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.