Interview with ultrasound expert Dr. Jacques Abramowicz

Dr. Jacques Abramowicz is an ultrasound expert, director of obstetrical and gynecological ultrasound and co-director of Rush Fetal and Neonatal Medicine Center at Rush University Medical Center. I had the opportunity to interview her and included some questions from you guys, submitted to me on twitter and facebook–thank you!

Q: Should women limit the number of ultrasounds they have during pregnancy? If so, limit them to how many and why?

A: Ideally, a woman should have 2-3 scans during her pregnancy.  The first screening is around 11-13 weeks.  This is early enough to get an accurate due date for delivery. It will also allow for early detection of multiple pregnancies as well as diagnosis of certain major anomalies. The second scan, around 20 weeks, is the anatomy survey, which is where you will obtain a clearer fetal image and look at the internal organs, such as the brain, spine, heart, and kidneys. You will also, in most cases, be able to find out the sex of the baby. The third ultrasound is conducted close to full term to check the fetal growth and prepare for labor.  This number of ultrasounds is on the assumption there are no specific problems during the pregnancy requiring additional examinations.

Q: Along those lines.. is there any long-term data on safety?

A: One of the reasons to limit the number of scans in pregnancy is safety.  While no effects have been demonstrated in humans (except for an increase in the number of left-handed boys in some Scandinavian studies), effects have been shown for prolonged exposures in animals.  The two major effects occurring when ultrasounds are conducted are an increase in temperature in tissues and changing pressures from the ultrasound waves.  However, all ultrasounds have a technology to indicate the likelihood of these effects.  Bottom line, while ultrasound technology offers physicians a useful diagnostic tool to examine babies in the womb, experts emphasize that this technology should only be used by trained professionals and only for clinical and diagnostic purposes.

Q: What problems or abnormalities can be detected by ultrasound? And how accurate is it?

A: Abnormalities of many organs can be detected by ultrasound.  A partial list includes: anomalies of the skull, spine, such as spina bifida, and heart, such as a hole in the wall between chambers.  It can also detect lung masses, diaphragmatic hernia, abnormalities of abdominal wall or the kidneys, and shorter than expected bones. Some anomalies should never be missed, for instance absence of the upper part of the skull, which is called anencephaly. Unfortunately not all possible anomalies can be detected.  Sometimes the fetus is in the wrong position or maternal characteristics may make the examination very challenging.

Q: How accurate are baby size measurements? Can a “too large baby” or “too small pelvis” be determined by ultrasound?

A: One of the most important roles of ultrasound is to measure the fetus and follow growth.  This is based on measurements of several fetal parts (head, abdomen and thigh bone), which the computer puts together into a formula to come up with an estimated fetal weight. The accuracy of these methods is about 90-92 percent. Based on the findings, the caregiver will determine whether the baby is too big or too small.

Q: What questions should pregnant women be asking an ultrasound tech during an appointment?

A: How long have you been doing this?

Who is the supervising physician?

What do you know about side effects of ultrasound screenings?

Will the ultrasound differ as I get further along in my pregnancy?

Q: How does ultrasound use in the US differ from other countries?

A: As surprising as it may sound, no professional or health insurance company has endorsed routine ultrasound in the U.S. While it is part of the prenatal package in many countries similar to checking weight or blood pressure, in the U.S. there must be an indication to perform the scan such as abnormal patient history that may affect fetal growth.  However, for example, in Germany up to seven non-specific scans are reimbursed by a third party payer or insurance company.  In reality, the vast majority of, if not all, women who come to prenatal care in the USA will have at least one ultrasound scan because it has become the standard of care in most areas.

Q: Why are ultrasounds done routinely now? They used to only be done if something seemed risky.

A: Many conditions can be diagnosed early and thus many problems can be avoided. Additionally, determining the precise due date can avoid questions such as: is this preterm labor that should be stopped; or is it past the due date and labor should be induced? In addition, the American College of Obstetricians and Gynecologists (ACOG) now recommends first trimester screenings for genetic anomalies for all women, regardless of their age.

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