Ultrasound Scanning Guide

Although ultrasound is pricey, routine scanning is of doubtful usefulness, and therefore the procedure has not nonetheless been proved to be safe, ultrasound machine technology is widely used, and its use is increasing rapidly without control. Nevertheless, health policy is slow to develop. No country is thought to own developed policies with regard to standards for the machines, nor for the coaching and certification of the operators. Some industrialized countries have begun to retort to the information showing lack of effectiveness for routine scanning of all pregnant women. In the United States, as an example, a consensus conference on diagnostic ultrasound imaging in pregnancy concluded that “the data on clinical effectiveness and safety don’t permit recommendation for routine screening at now; there is a want for multidisciplinary randomized controlled clinical trials for an adequate assessment.”

The World Health Organisation stresses that health technologies ought to be totally evaluated prior to their widespread use. Ultrasound screening throughout pregnancy is now in widespread use while not sufficient evaluation. Analysis has demonstrated its effectiveness for certain complications of pregnancy, however the published material will not justify the routine use of ultrasound in pregnant women. There’s additionally insufficient data with regard to the safety of ultrasound use throughout pregnancy. There’s as nevertheless no comprehensive, multidisciplinary assessment of ultrasound machine use during pregnancy, together with: clinical effectiveness, psychosocial effects, ethical issues, legal implications, price benefit, and safety.

WHO strongly endorses the principle of informed choice with regard to technology use. The health-care suppliers have the ethical responsibility: absolutely to inform the public concerning what’s known and not known about ultrasound scanning throughout pregnancy; and totally to inform each woman prior to an ultrasound examination as to the clinical indication for ultrasound, its hoped-for profit, its potential risk, and various accessible, if any.

Then, during the course of one month in late 1993, two landmark scientific papers were published. The first paper, a largely randomized trial of the effectiveness of routine prenatal ultrasound screening, studied the outcome of more than 15,000 pregnant ladies who either received 2 routine scans at fifteen to twenty two weeks and 31 to 35 weeks, or were scanned solely for medical indications.

Results showed that the mean range of sonograms in the ultrasound cluster was 2.two and within the management group (for indication only) was 0.6. The speed of adverse outcome (fetal death, neonatal death, neonatal morbidity), along with the rate of preterm delivery and distribution of birth weights, was the identical for both groups. In addition, within the author’s words: “The ultrasonic detection of congenital abnormalities has no impact on perinatal outcome.” Eventually we tend to have a randomized clinical trial of sufficient size to conclude that there’s no worth to routine scanning throughout pregnancy.

The second landmark paper, also a randomized controlled trial, checked out the safety of repeated prenatal ultrasound imaging. While the initial purpose of the trial was hopefully to demonstrate the security of repeated scanning, the results were the opposite. From 2,834 pregnant women, 1,415 received ultrasound imaging at eighteen, 24, 28, thirty four and 38 weeks gestation (intensive group) whereas the other 1,419 received single ultrasound imaging at 18 weeks (regular group). The sole difference between the two teams was significantly higher (one-third more) intrauterine growth retardation in the intensive group. This vital and heavy finding prompted the authors to state: “It would seem prudent to limit ultrasound examinations of the fetus to those cases in that the knowledge is likely to be of clinical importance.” Ironically, it is currently doubtless that ultrasound may result in the terribly condition, IUGR, that it’s for so long claimed to be effective in detecting.

Although we now have sufficient scientific data to be in a position to say that routine prenatal ultrasound scanning has no effectiveness and might very well carry risks, it might be naive to suppose that routine use will not continue.