Ultrasound Is 'The Best Way to Terrify a Pregnant Woman,' Says One Expert
Jan. 10, 2000 (Boston) -- Pregnancy ultrasound is a valuable tool for
evaluation of the fetus, but its use may lead to emotional distress for women
at low risk of having a child with Down's syndrome. That's what Roy A. Filly,
MD, writes in a guest editorial subtitled "The Best Way to Terrify a
Pregnant Woman" in the current Journal of Ultrasound Medicine. The
test, Filly tells WebMD, was originally used to search for abnormal findings in
women at high risk for having a child with Down's syndrome, such as being over
the age of 35. But the findings are now used to identify Down's syndrome
markers in women at low risk, he says. Filly is professor of radiology and of
obstetrics/gynecology and reproductive sciences at the University of
California, San Francisco.
"I think there's a lot of truth in [Filly's editorial]," Laurence E.
Shields, MD, tells WebMD. Shields is an associate professor of perinatal
medicine at the University of Washington School of Medicine, in Seattle.
"The points he's bringing up are reasonable. Ultrasound technology has
improved and people have identified a number of findings they refer to as soft
findings of ... abnormal chromosomes [abnormalities that are only rarely
associated with problems]. It's a tough thing to decide what to do with
that." Shields was not involved in the study.
Filly's goal in raising these issues is to stimulate the relevant
professional organizations to decree "it is not appropriate to mention
these [ultrasound findings, or markers,] to a woman," he tells WebMD. But
"I doubt that you are going to be able to find an organization to do
that." Shields, who thinks Filly mildly overstates the case, says that a
consensus statement on how to handle such findings would be in order.
The issue that Filly raises has been broached numerous times with respect to
screening tests in general. The question is, do screening tests do more harm
than good, either by needlessly scaring patients with positive findings that
turn out not to be true and/or by precipitating a series of diagnostic tests
that may be costly. "For the tiny residual number of Down's syndrome
fetuses that may potentially come to light by chasing down every last 'marker'
we intend to put at least 10% of all pregnant women with perfectly normal
fetuses through a great deal of worry," Filly writes.
"I have no instance in my recollection where one or the other of these
abnormalities was the sole reason I was able to recognize a fetus with
Down's syndrome in a low risk patient," Filly writes. "Obviously
someone has had such an experience, just not me."
Filly, who performed his first ultrasound on a pregnant woman 30 years ago,
suggests that most parents may be incapable of comprehending the minuscule
nature of these risks well enough to be relieved of their fears, he tells