Routine ultrasound scanning in first trimester: What are the risks?

doi:10.1016/S0887-2171(02)90009-0

Seminars in Ultrasound, CT and MRI

Volume 23, Issue 5, October 2002, Pages 387-391

https://doi.org/10.1016/S0887-2171(02)90009-0 Get rights and content

Abstract

Acoustic exposure from modern ultrasonographic devices is capable of disturbing biological tissue to varying extent depending on the type of ultrasound examination and the particular tissue under investigation. There is no strong evidence that these biological effects present a serious health hazard, however, knowledge is incomplete, particularly from human studies. Although ultrasound induced heating can be significant in later pregnancy, it is unlikely that diagnostic ultrasound poses a significant thermal risk to the developing embryo when used according to published safety guidelines. Nevertheless, uncertainties remain, particularly for nonthermal effects in early pregnancy where shear stresses from radiation pressure may become an important factor. The likelihood of producing some biological effects can be enhanced by new procedures such as the use of gas encapsulated echo-contrast agents. The particular sensitivity of the embryo to physical damage together with uncertainties of both risk and benefit suggest that caution should be applied to the scanning of early first trimester uncomplicated pregnancy.

References (19)

SB Barnett et al.
The sensitivity of biological tissue to ultrasound
Ultrasound Med Biol
(1997)
WL Nyborg
Safety of medical diagnostic ultrasound
Semin Ultrasound CT MR
(2002)
SB Barnett et al.
International recommendations and guidelines for the safe use of diagnostic ultrasound
Ultrasound Med Biol
(2000)
D Dalecki et al.
Hemorrhage in murine fetuses exposed to pulsed ultrasound
Ultrasound Med Biol
(1999)
SB Barnett et al.
Novel approach to evaluate the interaction of pulsed ultrasound with embryonic development
Ultrasonics
(1990)
H Kieler et al.
Routine ultrasound screening in pregnancy and the children's subsequent handedness
Early Hum Dev
(1998)
SB Barnett et al.
Guidelines and recommendations for the safe use of diagnostic ultrasound: the users' responsibilities
A Shaw et al.
Assessment of the likely thermal index values for pulsed Doppler ultrasonic equipment

There are more references available in the full text version of this article.

Cited by (27)

Early fetal ultrasound screening for major congenital heart defects without Doppler
2019, European Journal of Obstetrics and Gynecology and Reproductive Biology
Citation Excerpt :
To the best of our knowledge, no studies analyzing fetal cardiac anatomy without Doppler in the first trimester have been published [23–25]. The first trimester of pregnancy is a particularly vulnerable period for fetal development, such that acoustic exposure from ultrasound devices can disturb biological tissue that might be sensitive to certain types of ultrasonography examinations [15]. Because Doppler examinations expose tissue to much higher levels of energy than B-mode gray scale two-dimensional or three-dimensional ultrasonography, it has been hypothesized that Doppler ultrasound might produce adverse effects; especially during the early gestation period, when the rate of cell division is highest and when fetal blood ﬂow is less well developed and hence less likely to dissipate any heat created during the examination [16].
Congenital heart defects are the most common major structural fetal abnormalities. Color flow mapping has played a dominant role in the detection of abnormalities during the first trimester, regardless of the International Society of Ultrasound in Obstetrics and Gynecology warning on the use of Doppler during early pregnancy. The aim of our study was to investigate the use of transvaginal two-dimensional sonography without Doppler for assessing the four-chamber view and the outflow tract view of fetuses at 11–13 weeks of gestation for cardiac screening of major congenital heart defects.
This was a prospective observational study conducted in the Fetal Medicine Unit of Cabueñes University Hospital, between May 2014 and August 2015. Only low risk-pregnancies were studied. All ultrasonographic examinations were performed by two experienced sonographers in maternal-fetal medicine. The combination of high-frequency transvaginal (nine MHz) and transabdominal (six MHz) ultrasonography transducers were used. An early cardiac screening was performed in 97% of cases. Statistical analysis was carried out using successive multivariate logistic regression models in order to investigate the effect of crown-rump length and body mass index on the probability of visualizing the four-chamber view and/or the outflow tract view.
663 low-risk pregnant women were included. Regarding the transvaginal approach, neither the crown-rump length nor the body mass index had a statistically significant relationship on the probability of visualization of the four-chamber view and outflow tract view. For the transabdominal approach, the crown-rump length and the body mass index presented a statistically significant effect on the visualization of the four-chamber view and the outflow tract view. Using the transvaginal approach: the success rate of performing a four-chamber view was 89.4% and 82.4% for the outflow tract view. Using the transabdominal approach: the success rate of performing a four-chamber view was 77.8% and 61.5% for the outflow tract view. Four major congenital heart defects were diagnosed, and the prenatal ultrasonagraphic diagnosis was confirmed for all cases.
Routine first-trimester ultrasonagraphy without Doppler, when performed by experienced sonographers, can effectively identify major congenital heart defects. Additional multicenter well designed studies should clarify the feasibility of this approach.
Evaluation of Obstetrics & Gynecology Ultrasound Curriculum and Self-Reported Competency of Final-Year Canadian Residents
2018, Journal of Obstetrics and Gynaecology Canada
Citation Excerpt :
The utility, safety, and accessibility of ultrasonography make it the optimal first-line imaging modality in obstetrics and gynaecology (OB/GYN).1
Ultrasonography in obstetrics and gynaecology (OB/GYN) is a vital component of patient assessment, diagnosis, and management. Standards for Canadian obstetrician-gynecologists' ultrasound skills are limited and vague. The primary objective was to audit the current curriculum administered to Canadian OB/GYN residents. The secondary objective was to understand self-perceived competency of final-year residents in performing OB/GYN ultrasound. We also sought to identify perceived barriers to incorporation of ultrasound into practice.
A cross-sectional questionnaire, distributed to two cohorts of final-year Canadian OB/GYN residents, asked about ultrasound training they received and their perceived competency with respect to specific ultrasound skills. Respondents also answered questions on possible perceived obstacles to independently using ultrasound after graduation.
All Canadian residency programs were represented among the 81 respondents out of the possible 167 participants (49%). Ultrasound training varied in its delivery and quantity. The majority of training time was dedicated to obstetrics, with minimal focus on gynaecology. Self-reported competency for obstetric ultrasound was high, whereas that for gynaecologic ultrasound was variable. The main barrier to incorporating ultrasound into future practice was lack of adequate training.
Canadian OB/GYN programs lack standardisation of ultrasound training. The imbalance in training between OB/GYN ultrasound may influence the low levels of self-reported competency in gynaecologic skills in residents. Standardization of ultrasound education and increasing gynaecologic ultrasound training in residency are the necessary first steps in preparing OB/GYN graduates to use ultrasound.
En obstétrique-gynécologie, l'échographie est un élément essentiel de l'évaluation, du diagnostic et de la prise en charge. Les normes de compétence en échographie pour les obstétriciens-gynécologues canadiens sont limitées et vagues. L'objectif primaire de cette étude était de vérifier le curriculum actuel présenté aux résidents dans ce domaine. L'objectif secondaire était de comprendre le degré de compétence que les résidents en dernière année croyaient avoir en échographie gynéco-obstétricale. Nous avons aussi cherché à repérer les obstacles perçus par les résidents à l'intégration de l'échographie dans leur exercice.
Nous avons distribué à deux cohortes de résidents canadiens de dernière année en obstétrique-gynécologie un questionnaire transversal portant sur la formation reçue sur l'échographie et le degré de compétence perçu pour certaines aptitudes. Les résidents ont aussi répondu à des questions sur les obstacles qu'ils entrevoyaient quant à l'utilisation de l'échographie de façon autonome après la fin de leurs études.
Tous les programmes de résidence canadiens étaient représentés parmi les 81 répondants – sur une possibilité de 167 (49 %). La formation en échographie variait dans sa prestation et sa quantité. La majorité du temps de formation était consacrée à l'obstétrique, la gynécologie n'étant abordée que minimalement. Le degré de compétence autodéclaré pour l'échographie obstétricale était élevé, tandis que celui pour l'échographie gynécologique était variable. Le principal obstacle à l'intégration de l'échographie dans l'exercice futur était le manque de formation adéquate.
On note un manque d'uniformité entre les programmes canadiens d'obstétrique-gynécologie pour ce qui est de la formation en échographie. Le déséquilibre entre la formation en échographie obstétricale et celle en échographie gynécologique pourrait jouer un rôle dans les faibles degrés de compétences déclarés par les résidents pour les aptitudes gynécologiques. La normalisation de la formation et l'augmentation de la formation en échographie gynécologique durant la résidence sont des premières étapes nécessaires pour préparer les nouveaux obstétriciens-gynécologues à utiliser l'échographie.
Management of Pregnant Patients Undergoing General Surgical Procedures
2015, Surgical Clinics of North America
Citation Excerpt :
These waves are generally thought to be safe to the fetus. Although no documentation of adverse fetal effects from diagnostic ultrasonography procedures exists, the US Food and Drug Administration recommends limiting ultrasonography energy exposure to 94 mW/cm2.15 Because of the improved safety profile of ultrasonography, it has gained popularity and largely replaced radiographic diagnostic modalities using ionizing radiation.16
Nontraumatic Abdominal Pain in Pregnancy: Imaging Considerations for a Multiorgan System Problem
2012, Seminars in Ultrasound, CT and MRI
Nontraumatic abdominal pain in the pregnant patient can present a clinician with a variety of diagnostic possibilities. The overlap between signs and symptoms expected in normal pregnancy and these many pathologic possibilities does little to help focus the clinician's diagnostic efforts. Fear of ionizing radiation's effects on the fetus has driven efforts to refine medical imaging algorithms in such a way as to attempt to eliminate its use at all cost. In today's world, we are nearly there. In this review the differential diagnosis of nontraumatic abdominal pain in the pregnant patient will be explored. Of note is the recurring theme that much of what can be done today with regard to diagnostic imaging, both in general and with regard to this specific subset of patients, centers on the use of the non-ionizing modalities of ultrasound and magnetic resonance imaging.
Imaging of Abdominal Pain in Pregnancy
2012, Radiologic Clinics of North America
Citation Excerpt :
There are no documented adverse effects on the developing human fetus from diagnostic sonography. The FDA has proposed an upper limit of 720 mW/cm2 for spatial-peak temporal-average intensity for obstetric sonography.27 Doppler sonography can produce high intensities and therefore time exposure should be limited, and acoustic output should also be limited to the lowest level possible.28
Nonmedical use of ultrasound: Bioeffects and safety risk
2010, Ultrasound in Medicine and Biology

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Routine ultrasound scanning in first trimester: What are the risks?

Abstract

Ultrasound Med Biol

Semin Ultrasound CT MR

Ultrasound Med Biol

Ultrasound Med Biol

Ultrasonics

Early Hum Dev

Guidelines and recommendations for the safe use of diagnostic ultrasound: the users' responsibilities

Assessment of the likely thermal index values for pulsed Doppler ultrasonic equipment