Worried About Too Many Ultrasounds

[laodicean]

I haven't been able to find anything as comprehensive as the 1993 study, and I certainly think it should be replicated now that ultrasound imaging has changed.

Yes, in an ideal world it should be replicated, but do remember that no one wants to waste their academic time researching things that are held to be true. Scientists are people with egos and career-pressures too.

Places that are doing the research are places like Columbia; I can't read the papers in Spanish, but google translates of the abstracts all seem to come to the conclusion of "we're not picking up enough fetal anomolies to change outcome, and we think this is because we need better ultrasound equipment."

However, I don't see why the burden of proof is on me considering that most medical recommendations have been to avoid routine ultrasounds, and that includes the 20-week scan considering it's offered to all women regardless of risk status in most countries.

The burden of proof is on you the same way the burden of proof is on anti-vaxers to prove that vaccines do harm; the null hypothesis is that routine ultrasound scanning is beneficial (financially or otherwise) if offered routinely, as evidenced by the document I linked from which the UK has designed its routine, low-risk antenatal screening policy which includes 12 and 20wk ultrasounds. You are putting forward the hypothesis that routine scans offer no benefit and are potentially harmful, so please find me good evidence that disproves the null hypothesis.

And I don't know why you're saying "most medical recommendations". That may be "most medical recommendations in the area that I live" because in the UK it is recommended that you have a 12 and 20wk ultrasound scan, and that comes from the midwives and obstetricians who base their evidence on the NICE Guidance, a body which searches for and peer-reviews and collates all the available published evidence on a given subject in order to determine if it is financially beneficial.

At the end of the day, I follow the money; they wouldn't spend it if they didn't think it was saving costs elsewhere.

Ultrasounds also give TONS of false positives that end of stressing women out. (E.g. oh, your baby might have a kidney problem that we wouldn't be able to address in utero anyway. Let's do more scans every few weeks just to monitor it. Oh, turns out it's nothing.) I've seen those sorts of scenarios happen far, far more often than situations where care would change as the result of a diagnosis (like the hyperbolic ones you're talking about). So I still think it's best to avoid routine ultrasounds without any medical indication. And where there is a medical indication, I TOTALLY support getting a scan, because that's where outcomes have been shown to be altered.

They're not hyperbolic, they are things that I have seen happen in real life. I am but one doctor who has only been working a relatively short time; talk to some of my colleagues and you'll hear a lot more of the same.

And I'm sorry, but your example makes no sense to me: if my unborn child has a potential kidney abnormality, I want to know about it whilst it's still in utero and a plan of action can be made to deal with it time-appropriately once it is born. Kidney's are kinda important.

Yes, this is stressful, and often fizzles out to mean nothing at all, but you're now ignoring the stress experienced by low-risk parents who have given birth to child with significant needs because they were told because they were low risk, their unborn baby would be.

I think you have your risk/benefit opinions, and I have mine, and I really don't think there's any benefit to discussing it further. I have seen a recently peer-reviewed literature that supports it and I agree with what it says, given my own knowledge of how ultrasound works and its use in the medical field.

You have your opinion based on outdated evidence, that you are unwilling to change just because the exact same study hasn't been repeated in 22yrs, and in the meantime, "we just don't know the long-term risks".

We don't know the long-term risks of many things that we do - does that mean we stop doing all of them even though many have been shown to have short-term benefits?

Your answer is yes, my answer is no.

There is no middle ground here.

 

[mel28nicole]

Regardless of what any advice shows, medical ultrasounds are a MUST. I wouldn't skip my 20 week ultrasound. If a problem arises during that scan then that could possibly save a child's life with having routine ultrasounds! I had ultrasounds every 3 weeks due to size. I found them necessary and I would do it again. OP has reasons to have the ultrasound and I find no harm in it. The research you ladies are arguing about is trying to put people off of ultrasounds completely and that's not right.

 

[mel28nicole]

Also I agree that article is very outdated. I studied psychology and when it came to our research papers, anything older than 5 years was considered outdated and we were not allowed to reference it.

 

[Feronia]

How is it "held to be true" that 20-week ultrasounds improve outcomes if there hasn't been any research to support that? We know that they can catch anomalies that allow women to terminate, but we don't know that they improve outcomes. The only large-scale study done on it was from 1993, which you're discounting, and then holding the opposite to be true despite there being any evidence.

The kidney example was just one of many that I've seen happen with friends and family and as a doula. Yeah, kidneys are important, but ultrasounds give a LOT of false positive with things like soft markers, growth problems, kidney problems, etc. Things that end up being stressful and most of the time it's nothing. I'm sure that's why they don't really improve outcomes, especially because there's not much you can do in utero besides choose to continue the pregnancy or not. For some people that's important, certainly, but there's no evidence that it improves outcome.

 

[SarahBear]

I think people have way too much faith in ultrasounds. I haven't done much research on it this time around, but I did a good bit last time. From what I could find, they weren't shown to improve outcome when done routinely. There were also concerns regarding how it affects development, particularly when done early on. It has been shown to alter cells. It's also incredibly loud for the baby. I believe the studies I saw were old and guess what, ultrasound technology has only become more powerful since then. Then there are dopplers which are even stronger than regular ultrasounds. It always makes me uneasy when I hear about people using those at home at a super frequent rate. I think one reason studies are limited and one reason they appear safe is that if there was an effect from it, it would be incredibly difficult to rule out confounding factors. You might also not be looking for the right effect. You would also have to conduct a longitudinal study for it to be worth anything. I did consider an ultrasound for this pregnancy since I'll be further from a hospital when I give birth than I was last time, but I've done my quad marker which came back with great results, and nothing else has indicated a problem. That's not to say there is none, but the chances are very tiny and as mentioned already, ultrasounds when done routinely, don't necessarily improve outcome. If my quad marker had been off or if something else came up, I'd consider an ultrasound.

 

[Feronia]

I totally agree, SarahBear. I would have also done one if my quad marker was off or if any number of other problems were suspected. I had two ultrasounds this time early on (at 6 weeks and 8 weeks) because I was hemorrhaging quite badly and both times we thought we had lost the baby. I regret doing the second one, but at the time HCG wouldn't have told us whether the pregnancy was continuing for a few days, and since it starts to level out at that point, we might not have been sure. I wanted to know right away whether we had a live baby or not, but I felt a huge amount of guilt over the early scans, and it was one reason I wanted to skip any more unless complications came up.

What makes me confident to birth at home without a 20-week scan is that my midwife can hear my placenta's location easily, can tell my fluid level, and I've been measuring within range. I also happen to be 4 minutes away from the hospital this time. I do understand that there is a tiny chance of something being wrong that can be detected, but I'm comfortable with the risk since it is very, very small.

 

[kit10grl]

Its easier to think of it being a tiny risk when you havent been affected. Robyns condition was a 1 in 15,000 shot. We were the lucky one. She was my second child and i was planning a home birth until ultrasounds kicked up issues with her heart. Our quad screen also came back perfectly clear as did an amnio. The only indication we had that something was going wrong was the ultrasounds.

If i had had my home birth quite simply my baby would have died. So as far as im concerned yes those ultrasounds did improve her outcome. I could never ever reccomend not having the routine scans the NHS has deemed neccesary. Its a tiny risk but how are you going to feel if one person follows that advice and that one person has a child with a detectable problem and they die. Trust me someone has to be that 1, and its easy to believe it will never be you until it is you.

 

[SarahBear]

Yes, it is much easier to be comfortable with the tiny risk if you haven't been affected. That is true. And yes you were one of the lucky ones as far as that condition is concerned since you were able to catch it and take care of it. When you look at the statistics on heard issues overall, though, many of them are not caught until after birth anyway. For those that are caught before birth, they generally do not operate right away anyway.

I do understand that low stats mean that some people are still being affected. I also understand that those people are probably not going to turn down an ultrasound in subsequent pregnancies. As someone who has not been affected by a similar situation, I do feel comfortable proceeding as I am.

 

[Feronia]

I understand that as well, and I'm glad that your 20-week scan was able to catch some problems so that you were better prepared. That must have been a scary time! I'm sure I'd feel the same way you do if what happened to you happened to me.

Would she really have died if you had a home birth and the condition was undetected? Did you have any other external signs of the condition (like lower or higher fluid, an unusual heart beat, or measuring ahead or behind)? I don't mean to be insensitive in any way, but with my own home birth coming up quickly sometimes these things do cross my mind. From reading your blog, it sounds like she didn't have her first operation immediately and was breathing on her own right away, but obviously I don't know the whole story. I am only 4 minutes away from the largest maternity hospital in the area and my midwives have neonatal resuscitation equipment with them, which is comforting, though I would home birth from farther away as well.

Edit: your blog says that she got a 1:144 for Down's Syndrome. If I had a screening like that, I would have done my 20-week scan for sure.

 

[Bookwrmgal]

Well I have a baby with a medical condition that would have put her life and mine into serious jeopardy if it hadn't been caught on the 20 week ultrasound and consistently monitored on bi-weekly scans. Her condition requires delivery at a hospital with a level 3 nicu with ecmo capabilities in case she is in distress at birth. It also requires a team of specialists in 2 hospitals monitoring both her and I. That wouldn't have taken place if I hadn't had that anatomy scan.

 

[kit10grl]

Baby was born unable to breathe through her nose, when she stopped crying she turned blue, we had consultants standing by because of her heart and they identified the condition with her breathing which meant they could treat it which kept her breathing, A midwife inexperienced in this might not have. So yes babies with choanal atresia have suffocated at birth. I truly don't mean to scare you with that i hope i haven't it is a very rare complication. I did have higher fluid diagnosed very late in pregnancy but that can be caused by lots of things or nothing so they didnt connect that to the atresia until after birth.

The 1:144 for Down Syndrome was mostly connected to the NT scan part of it. My son was born a year before just and in that year they started nt testing. With my son i was low risk, with the nt scan with Robyn i became high risk, but marginally, the cut off is 150 for high risk. So if i hadnt had the NT scan i would have remained low risk. The NT scan is done at the routine 12 week scan

 

[kit10grl]

oh and her first surgery was done at 4 days old, the second at 8 days old, the third at 17 days old. Between the first and second they had to life flight her to another hospital on a ventilator as they couldnt wean her off and get her breathing by herself again

 

[Feronia]

So sorry you went through all of that, it must have been incredibly scary for all of you. I hope she's doing better now and that you can put some of the worries behind you. I'm glad you were able to get some answers before birth, too.

Thinking about my own care, my down's syndrome screening was somewhere in the range of 1:20,000 for both kids, but if it were even 1:1,000 or so, I would have opted for a scan personally. I didn't do the NT scan, but it's only offered routine for high-risk women and women who had NT defects in their background here, so it's not routine for everyone. I also would have been sent for a scan if I were measuring way off or had higher/lower fluid levels, so I'm hoping that if there was something to catch, I would have had -any- symptoms of such. Of course I know there is a tiny chance that I had absolutely no signs of anything and that there is something wrong though.