routine ultrasound - is it safe??

[tinkerbelle]

Can someone please tell me why the medical profession is still recommending routine ultrasound when it seems that most of the studies say that it has found to have no or little effects on foetal outcome, and has not been fully verified as safe by an adequate amount of well designed medical studies?? Even the Cochrane has advised caution and that further research is needed on safety..
WHY WHY WHY???

Imaging ultrasound in pregnancy :: Guide Chapter 08*PDF*::*Childbirth Connection

Fetal and umbilical Doppler ultrasound in normal pregnancy
Prenatal Testing: Ultrasound Safety and Accuracy

If anyone has any more recent info from systematic reviews of randomized controlled trials, I would love to hear about it. Thanks!

Got 20 week scan tomorrow and my instinct tells me not to do it! But my husband... wants the pictures!! - great reason I say! (not). Im still annoyed about the 10 week one I got bullied into!!! - by the ob that is, not my hubby.

[LimeSlice]

Generally if you are a low risk pregnancy with no other indications of abnormalities or issues, you should only have 3 'routine' scans during your pregnancy.

One usually around 7 weeks, to determine viability of the pregnancy, and determine approximate age (Dating Scan)
The second at 12-4 weeks in conjunction with a series of blood tests in order to ascertain risk of deformities etc such as Down Syndrome (NT Scan)
The thrid at 20 weeks, which is used to ensure the correct for development of limbs, and ensure there are no defects such as spina bifida, heart problems, and quite importantly the position of the placenta.

There are many many benfits to having hte scans - and NONE are obligatory - they are always optional, although some women may need them for other reasons to ensure all is well if there is histpry of abnormalities or recurrent miscarriage, placenta issues etc etc.

Many people like to know the sex of the baby, many parents want to know if there are abnormalities, as for some it can affect the viability of the pregnancy and quality of life issues. they can also inidcate conjoined twins, as they did with my first pregnancy, which again has massive impact on how the pregnancy proceeds and how the birth will unfold.
Needing to know the cord is around baby's neck, or that its legs have not formed properly, or tht abdominal wall is not developed correctly, that you are in fact having unexpectedly twins, or triplets (as one of our members found out last year)...all these things are important for parents, your care providers, or both, to know of in advance - and the defects/abnormalities and developmental aspects are exactly what obstetric ultrasound has been developed for - and it has saved many lives, and helped many parents make informed choices about their pregnancies.

Ultrasounds are not handed out willy nilly nor treated as some sort of game. The need to regular ultrasounds occurs, but not in normal, low risk pregnancy.


As for the notion that early routine ultrasound leads to more induced labour due to 'post-term dates' as ine of those articles suggests, I have never had an Ob/Midwife or GP for that matter, take an ultrasound date over my own dates - but I know my dates. I think there is no substitute for women knowing their own bodies, their cycles...The only way you can be 'bullied' by anyone during your pregnancy is if you are not arming yourself with enough information.
Another article you posted is 7 years out of date, and contains some information that is not referenced.
(I have issues with biased data with no referencing)

Anyway, in answer to your questions - there are MANY reasons why routine ultrasounds are considered by both parents and care providers to be necessary and for those in high risk groups and with family history or fetal issues, they are more than necessary.
As for having no or little effect of feotal outcome, I think that is hugely inaccurate - an ultrasound cannot CHANGE your baby, and nobody proports that is does. What it CAN do is identify serious (and not so serious) issues with a feotus and gives both parents and caregivers a basis on which to make informed care and pregnancy decisions.
I am yet to see anyting that condemns it as UNsafe either, and since it has been in use since 1958 in obstetrics, I would expect that anything that would even remotely be considered 'dangerous' as having been espoused somewhere by someone.

Only you and your husband can make the decision that you will have a further scan - you should not need anymore, so that will be 2 for the pregnacy - sounds fairly "cautious' to me (as you point out the Cochrane suggests caution - not the complete disuse of them). But you also need to remember that it is your husband's baby also, so you two need to find some way to meet in the middle on this issue. So good luck! I hope you can find an outcome that works for both of you and all is well with bubs and the rest of your pregnancy.

[ETA - there have been issues as to whether the sound waves affect the baby - in terms of can they hear it? Is it uncomfortable for them? etc, but I have not seen any evidence to suggest that this is or isn't the case - there was a thread on it not so long ago on BB too if you want to look for it ]

[HotI]

Ultrasounds are not handed out willy nilly nor treated as some sort of game. The need to regular ultrasounds occurs, but not in normal, low risk pregnancy.

Not in the public system, but i have heard of many Obs who "just check how bub is going" with a "quick" ultrasound every appointment! And then there are the places who offer 3D/4D scans for cash where you don't need a prescription. You can even bring friends and nibblies, hang out on the couch and watch bub wiggle!

[meow]

Generally if you are a low risk pregnancy with no other indications of abnormalities or issues, you should only have 3 'routine' scans during your pregnancy.

I think 3 is 2 more than the actual medically 'required' amount and there are no "shoulds" about it. The 20 week scan is the only one that is funded by my hospital. It is used to assess the baby's health and also at this time you can find out about the position of the placenta, cervix etc.

A dating/viability scan is not at all necessary and the 12 week scan only determines risk of a couple of conditions (plus checks other health factors which you don't 'need' to know at 12 weeks as birth is so far away).

Personally I would NEVER have an ultrasound for photos! Or 'just because' scans every time you see an OB. It all seems a bit crazy.

We decided to have the 12 and 20 week scans as we wanted to know and be able to work with the information given. But I have plenty of friends who have no scans- they are not necessary. Are you also aware of the risk of doppler use? I have declined the use of the doppler. In my previous pregnancy no-one was able to find my son's heartbeat by using the pinnard instead (a lost skill!) but it didn't matter because he was kicking. What's the point of then checking for a heartbeat??

[Junglemum]

But I have plenty of friends who have no scans- they are not necessary.

Well that depends on your perspective really. If you have cancer, treatment is not necessary but is more than often helpful. Not a lot of things are not necessary, but doesn't mean they don't help.

If i had a baby with a life threatening illness that needed a team of pediatric surgeons on the ready at it's birth, the only way i could possible know would be to have an ultrasound.

I read the first link that referred to a study that showed that routine ultrasounds increase the incidence of left handedness?! i have heard that before as well as a myriad of other wild claims. The fact is that none of the claims are backed up by any credible study (well the left handed one is, but really?!).

If the only reason you are having the ultrasound is for the pics then i agree, you shouldn't be having it. But if you are having it to check the health of you baby and to look for any causes for concern then i think it is a very valuable tool.

ETA- you are correct in saying that there is no specific evidence saying ultrasound is 100% safe. Ultrasound hasn't really been around for that long, but chances are most of us had an ultrasound inutero. I guess if there was any cause for concern, or a study actually showed that ultrasound was in anyway unsafe then people would devote time and effort into proving it was safe.

[onthefly]

We had lots with DS, this time we're trying to limit it. I think ultrasound is a very important diagnostic tool when used judiciously during pregnancy.
In my opinion, the 20-week ultrasound is a good idea for all pregnancies, but that's probably the only one that is really needed, barring other medical indications.
But there are lots of reasons people have routine ultrasounds - it can be very reassuring, especially in cases where parents are particularly anxious and not yet feeling regular movements. I don't think the evidence is conclusive either way, so it's probably not fair to judge parents that decide to get lots of scans, particularly when many private-practice OBs will offer them as routine (which obviously suggests they see no risk in having many scans).

We've had 3 this pregnancy. 1 early on due to bleeding. Then we had our official 7-week one to confirm viability (standard after IVF). Then the 20-week one. We won't have more unless complications arise.

I would be more concerned about your OB bullying you than whether your not the 20-week ultrasound is worthwhile doing. All the best

[ashie]

i have had 2 scans already one for dates and one for check up as i had bleeding and i have had previous m/c's. my ob checks with u/s each visit to make sure bubs is growing and no problems have arised. scans are useful i had a placenta covering some of my old c section scar at 20 weeks and having a repeat c section it can be dangerous, so i was monitored by my ob to make sure it moved. its good to know certain things as they can be life threatening and will be doing the same things with this pregnancy to ensure my baby is healthy and stays safe until he or she is ready to meet us.

[LimeSlice]

I think 3 is 2 more than the actual medically 'required' amount and there are no "shoulds" about it. The 20 week scan is the only one that is funded by my hospital. It is used to assess the baby's health and also at this time you can find out about the position of the placenta, cervix etc.

A dating/viability scan is not at all necessary and the 12 week scan only determines risk of a couple of conditions (plus checks other health factors which you don't 'need' to know at 12 weeks as birth is so far away).

Personally I would NEVER have an ultrasound for photos! Or 'just because' scans every time you see an OB. It all seems a bit crazy.

We decided to have the 12 and 20 week scans as we wanted to know and be able to work with the information given. But I have plenty of friends who have no scans- they are not necessary. Are you also aware of the risk of doppler use? I have declined the use of the doppler. In my previous pregnancy no-one was able to find my son's heartbeat by using the pinnard instead (a lost skill!) but it didn't matter because he was kicking. What's the point of then checking for a heartbeat??

All of my scans are bulk billed - so a portion i get back form medicare. I am not through a hospital.
I can certainly tell you though if you have had an ectopic (or more than one) then the dating/viability scan IS absolutely necessary - for both medical reasons and for emotional reasons.

As for the 12/3 week scan - if you are a parent who is concerned about DS, then this scan also matters - and has nothing to do with being "so far away from the birth" - you may not even want the birth to take place if you child has such abnormalities!

As a PP said, there are many couples who use IVF and the early scan is also vital to ensuring a viable pregnancy in this situation.

(Oh and the 'should' I used was referring to the ones deemed 'necessary', nothing to do with what a patient should or shouldn't do - there is a should about it, the ones your doctor says you 'should' have.)

I have never been offered more scans during pregnancy, but them my viable pregnancies have always been completely normal with no issues, and my pregnancy with conjoined twins did not last long enough to need anymore.
I have also never been through an OB, so not been offered them in a routine examination - and I certainly wouldn't take them if I had, they aren't necessary (for me).

It is a personal decision, but I really don't think there should be any illusions about the fact that there are viable reasons behind each of the 3 scans that are routinely given in this country, and they are very serious reasons and often vital for the informed decision making of both parents and care providers.

As for the husband wanting pictures - I really don't think that is such a bad reason when you think about it. We get to feel the baby, experience it in full. They get a kick every so often and see a growing belly - they have no other connection or attachment to the baby and I can totally understand a partner wanting the pictures - it is a more tangible thing to get attached to - and from what I understand, that is a fairly normal male way of thinking. I know my husband felt much better and more connected after seeing the ultrasounds (and if he couldn't be there for the scan in person, the pictures are vital.) Just something to think about before we judge how silly or foolish a reason it is for having an ultrasound.

[Kirley64]

In my opinion, the 20-week ultrasound is a good idea for all pregnancies, but that's probably the only one that is really needed, barring other medical indications.

I only had the 20week ultrasound. I knew my dates so i didn't need a dating scan, i am low risk for downs syndrome and we are against termination (even if bub had something wrong with it) and so had no need for the 12 week one. I really wanted to see bub more often but there was no need for it.

I would be more concerned about your OB bullying you than whether your not the 20-week ultrasound is worthwhile doing.

agreed. if it's low risk pregnancy then obstetricians don't really need to see what position bub is in cuz it can change every day....so on the day of labour it will be different from every other day...why do they need to 'check' on it??

[*Beema*]

Being High Risk I have had a lot of scans, TBH I have lost count, of how many internal and external scans I have had, starting from 7 + 4 weeks I started to lose one of the twins and bled for weeks and on numerous occassions it looked as though the second twin wasn't going to make it as well. I had a very short cervix, so have been under constant monitoring for that to ensure that it is not funneling or shortening again, retained product from the first twin, my placenta is located over the septum (septate uterus) so where there is basically no blood flow in that section, my placenta is small so we are on constant monitoring for growth restriction, via growth scans and uterine dopplers. Low amniotic fluids which have picked up of late, and having constant BH's and being on Meds to calm them and having had a prem before, without all the monitoring and scans I hesitate to think about where we would be as I have been on rest, no lifting for the last few months.

So while it isn't ideal and not my preferred way, we need to be aware with what we are dealing with, and are making all attempts to make this pregnancy as long as possible, and a lot of the information we are looking at you can only get from US.

My OB take a number of images of my scans and puts them on file and refers back to them at each appointment, they are a good reference for her as a visual image to compare things rather than just a measurement, but a lot of the photos are of my cervix, the placenta, and not just a series of photos of a growing baby.....

So while it is not ideal to have so many scans we have to weigh up the risks and delivering a baby very prematurely or using technology to prolong a pregnancy for as long as possible I know what my choice is.

I hesitate to agree with articles due to the lack of referencing in the articles, and the age there is much mroe recent information, I have read a bit about the risks of having too many US but there is certainly a point when the benefits outweigh the risks.

[Kirley64]

As for the husband wanting pictures - I really don't think that is such a bad reason when you think about it. We get to feel the baby, experience it in full. They get a kick every so often and see a growing belly - they have no other connection or attachment to the baby and I can totally understand a partner wanting the pictures - it is a more tangible thing to get attached to - and from what I understand, that is a fairly normal male way of thinking. I know my husband felt much better and more connected after seeing the ultrasounds (and if he couldn't be there for the scan in person, the pictures are vital.) Just something to think about before we judge how silly or foolish a reason it is for having an ultrasound.

Totally agree with this statement!! Very good point!

[Arcadia]

My key concern with ultrasound is their inherent ability to undermine a mother's own trust in her body, by placing the knowledge of her baby in the hands of a care provider.

Placenta, baby and cervix conditions can all change, and I question why doctors need to "know" what is going on at a regular basis (as in every appointment for a "quick look"). I support a 20 week morphology scan, to check for congenital issues which may need treatment at the time of birth, but even then, I wonder how many conditions need "in-utero" diagnosis and immediate treatment (just a hesitation, but I still support morphology scans).

In the case of bleeding, high risk pregnancies, or concerns about DS or other conditions, then I can see further ultrasounds are useful...but as was discussed in other threads...sometimes ultrasounds just stress out parents, rather than put their minds at ease.

As for checking size of the baby I think its a waste of time. It seems there is a great fear that babies will somehow be too big for women to birth. How can we grow babies that are too big for our bodies??? I just don't understand that...unless of course the woman has GD, but that can be detected by other means.

Ultrasounds haven't been checked for safety, we just assume they're safe because there are no obvious side effects. That in itself is a concern for our whole society, because we seem to embrace technology so openly, often with little critique of the knowledge the so called experts have on the subject. And lets face it...who wants to subject their baby to randomised trials on the safety of prenatal tests? That's why it hasn't been tested. We are the guinea pigs.

[juniper76]

That in itself is a concern for our whole society, because we seem to embrace technology so openly, often with little critique of the knowledge the so called experts have on the subject.

There are always people such as yourself who do not rush to embrace technology without seeing evidence of its safety and are willing to speak up about it. When enough people are speaking up, that's when they go to the trouble of proving their claims.

Personally, I'm grateful for the scans we've had. We took so long and went through so much to get pg and had one early loss along the way, so I find it reassuring to know that everything is on track. I can't wait until I can actually feel movement so that I can feel reassured without any tests.

I think, given the prevalence of pg u/s these days, if it were going to cause a problem, they would have seen a pattern of problems by now. This is not the first generation of children to be spied on in-utero. But that is not the same as proving that it's safe, so your point is entirely valid.

[TeniBear]

And for some of us, even though we don't know it yet, the "just because" u/s is the only picture we have of our babies alive...

[LimeSlice]

And for some of us, even though we don't know it yet, the "just because" u/s is the only picture we have of our babies alive...

x

[Junglemum]

And for some of us, even though we don't know it yet, the "just because" u/s is the only picture we have of our babies alive...

[Traveller]

The concern with the increased incidence of left handedness following ultrasound is, as I understand it, because this can be an incidation of brain changes being made in the developing fetus. The fear is not the left handedness, but what else could be going on. Also most recent trials in ultrasound have been done post 20 weeks, which of course is very different from the very early and very close to the fetus transvaginal ultrasounds which are so often offered these days.

The decision to accept an ultrasound, or not, is a very personal one. As with any medical decisions there can be consequences of accepting, or refusing, this test which has been made clear on this thread and I am sure you are aware of yourself. Personally, for me, I was happy for one scan post 20 weeks, which did in fact diagnose twins. Armed with this information I was able to make a decision to have one more scan, and my OB readily agreed to this. The fact that you are worried about feeling bullied speaks volumes about the lack of trust you have for your care provider. Perhaps rather than worrying about this one test, you should be thinking about getting a care provider who you are not worried will bully you, so that if they do suggest a test or intervention you can be confident that this is based on your personal health needs, and not on any routine recommendation.

[Junglemum]

Yes Traveller, that is the general idea of the claim, but it is still a very long bow to draw and not proven. And does that therefore imply that there is something wrong with the brains of lefties out there?! maybe