Ethical Analysis of Non-Medical Fetal Ultrasound
"After considering and applying four major theories of ethics, a reasonable conclusion
can be drawn that obstetric ultrasound practice is ethically justifiable if, and only if,
its indication is based on medical reasoning. Non-medical fetal ultrasound can be con-
sidered ethically unjustifiable." (possibly available on-line and I can PM if anyone would like)
Abstract of a study not available:
The safety of obstetrical ultrasound: a review.
Houston LE,Odibo AO,Macones GA
Ultrasound is a commonly employed imaging modality in obstetrics and is generally regarded as safe to the fetus. Current ultrasound technology, however, has significantly higher output potential than older machines used in most clinical studies, and the safety profile for the increasing use of Doppler, 3-dimensional (D) and 4-D ultrasound with modern machines is unknown. This article reviews the current status of ultrasound safety within obstetrics, including proposed mechanisms of harm, existing scientific and clinical evidence regarding those mechanisms, and considerations of safety for the clinical user.
was distributed to 145 doctors, 22 sonographers and
32 midwives from nine European countries. All of them
were using diagnostic ultrasound on a daily or weekly
basis. The results of this study were depressing. About
one third knew the meaning of MI and TI, and only 28%
knew where to ﬁnd the safety indices on the screen of
their own machine. More alarmingly, only 43 (22%) of
199 respondents knew how to adjust the energy output
on their machine 3."http://onlinelibrary.wiley.com/doi/10.1002/uog.6381/pdf
and neonatal deaths
A large randomized study by Saari-Kemppainen
and colleagues (1990) randomly divided over
9 000 women into two groups which did or
did not have routine early ultrasound scans.
There were 20 miscarriages after 16 to 20
weeks in the screened group and none in the
BRITISH JOURNAL OF MIDWIFERY, JULY 2008, VOL 16, NO 7
(I can PM the article)
Guidelines and recommendations for safe use of Doppler ultrasound in perinatal applications.
Barnett SB; Maulik D
Commonwealth Scientific and Industrial Research Organisation, Lindfield, Australia
Journal of Maternal-Fetal Medicine (J MATERN FETAL MED), 2001 Apr; 10(2): 75-84 (36 ref)
"Standard recently adopted by the FDA, in the USA, encourages self-regulation of acoustic exposure by the ultrasound user, on the basis of assumed knowledge of the implications of biophysical interactions. When modern sophisticated equipment is used at maximum operating settings for Doppler examinations, the acoustic outputs are sufficient to produce obvious biological effects, e.g. significant temperature increase in tissue or visible motion of particles due to radiation pressure streaming effects. The risk of inducing thermal effects is greater in the second and third trimesters, when fetal bone is intercepted by the ultrasound beam and significant temperature increase can occur in the fetal brain. Non-thermal bioeffects may be more significant in early gestation, when the relatively loosely tethered embryonic tissues are exposed to an ultrasound beam in a liquid path."
I like this article:
"It is likely that a routine ultrasound scan will be suggested fairly early in your pregnancy. This presents a perfect opportunity to ask a few questions" "What is the chance the scan will make things worse? Is such a scan safe?" If the answer is a flat "Yes, ultrasound scanning during pregnancy is safe," alarm bells should start going off in your head, because you are not getting the full information. You must then ask, "Show me the data on the safety of prenatal ultrasound," in order to check on what you may be told about the data on the safety of prenatal ultrasound. As a scientist I can assure you that the only correct answer to your question is, "We don't know because there is not sufficient scientific data to prove the safety of prenatal ultrasound."
The next question to ask when ultrasound scanning is proposed to you is, "What is the chance that a scan will make things better?" When you are told that one reason for the scan is to look for defects in the fetus, ask: "What is the chance a defect will be correctly identified (true positive screening test) and what is the chance a defect will be incorrectly identified (false positive screening test)?" If your provider cannot, or will not, answer this question, watch out!
Your next question when ultrasound is suggested should be, "Is there a better chance my baby will survive the pregnancy and birth if an ultrasound scan is done, and what are the data?" The correct answer is that a large study in the United States of more than 15,000 regnant women showed no improvement in the mortality rate of the babies if ultrasound is routinely used during pregnancy."http://www.midwiferytoday.com/articl...ogyinbirth.asp
"When the detection of fetal abnormality is a speciﬁc aim, the
number of planned terminations of pregnancy increases. In the
trial in which this policy was pursued with greatest commitment
(Helsinki), this resulted in fewer perinatal deaths. Overall, how-
ever, no clear beneﬁt in terms of a substantive outcome measure
like perinatal mortality can yet be discerned to result from the
routine use of ultrasound."http://apps.who.int/rhl/reviews/CD000182.pdf
A good general article from the "anti-ultrasound camp":http://www.motherandchildhealth.com/...ltrasound.html
A whole collection of links (I have not looked at):http://www.vaclib.org/basic/ultrasound.htm