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SCANS ULTRASOUND SAFE SOUND Not AND Ultrasound has been promoted as risk-free and satisfying for prospective parents, but scientific research reveals serious concerns about its safety and usefulness. en I was pregnant with my first baby in 1990, I decided against having an ultrasound scan. This was a rather unusual decision, as my partner and I are oth doctors and had even done pregnancy scans ourselves—rather ineptly, ut sometimes usefully—while training in GP obstetrics a few years earlier. What influenced me the most was my feeling that I would lose something important as a mother if I allowed someone to test my baby. I knew that if a minor or uncertain prob- lem showed up (this is not uncommon), I would be obliged to return again and again, and that after a while it would feel as if my baby belonged to the system and not to me. In the years since then, I have had three more unscanned babies and have read many articles and research papers about ultrasound. Nothing I have read has made me reconsider my decision. Although ultrasound may sometimes be useful when specific problems are suspected, my conclusion is that it is at best ineffective and at worst dangerous when used as a "screening tool" for every pregnant woman and her baby. ULTRASOUND, PAST AND PRESENT Ultrasound was developed during World War II to detect enemy submarines, and was subsequently used in the steel industry. In July 1955, Glasgow surgeon Ian Donald borrowed an industrial machine and, using beefsteaks as controls, began to experiment with abdominal tumours which he had removed from his patients. He discovered that different tissues gave different patterns of "echo", leading him to realise that ultrasound offered a revolutionary way to look into the previously mysterious world of the growing baby (Wagner, 1995). This new technology spread rapidly into clinical obstetrics. Commercial machines became available in 1963 (de Crespigny, 1996), and by the late 1970s ultrasound had become a routine part of obstetric care (Oakley, 1986). Today, ultrasound is seen as safe and effective, and scanning has become a rite of pas- sage for pregnant women in developed countries. Here in Australia, it is estimated that 99% of babies are scanned at least once in pregnancy—mostly as a routine prenatal ultra- sound (RPU) at four to five months. However, there is growing concern as to ultrasound's safety and usefulness. UK con- sumer activist Beverley Beech has called RPU "the biggest uncontrolled experiment in history" (Beech, 1993), and the Cochrane Collaborative Database—the peak scientific authority in medicine—concludes that "no clear benefit in terms of a substantive outcome measure like perinatal mortality [number of babies dying around the time of birth] can yet be discerned to result from the routine use of ultrasound" (Neilson, 2002). This seems a very poor reward for the huge costs involved. In 1997-98, for example, A$39 million was paid by the Australian federal government for pregnancy scans—an enormous expense compared to $54 million for all other obstetric Medicare costs. This figure does not include the additional costs paid by the woman herself. The 1999 Australian Senate Committee report, "Rocking the Cradle", recommended that the costs and benefits of routine scanning and current ultrasound practices be formally assessed. Recommendations were also made to develop guidelines for the safe use of all obstetric ultrasound, as well as for the development of standards for the training of ultra- sonographers (Senate Community Affairs Reference Committee, 1999). So far, none of these recommendations has been implemented. Brisbane, Australia NEXUS ¢ 17 OCTOBER — NOVEMBER 2002 www.nexusmagazine.com