before birth (74.1%) or not (30.4%).
So what difference did diagnosis make to the outcome for the baby? Pre-term elective delivery was 5 times more frequent in those whose IUGR was diagnosed before birth than those who were not. 77% of these were the result of medical interventions because of suspected fetal distress and not related to premature labour or rupture of membranes. The average diagnosed pregnancy was 2-3 weeks shorter than the undiagnosed one. The admission rate to intensive care was 3 times higher for the diagnosed babies.
Jahn A et al. Routine screening for intrauterine growth retardation in Germany: low sensitivity and qustionable benefit for diagnosed cases. Acta Ob Syn Scnd, 1998, 77, p643-689.
Ultrasound , Unsound? by Beverley Beech, published by AIMS
BMJ article about ethical issues in first trimester scanning
Fetal Medicine – organisation headed by Kypros Nicolaides, pioneer of the nuchal scan. There is a pdf document on the site with loads and loads of detail about it, but you may have to hunt around for it.
VALUE OF GENETIC SONOGRAM AFFIRMED IN REDUCING NEED FOR AMNIOCENTESIS
Second-trimester ultrasonography is valuable for identifying Down syndrome and reducing the need for invasive procedures.
MOST COMMON SCREENING TEST FOR DOWN’S SYNDROME MAY NOT BE SAFEST
The screening test for Down’s syndrome that is most commonly used in the UK may not be the safest for the unborn child or the most cost-effective, according to a report in the British Medical Journal for August 25.
RIGHTS TO NONINVASIVE TEST FOR DOWN’S SYNDROME ACQUIRED BY UK FIRM
The rights to a noninvasive method of detecting foetal DNA in the blood of pregnant women have been acquired by BTG, the UK-based technology transfer firm announced on Tuesday.
Private scan services:
3D Scans available privately. Professor Campbell, Create Health, Devonshire Place, London 0207 4865566
AH updated 18 July 2002