Prenatal Ultrasound Does Not Improve Perinatal Outcomes by Judy Slome Cohain

2012 Midwifery Today, Inc. All rights reserved.

[Editors note: This is an excerpt of an article which appears in Midwifery Today Issue 102, Summer 2012. View other great articles and columns in the table of contents. To read the rest of this article, order your copy of Midwifery Today, Issue 102.]

Abstract: Based on accurate randomized controlled studies, the correct evidence-based recommendation would be for women not to undergo prenatal ultrasound except to assist with turning a breech baby to head down, evaluating ectopic pregnancy and directing the needle during amniocentesis and fetal blood transfusions. First and second trimester organ scans, biophysical profile (BPP), amniotic fluid index (AFI), placental grading 0-III and Doppler umbilical, uterine and fetal artery velocity testing have been tested in randomized controlled studies on tens of thousands of women. They are used to attempt to predict suspected fetal growth restriction (FGR or IUGR), suspected placental insufficiency and suspected postdate pregnancy. They are unable to predict those with sufficient accuracy to direct management that will reduce the number of stillbirths or improve perinatal mortality rates and in most settings result in increased cesarean rates as a result of failed induction.

The experiences of past decades have provided considerable objective evidence that recommendations should be made to women not to undergo amniotic fluid index, biophysical profile and placental grading testing or dating ultrasounds. However, ultrasound screening continues to be promoted as the gold standard and is assumed by many to be exceptionally accurate. This assumption is contrary to what is known, and therefore, current protocols should be reexamined.

In 2009, the US Preventative Services Task Force changed mammography protocols to recommend that most women take mammograms later and less often. Two years later, the task force recommended that men stop taking the prostate-specific antigen PSA test for prostate cancer screening because it caused more harm than good. The treatments caused an increase in erectile dysfunction and loss of bladder control without lowering prostate cancer deaths significantly. The cancers are either easy to detect by manual exam, not life threatening or so aggressive that little could be done about them. Some obstetric protocols are similarly useless in improving outcomes but continue to be used routinely. Shaving pubic hair and giving enemas before birth were

discarded in some places as useless. However, although no evidence supports continuous electronic fetal monitoring, IV fluids, hospital birth or delivering on a hospital table for low-risk women, these routines are widely used and promoted.

Screening is meant to diagnose postdate and IUGR pregnancies. When routine ultrasound screening or measuring fundal height suggests that the baby is in the lowest tenth percentile for growth, the mother is referred for an organ scan, amniotic fluid index and biophysical profile, and if those results are questionable, then the woman undergoes Doppler velocity studies. Like the tests for cancer, research shows that these tests are somewhat able to detect findings of questionable relevance but unable to improve outcomes.