The Complexity of Fetal Imaging
Department of Family and Preventive Medicine, University of Utah, Salt Lake City, Utah, United States Obstetrics and Gynecology
(Impact Factor: 5.18).
01/2009; 112(6):1351-4. DOI: 10.1097/AOG.0b013e31818f0c0c
Currently in the United States, pregnant women may obtain both medical fetal ultrasonography for screening and commercial fetal ultrasonography for entertainment purposes. The proliferation of commercial fetal ultrasonography suggests that medical screening alone does not satisfy patient expectations regarding fetal imaging. We investigated the prevalence of nonmedical fetal imaging and patient experiences and perceptions with both medical and nonmedical ultrasonography in our metropolitan area. We initiate a dialogue to explore the distinctions between medical and nonmedical fetal ultrasound imaging and the role of entertainment imaging in the medical setting. Concerns about safety, false reassurance, and unnecessary anxiety that might be generated by nonmedical ultrasonography should prompt us to examine the expectations of women regarding entertainment imaging, current clinical practice, and the potential for regulation of this commercial industry.
Available from: Julian Savulescu
Available from: John You
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ABSTRACT: The extent to which temporal increases in the use of prenatal ultrasonography reflect changes in maternal risk is unknown. In this population-based study, we examined the use of prenatal ultrasonography from 1996 to 2006 in Ontario.
With fiscal year 1996/97 as the baseline, we evaluated the relative risk (RR) and 95% confidence interval (CI) for the change in rates of ultrasonography for each subsequent year. The RR was adjusted for maternal age, income, rural residence, maternal comorbidities, receipt of genetics consultation or amniocentesis--all in the index pregnancy--and history of complications in a prior pregnancy.
The study sample consisted of 1 399 389 singleton deliveries. The rate of prenatal ultrasonography increased from 2055 per 1000 pregnancies in 1996 to 3264 per 1000 in 2006 (adjusted RR 1.55, 95% CI 1.54-1.55). The rate increased among both women with low-risk pregnancies (adjusted RR 1.54, 95% CI 1.53-1.55) and those with high-risk pregnancies (adjusted RR 1.55, 95% CI 1.54-1.57). The proportion of pregnancies with at least four ultrasound examinations in the second or third trimesters rose from 6.4% in 1996 to 18.7% in 2006 (adjusted RR 2.68, 95% CI 2.61-2.74). Paradoxically, this increase was more pronounced among low-risk pregnancies (adjusted RR 2.92, 95% CI 2.83-3.01) than among high-risk pregnancies (adjusted RR 2.25, 95% CI 2.16-2.35).
Substantial increases in the use of prenatal ultrasonography over the past decade do not appear to reflect changes in maternal risk. Nearly one in five women now undergo four or more ultrasound examinations during the second and third trimesters. Efforts to promote more appropriate use of prenatal ultrasonography for singleton pregnancies appear warranted.
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ABSTRACT: Our objective was to quantitatively compare maternal reactions to viewing a three-dimensional (3D) ultrasound image of the foetal face to a traditional two-dimensional (2D) sonographic image. One hundred and twelve pregnant women were asked to evaluate their excitement, relief, amazement and satisfaction reactions to 2D and 3D ultrasound images of their foetus' face. A weighted kappa Cochran-Armitage trend test, Fisher exact test and generalised estimating equations were used to analyse the data obtained. 3D imaging was found to result in significantly more favourable reactions than 2D imaging of the foetal face. 3D imaging was significantly better than 2D in regard to the clearness of the image, feeling closer to the baby, experiencing amazement and recognising specific facial features. We hypothesised that 3D images might evoke more feelings of fear than 2D, but our analysis found there were no significant differences in this regard. 3D ultrasonography of the foetal face is well received by patients. It has been shown in this study to elicit stronger and more positive maternal reactions regarding excitement, amazement and satisfaction than experienced with 2D ultrasound.
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