Public Education
The Benefits of Prenatal Ultrasound
Extensive research has been performed on the use of ultrasound and has shown a great rise in the scope of benefits available through ultrasound, in many ways attributable to the development of three-dimensional ultrasound technology.
Both two- and three-dimensional ultrasound have been proven to increase the maternal-fetal bonding and to produce improvements in the baby's health and size at birth. Three-dimensional ultrasound adds the benefit of mothers being better able to visualize the baby before birth and they have reported having a more immediate sense of 'knowing' the baby after birth. Not only is her perception of her unborn child improved during and after pregnancy, but it has also been shown that the perception of her body improves after having an ultrasound. As a result of feeling more connected to her unborn child, a stronger sense of well-being and reassurance about her pregnancy, ultrasounds typically evoke increased commitment to prenatal health behaviors, such as an improved diet, exercise and smoking cessation.
A common focus in many studies has been the issue of maternal anxiety, the negative effects of such on the fetus and the use of ultrasound to reduce anxiety. One study reported a consistent decrease not only in anxiety but also in depression, somatic symptoms and hostility. Feedback and explanation during an ultrasound, which are highly valued at our clinic, were shown to be of great importance in the area of reassurance. Several studies have also reported significant reductions in paternal stress when fathers view an ultrasound of their unborn child. This benefit can also be applied to other family members, creating greater understanding in those closest to the mother and a stronger support system for the mother and child.
To read about these studies in greater detail, please see the individual studies summarized here.
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.
Ultrasound Safety
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 Tittut 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 customers 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.
Maternal Smoking Habit Modification Via Fetal Visualization
Pretorius, Dolores H. 1996 "Maternal smoking habit modification via fetal visualization." University of California tobacco related disease research program. Annual report to the California State Legislature. 1996: 76
The objective of this work is to reduce rates of maternal smoking, leading to consequent improvement in fetal well-being, neonatal development and maternal health. The consequences of maternal smoking pose long-term as well as immediate hazards to the developing fetus. Fortunately, most pregnant women have some degree of interaction with the health-care system during their pregnancy which offers the opportunity to incorporate smoking cessation assistance in their care.
In our study we are evaluation the effect of fetal viewing from conventional 2-dimensional ultrasound imaging, from 2-dimensional ultrasound imaging and new 3-dimensional imaging combined with smoking cessation assistance and comparing them to a control group of patients who do not undergo ultrasound examinations. We are assessing the maternal smoking cessation motivational levels as well as actual decreases in smoking in women who have an opportunity for increased fetal-maternal bonding resulting from viewing their developing fetuses. To date, we have observed that mothers are very interested in ultrasound studies of their fetuses be it 2-dimensional or 3-dimensional imagin studies. Patients who undergo ultrasound studies have been given a videotape showing thei fetus inside the uterus. Typically, images of the fetal face, heart, spince, stomach, hands, feet and genitals are recorded for the mother. We have patients enrolled in all three study groups identified in our original proposal but due to the length of pregnancy and follow up time we are unable to make any conclusions regarding our data to date.
The implications of this work is significant in attempting to improve fetal neonatal and maternal health. The economic costs to society, both human and medical, for both the child and the mother are immense. Fetal complications of maternal smoking include increased mortality, prematurity, placental previa and abruption, low birth weight, spontaneous abortion, learning deficits, impaired cognitive development and congenital abnormalities. Pregnancy offers a great opportunity to influence women to stop smoking for their own benefit as well as their child's.
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
Backgound : Despite the widespread use of prenatal ultrasound studies, there are no published data from randomised controlled trials describing childhood outcomes that might be influenced by repeated ultrasound exposures. We previously undertook a randomised 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 childrens' 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 generalised 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, behaviour, and neurological development.
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 midtrimester 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 Pyschological 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.
