There are correlations between the size of that sack of fluid and the likelihood that the fetus could be affected by a major chromosomal disorder. After the ultrasound has been performed, your OBGYN will interpret the results and share the information with you. You may also meet with a genetic counselor who could recommend having additional tests done to verify the ultrasound results.
Keep in mind that ultrasound screenings for other genetic disorders or anatomic abnormalities become more accurate further into the pregnancy. Ultimately, the decision is up to you. Here are some good questions to ask yourself as you decide whether to have the genetic screening:. Whether you choose to have genetic screening done at this time is entirely your decision.
Some women prefer to have as much information as possible as early as possible, while other women do not. This is the ultrasound that people look forward to the most! The full anatomy ultrasound is typically performed at about 20 weeks, or 5 months. The full anatomy scan is a transabdominal ultrasound.
It uses a transducer that looks a lot like a store checkout scanner. The ultrasound technician will put warm ultrasound gel on your stomach and then slide the transducer in the gel around your stomach. The gel helps the sound waves travel through your skin. Tip: Come to your appointment with a relatively full bladder. This will make it easier for your ultrasound technician to get better images of your baby.
Because there are so many things to look for, this ultrasound will take at least 45 minutes—if your little one cooperates! During the full anatomy, week ultrasound, you can find out if your baby is male or female. When the scan is complete, Meriter will even send you a link to view some fun photos of your baby! After your ultrasound technician has captured all these images and measurements, your OBGYN will review the pictures and look for abnormalities such as congenital heart defects or cleft lip or palate.
Ultrasound has broad application in obstetrics, including screening, diagnostics, and fetal surveillance during the course of pregnancy. The examinations are generally conducted by obstetricians or generalist physicians, radiologists, sonographers [ 3 ], or specially trained midwives [ 5 ].
The benefits of routine screening ultrasound include gestational age assessment, detection of multiple births, placenta localisation, assessment of fetal wellbeing, and detection of fetal anomalies [ 6 ]. Further, ultrasound plays an important role in surveillance and management of high-risk pregnancies, where its use has been shown to reduce obstetric interventions and also the risk of perinatal deaths [ 7 ]. There is no doubt that the advantages of obstetric ultrasound technique have led to improvements in pregnancy outcomes.
At the same time however, it has been argued that continuing medico-technical progress has led to an increased medicalisation of pregnancy [ 8 ]. Its use has also raised many ethical challenges, especially in relation to non-medical provision [ 9 ], and its role in the practice of sex-selective abortions [ 10 , 11 ], and fetal reduction in multiple pregnancies [ 12 ]. Ultrasound is generally very appealing to expectant parents [ 2 , 13 ].
However, unpreparedness for adverse findings has been reported as common, as well as lack of knowledge about the purpose of the ultrasound examination and the limitations of the procedure [ 2 , 13 , 17 ].
The CROCUS-study is a two-phase project, with qualitative and quantitative components, being undertaken in a number of low-income and high-income countries in Europe, Africa, Asia, and Oceania. This study was the first exploratory sub-study of the qualitative phase.
The countries involved in the CROCUS-study have been selected to represent a variety of contexts, including culture, religion, gender perspectives, legislation, organisation of obstetric and maternal health care, and organisation of and access to ultrasound examinations during pregnancy. The Australian health care system consists of both public and private funders and providers. Medicare, the compulsory tax-funded national health insurance scheme, offers patients free public hospital treatment and access to subsidized medical services and pharmaceuticals.
Voluntary private health insurance assists people with access to hospital treatment as private patient and with access to allied health services and dental services. Private medical practitioners provide most community-based medical treatment, and general practitioners GPs are normally the first point of medical contact in the health care system [ 18 , 19 ]. Pregnant women in Australia have a range of choices for model of health care during pregnancy, birth and the postpartum period [ 20 ].
All pregnant women are offered dating ultrasound examinations, although the screening approach varies across the country [ 21 ]. Women may undergo a number of ultrasound examinations during the course of pregnancy if pregnancy-related complications occur. Participants for this study were recruited from two large hospitals in Victoria, Australia, each hospital with over births per year. Approval to involve obstetricians was sought from the heads of each department of obstetrics and gynecology.
Inclusion criteria for participation were being an obstetrician working with obstetric ultrasound examinations as a major work task, or doing obstetric ultrasound examinations as part of their general obstetric care, or using the results of obstetric ultrasound in clinical management of pregnant women. Names and contact details of obstetricians were obtained via the department heads, who also mediated bookings of appointments for interviews. All participants were provided written information about the study aim and procedures.
A convenience sample of 14 obstetricians meeting the inclusion criteria was assembled and no one approached declined participation in the study. Verbal and written informed consent was obtained prior to the start of each interview. Fourteen obstetricians agreed to participate; ten females and four males. Their ages ranged between 33 and 59 years mean A few of the participants were of non-Australian origin and had previously practised obstetrics overseas.
All were qualified in performing obstetric ultrasound examinations. An interview guide, developed by the research group and linked to the overall aims of the CROCUS study, was used to guide the interviews. The following key domains were included topics addressed in this paper are shown in italic. The importance of obstetrical ultrasound in comparison to other surveillance methods during complicated pregnancy. Their professional role in relation to other occupational groups working with obstetric ultrasound examinations or the outcomes of these examinations.
The individual interviews were performed by two of the authors IM and MP. All participants were asked to complete a short anonymous questionnaire with demographic questions including sex, age, qualifications and professional experience of obstetrics and obstetric ultrasound. The interviews lasted between 22 and 65 minutes mean 37 minutes and were all digitally recorded. After performing 14 interviews, the whole research group met to discuss whether further data collection was needed.
The authors concluded that further interviews were unlikely to provide any new information and that saturation of data had been reached [ 23 ]. The interview discussions were broad-ranging and it is not possible to report all findings here. We describe those findings of central relevance to our stated aim. Remaining findings will be reported in forthcoming papers. Data were analysed using qualitative content analysis [ 24 ].
The researchers then discussed general impressions and emerging content areas. KE compared the codes for similarities and differences, grouped them into content areas and subsequently into preliminary categories and sub-categories. These were then reviewed by RS and IM, and uncertainties in interpretations were thoroughly discussed between the three researchers until consensus was obtained.
An overall theme emerged during these discussions. All five researchers then reviewed the categories and theme against the original transcripts, which resulted in minor adjustments to the labelling and the order of categories.
The research group represents various professional disciplines and research traditions including obstetrics and gynecology, midwifery, nursing, behavioral science, maternity services and maternal health research, public health, epidemiology, and qualitative methods. All participation was voluntary and based on informed consent. To ensure confidentiality, characteristics of participants are presented only with means and ranges and the participants are referred to with individual numbers where quotations are presented.
An overview of the theme, categories and sub-categories is presented in Table 1. The participants described obstetric ultrasound as an essential and useful tool for screening, diagnosis and surveillance of maternal and fetal health. It was depicted as an integral and essential part of everyday obstetric care, in clinical management to optimise health outcomes for pregnant women and their fetuses.
In addition, obstetric ultrasound was viewed as an accessible and safe screening tool, said to play a key role in identification of first trimester fetal malformations and Down syndrome screening. The possibility of screening for chromosomal abnormalities was perceived as having changed obstetric practice. It will remain a very good screening tool. Obstetric ultrasound was also described as essential for identifying the number of fetuses present and the localisation of the placenta so that the management of the pregnancy could be adjusted accordingly.
Screening for other conditions, such as intrauterine growth retardation, markers for development of pre-eclampsia and fetal blood flow abnormalities were also described as highly significant for clinical management during the course of pregnancy. Since its clinical introduction, ultrasound has dramatically changed the way obstetrics is practised:.
Reliance on ultrasound was sometimes viewed as outweighing clinical experience. A few suggested that some clinical skills had been lost because of the increased use of obstetric ultrasound. Obstetric ultrasound was described as being used liberally and not always with appropriate medical indications. Participants discussed the implications of too liberal use, and highlighted the risk of picking things up that they had to act upon, although in the end, findings might be non-significant.
This was also viewed as contributing to unnecessary anxiety for the parents to be. Liberal use of obstetric ultrasound was described as occurring because of reasons such as not to be blamed by colleagues or expectant parents if major problems were not detected or anything subsequently went wrong. This was particularly mentioned in relation to more risk-averse private practitioners and junior or less experienced doctors. The obstetricians sometimes also reported performing extra scans, in some cases at every visit and without medical indication, with the main purpose of providing reassurance, particularly for women with previous adverse outcomes such as stillbirths.
For those patients I tend to do scans every time I see them because they like the reassurance. The increasing popularity of non-medical, commercially driven ultrasound examinations was also mentioned as concerning, with the potential for such examinations to create unnecessary anxiety. Obstetric ultrasound was described as an outstanding surveillance method compared to other methods used during pregnancy.
Obstetric ultrasound was seen by all as an essential tool for decision-making; a tool that they could not do without in the management of complicated pregnancy. Participants described its central role in optimising pregnancy outcomes, whether for intervention or non-intervention, in different clinical situations. For example, the use of obstetric ultrasound could allow obstetricians to plan the timing of the delivery more optimally. The use of obstetric ultrasound was also described as contributing to clinical preparedness for fetal problems.
Detecting problems such as heart abnormalities meant that women could deliver at the appropriate sites and the health care of the fetus could be planned in advance. The obstetricians all believed that the management of complicated pregnancy had improved significantly over the years due to the advances made in obstetric ultrasound.
There was universal agreement on the positives of early detection and diagnosis of clinical problems via obstetric ultrasound, with improved survival rates and prognosis for many fetal conditions.
I think that ultrasound is so important for this management nowadays. Obstetricians reported that in general, expectant parents put a very high value on obstetric ultrasound examinations; expectant parents had high expectations, saw its role as important and had a high level of trust in the examination.
They had also experienced a general increased interest in obstetric ultrasound in the community. Reassurance that everything was fine was described as the main expectation of the examination by expectant parents, and also the incentive for wanting additional scans. The obstetricians saw expectant parents as believing that the obstetric ultrasound examination would provide a clear-cut answer whether something was wrong or not. Rather, they frequently mentioned that expectant parents did not always understand the limitations and potential disadvantages of pregnancy ultrasounds, such as false positive and false negative findings.
Some also felt that even their midwife colleagues sometimes had a somewhat naive understanding of obstetric ultrasound with regard to the consequences of false positive and false negative findings. To avoid such situations, obstetricians frequently described how they tried to inform pregnant women about the limitations of the examination.
During the interviews, obstetricians pointed out that no test is perfect and that mistakes and uncertain findings could occur at any point during the pregnancy.
Despite being aware of these limitations, there was indeed disappointment even for the obstetricians when a deviation was not picked up by ultrasound. That has increased dramatically. They commonly described how pregnant women and their partners were focused on getting good images of the fetus during the examination, how they asked for photos and wanted to find out the sex of the fetus, although this was not the aim of the scan from a medical perspective.
The obstetricians felt that expectant parents may not always fully understand the aim of, or the indication for the examination. The pregnant women and their partners were seen as sometimes conceptualising the examination as an event and an experience to share with family and friends. Although described as infrequent, obstetricians perceived these situations as challenging if the examination detected any significant abnormality.
The dilemmas posed by obesity and increasing weight in pregnant women were raised in relation to ultrasound performing less well as regards imaging quality in women overweight or obese.
So our imaging ability on those women is not as good and their expectations are not less. The obstetricians believed that many women were unaware of what problems overweight and obesity could confer in the context of obstetric ultrasound examinations.
Some even thought that increased weight in the pregnancy population outweighed the advances made in ultrasound imaging resolution. Skip to Main Content Skip to Search. News Corp is a global, diversified media and information services company focused on creating and distributing authoritative and engaging content and other products and services. Dow Jones. Feintzeig wsj. To Read the Full Story. Subscribe Sign In.
Continue reading your article with a WSJ membership.
0コメント