Fetal ultrasound usage grows, without compelling medical need: report

July 21, 2015
by Thomas Dworetzky, Contributing Reporter
Fetal ultrasounds are surging in popularity and usage, and some experts are advising that scans of pregnant women may be becoming too frequent.

The latest report on the issue features a new study of data analyzed by FAIR health, nonprofit insurance claims aggregator, for the Wall Street Journal. It shows just how fast these scans' popularity has grown, and raises concerns about their overuse.

Fetal ultrasound procedures hit 5.2 per delivery in 2014, up a whooping 92 percent from 2004, according to the publication. And 80 percent of these pregnancies were low risk.

Medical experts are cautious about this high-frequency utilization. According to the American Congress of Obstetricians and Gynecologists, "Currently, there is no reliable evidence that ultrasound is harmful to a developing fetus. No links have been found between ultrasound and birth defects, childhood cancer, or developmental problems later in life. However, it is possible that effects could be identified in the future. For this reason, it is recommended that ultrasound exams be performed only for medical reasons by qualified health care providers."

ACOG also recommends just one or two ultrasounds during uncomplicated, low-risk pregnancies, according to information on its website.

"2-D ultrasounds are the safest radiological modality offered to pregnant women, but as with everything, should be used in moderation," Dr. Monica Mendiola, of Beth Israel Deaconess HealthCare-Chelsea, noted in an article on the Beth Israel website about the frequency of ultrasounds during pregnancy.

"The first is, ideally, in the first trimester to confirm the due date, and the second is at 18 weeks to confirm normal anatomy and the sex of the baby," reported Dr. Mendiola. "As long as these ultrasounds are normal and mom's abdomen measures consistent with her gestation, then that is all most women need."

In 2014, ACOG joined with several other medical societies in a statement that calls for just one or two ultrasounds when pregnancy is uncomplicated and low risk. The statement said, in part: “Ultrasonogram should be used only when clinically indicated, for the shortest amount of time...and with the lowest level of acoustic energy compatible with an accurate diagnosis.”

Adding to safety concerns of some experts, the Journal noted, is that most of the safety studies were done in the early 1990s, when ultrasounds were less frequent and generated less acoustic energy. Some physicians think that because there is no radiation, the procedures are naturally safe. "They think, 'It's not X-ray. It's safe. Period," Wayne State University obstetrician Dr. Jacques Abramowicz told the Journal.

Of course, ultrasounds are of great benefit, especially in higher-risk and complicated pregnancies. They permit accurate estimates of the beginning of conception and help physicians identify multiple fetuses and potential abnormalities, according to the paper.

That said, the scans can also yield false-positives, leading to unnecessary worry and procedures, such as cesarean sections. "If you go looking for trouble, you will find it," Duke University obstetrics professor Dr. Jeffrey Kuller said, according to the paper.