Ultrasound Safety and Other Important Facts
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Ultrasound has been used safely in obstetrics for over 35 years, encompassing three generations of women and millions of ultrasounds. Several studies have verified that it is a non-invasive tool with vast benefits. Specific studies can be reviewed on Dr. Joseph Woo's renowned site www.ob-ultrasound.net, a highly respected source of information in the field. These studies confirm that no adverse findings of diagnostic ultrasound levels have ever been replicated. In fact, new studies are showing its psycho-social benefit for expecting women, where viewing an ultrasound resulted in benefits from improved diet to smoking cessation.
The FDA emphasizes the safety of ultrasound: "The agency sets the standard for the level of energy to be used for various treatments or diagnoses, including fetal ultrasounds. This standard restricts ultrasound exposure to levels that produce few, if any, effects on the fetus, based on epidemiological evidence" (FDA Consumer magazine, January-February 2004 Issue).
The Three- and Four-Dimensional ultrasound imaging performed by Miracle View Ultrasound uses ultrasound energy subject to the same limits as conventional (2D) ultrasound to create the Three- and Four-Dimensional images. Our policy dictates that all systems be used only in the Obstetrics Application. As a result, the ultrasound energy is limited by the manufacturer below FDA limits for obstetrical ultrasound, whether scanning 2, 3 or 4 Dimensionally. (The FDA limit for obstetrical ultrasound is 94 milliwatts/cm2.)
Three- and Four-Dimensional ultrasound imaging is not a product of increased frequency or "power" levels, but a combination of increased data gathering (listening) by the transducer and software interpretation after data acquisition.
We are grateful for the opportunity to offer this positive experience to expectant women. We have seen first hand how happy our patients are to hear of us. They appreciate the experience we provide, which uses a safe, proven technology to help expecting women and their families further invest in the pregnancy.
Effects of repeated prenatal ultrasound examinations on childhood outcome up to 8 years of age
John P Newnham, Dorota A Doherty, Garth E Kendall, Stephen R Zubrick, Louis L Landau, Fiona J Stanley . Lancet 2004; 364: 2038-44
Background: Despite the widespread use of prenatal ultrasound studies, there are no published data from randomized controlled trials describing childhood outcomes that might be influenced by repeated ultrasound exposures. We previously undertook a randomized controlled trial to assess the effects of multiple studies on pregnancy and childhood outcomes and reported that those pregnancies allocated to receive multiple examinations had an unexplained and significant increase in the proportion of growth restricted newborns. Our aim was to investigate the possible effects of multiple prenatal ultrasound scans on growth and development in childhood. Here, we provide follow-up data of the children's development.
Methods: Physical and developmental assessments were done on children whose pregnant mothers had been allocated at random to a protocol of five studies of ultrasound imaging and umbilical artery Doppler flow velocity waveform between 18 and 38 weeks' gestation (intensive group n=1490) or a single imaging study at 18 weeks' gestation (regular group n=1477). We used generalized logistic and linear regression models to assess the group differences in developmental and growth outcomes over time. Primary data analysis was done by intention-to-treat.
Findings: Examinations were done at 1, 2, 3, 5, and 8 years of age on children born without congenital abnormalities and from singleton pregnancies (intensive group n=1362, regular group n=1352). The follow-up rate at 1 year was 85% (2310/2714) and at 8 years was 75% (2042/2714). By 1 year of age and thereafter, physical sizes were similar in the two groups. There were no significant differences indicating deleterious effects of multiple ultrasound studies at any age as measured by standard tests of childhood speech, language, behavior, and neurological development.
Interpretation: Exposure to multiple prenatal ultrasound examinations from 18 weeks' gestation onwards might be associated with a small effect on fetal growth but is followed in childhood by growth and measures of developmental outcome similar to those in children who had received a single prenatal scan.
Effects of Ultrasound on maternal-fetal bonding: 2D vs. 3D
D.H. Pretorius, K.M. Uyan, R. Neton, A. Hull, G. James & T. Nelson. 11th World Congress on Ultrasound in Obstetrics and Gynecology. 12-28 October 2001. Melbourne, Australia.
Objectives: To compare the effects of two-dimensional ultrasound (2DUS) vs. three-dimensional ultrasound (3DUS) imaging on the maternal-fetal bonding process.
Results: A randomized sampling of data was preformed to equalize cells for some study questions. Mothers who received 3DUS shared their ultrasound photographs with significantly more number of people (mean, 31.72) than did mother receiving 2DUS (mean, 16.02). Subjects screened with 3DUS had a greater tendency to form a mental image of the baby post-screening (82%) than 2DUS subjects (39%). The 3DUS parents were more likely to receive comments on similarities/differences with the actual baby than parents having 2DUS studies. Further, 70% of the mothers receiving 3DUS felt they 'knew' the baby right after birth because of the images they saw compared to only 56% of 2DUS moms.
Conclusion: The 3DUS images appears to have a more positive influence on the perception of mothers compared to 2DUS images. Specifically, mother who had 3DUS showed their images to twice as many people as those having 2DUS studies. 3DUS may have the potential benefit to strengthen the support system for families expecting their newborns.
Psychological effects of ultrasound examinations: changes of body perception and child image in pregnancy
Langer M, Ringler M & Reinold E. Psychological effects of ultrasound examinations: Changes on body perception and child image in pregnancy. J. Psychosom Obstet Gynaecol, 1988; 199-208.
Ultrasound scanning is known to have psychological effects due to its vivid imagery. In a prospective study on 60 healthy gravidae in mid trimester pregnancy the impact of a single scan upon child image and body perception was evaluated. Seven-point numerical scales were filled in by the women before and after ultrasound and high feedback of the screen image was given during the scan. Medical and socio-economic information was collected in an interview.
Child image changed considerably towards a brisker, more active and more familiar view; for body image, an increase in reassurance could be observed. Parity and partner status had an influence on the experience of the scan. Primiparae without partners and women with pregnancy complaints could benefit by the scan in certain aspects of their body perception.
Implications of these finding for early mother-infant bonding, abortion and daily clinical practice are discussed.
The Psychological Impact of Diagnostic Ultrasound
Cox DN, Wittmann, BK, Hess, M, Ross, AG, Lind, J, Lindahl, S. The psychological impact of diagnostic ultrasound. Obstet Gynecol 1987; Vol 70 (5): 673-6.
The psychological impact of ultrasound scanning in pregnancy was examined in low- and high-risk pregnancies. Women in each category were assigned consecutively to a condition of either low or high feedback. In the latter condition, the women received extensive verbal and visual feedback, whereas in the former, subjects were denied visual access to the monitor. Psychological changes were measured using the State Anxiety Inventory and the Subjective Stress Scale. When a male partner attended, he was included in the assessment. The emotional impact of ultrasound was influenced by the level of feedback provided, with those in the high-feedback condition indicating significantly less anxiety and more positive emotional experiences during the scan, compared with those who received less feedback.
Psychological Reactions to Ultrasound Examinations during Pregnancy
Michelacci L et al. Psychological Reactions to Ultrasound. Examination during Pregnancy. Psychother Psychosom 1998, Vol 50, pp. 1-4.
Twenty women underwent ultrasound examination three times during low-risk pregnancy. Before and after ultrasonography, the Symptom Questionnaire was applied to evaluate changes in psychological distress. Anxiety, depression, somatic symptoms, and hostility significantly decreased after the patients received video and verbal feedback during the first ultrasound examination. Such changes were consistently observed also during the subsequent two examinations.
The importance of ultrasound to first-time mothers' thoughts about their unborn child
K. Dykes, K. Stjernqvist. The importance of ultrasound to first-time mothers' thoughts about their unborn child. Journal of Reproductive and Infant Psychology, Vol. 19 (2), 95-104. The aim of this study was to evaluate the importance of ultrasound to women's thoughts about their unborn child. Ten primigravidae were interviewed approximately 1 week before and 1 week after their first ultrasound screening. Analysis of the interviews was conducted using the techniques of grounded theory. The results showed that ultrasound was of great importance for increasing the women's awareness of bearing a child. This realization process was expressed in various categories of thoughts about the unborn child: (1) the existing foetus, (2) the coming child, (3) the woman's life situation, (4) parenthood and (5) delivery. The paper examines the way in which ultrasound influences these categories of thought.
Short-Term Impact of Fetal Imaging on Paternal Stress and Anxiety
Brown GF. Short-term impact of fetal imaging on parental stress and anxiety. Per and Peri-Natal Psychology Journal, 1988, Vol. 3, pp. 24-40.
This study compared the stress and anxiety responses of expectant fathers attending a routine visit with their partners who saw ultrasound imaging of their unborn chid with those of fathers also attending a routine office visit with their partners who did not view ultrasound imaging of the fetus. Fathers were given the State-Trait Anxiety Inventory and the Subjective Stress Scale in addition to a demographic questionnaire and the Paternal Attitudes towards Pregnancy Inventory prior to the examination. The anxiety and stress measures were re administered after the examination. Anxiety measures showed no significant differences between experimental and control groups, but fathers who saw fetal imaging did experience significant reductions in stress.
The Influence of Maternal Emotions during Pregnancy on Fetal and Neonatal Behavior
Van den Bergh, B. R. H. The Influence of Maternal Emotions during Pregnancy on Fetal and Neonatal Behavior. Per and Peri-Natal Psychology Journal, Vol. 5 (2), 1990, 119-130.
This study was designed to examine: 1) whether the influence of maternal emotions on fetal behavior could be established using real-time ultrasound echography and cardiography; and 2) whether the prenatal influence was reflected in neonatal behavior. In a longitudinal study of 30 women out of a larger group of 70 nulliparous women revealed that maternal state anxiety during echographic recording was significantly correlated with fetal behavior. Moreover, fetal behavior was sensitive to the influence of material chronic anxiety during pregnancy. Results on the subgroup of 30 women and their babies suggest a certain degree of continuity between fetal and neonatal movement patterns, and further indicate that the prenatal influence is reflected in neonatal.
Three-dimensional ultrasound experience in obstetrics.
Timor-Tritsch IE, Platt LD. Three-dimensional ultrasound experience in obstetrics . Department of Obstetrics and Gynecology, New York University School of Medicine, New York, New York 10016, USA.
Three-dimensional (3D) ultrasound is a natural development of the imaging technology. Fast computers are essential to enable 3D and four-dimensional (4D) ultrasound pictures. A short review of the technical points and clinical aspects is presented. Our purpose is to acquaint the reader with the possibilities of this new technology and to increase awareness of its present clinical usefulness. A short review of technical information is provided.
RECENT FINDINGS: The advantages of 3D and 4D ultrasound in certain areas are unequivocal. Its use in the workup of fetal anomalies involving the face, limbs, thorax, spine and the central nervous system are already applied by most centers. The use of this technology in applying color Doppler, in guiding needles for different puncture procedures as well in evaluating the fetal heart are under close research scrutiny. The bonding effect between the parents and their future offspring is becoming evident as 3D ultrasound is used. Consulting specialists understand fetal pathology better and can better plan postnatal interventions. 4D or real time 3D ultrasound was developed and is expected to achieve new meaning with the planned introduction of electronic transducer multi linear arrays.
SUMMARY: 3D ultrasound is an extremely promising imaging tool to image the fetus. In spite of the scant outcome studies the potential of 3D ultrasound is understood by a large number of obstetricians, maternal fetal specialists and imaging specialists.
Seeing the Baby: The Impact of Ultrasound Technology
Black RB. Seeing the baby. The impact of ultrasound technology. J. Genet Counsel 1:45, 1992.
This paper reports results of a study of prenatal diagnosis patients who underwent ultrasound examinations and lost their pregnancies through miscarriage or elective terminations. The majority of the women felt that viewing the ultrasound image influenced their relationship to the fetus and their coping with the pregnancy loss. The women commented on the power of ultrasound to make their pregnancies more real as well as the painful yet sometimes beneficial consequences of seeing the fetus. Clinical implications are considered for health professionals who provide prenatal diagnostic services or counseling after pregnancy loss.
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