Most parents-to-be want mementos of baby’s first everything, and many obstetricians don’t mind obliging with multiple, often financially rewarding, fetal ultrasound orders—which have been on the rise despite serious doubts about medical necessity.
The situation got a detailed airing July 17 in The Wall Street Journal.
An analysis of insurance claims commissioned by the newspaper showed that utilization of fetal ultrasound shot up 92 percent, to 5.2 procedures, between 2004 and 2014. This led to several medical societies issuing a joint statement last year warning that frequent scans in pregnancies—80 percent of which are deemed low-risk—are clinically uncalled for. Led by the American College of Obstetricians and Gynecologists, the societies recommended just one or two ultrasounds in complication-free pregnancies.
The journalistic research showed that some women are scanned at every doctor visit during pregnancy. More than a few go beyond that, getting additional “keepsake scans” at nonmedical sites.
“Posting fetal images on social media has become a new rite,” the paper reported, “and obstetricians’ websites increasingly are decorated with fetal images.”
The article noted that fetal ultrasound in humans has raised no serious safety concerns, although it’s not without risk and been little studied on that score since the FDA raised the allowable output of acoustic energy eight-fold—from 94 milliwats per square centimeter to 720.
The article pointed out that the benefits of fetal ultrasounds are uncontestable. Not least among the pluses are assessing for changes in risk level and providing an accurate estimate of when conception occurred so that labor can be induced at an optimal time when a pregnant woman is overdue. Research has even suggested that parents bond better with their unborn children and make healthier choices for themselves after seeing the images.
However, the experts seem to agree that more than a couple of scans in a normal pregnancy is too much of a good thing. At least one wonders aloud about motives on the part of the ordering physicians. “I suspect that some of this is padding their wallet,” Jeffrey Kuller, MD, a professor of obstetrics at Duke, told the WSJ.
Then too, obstetrics “pays among the highest malpractice premiums of any medical specialty, and experts in the field say it isn’t uncommon for lawsuits against obstetricians to allege that more ultrasounds should have been performed,” the paper reported.
The article mentioned that fetal ultrasound sometimes produces false positives, which can lead to additional unnecessary scans. It cited a 2012 study in the American Journal of Obstetrics and Gynecology showing that women who received a fetal-weight estimate via ultrasound within a month of delivery were 44 percent more likely to be delivered by caesarean section.
“If you go looking for trouble,” Kuller told the WSJ, “you will find it.”