We humans, we’re definitely a sentimental lot. Some might even argue that is one of the key traits that separate us from other animals – our desire to acquire mementos of life’s experiences. We sure do treasure our keepsakes, those tangible tokens of endearment to commemorate a special time, person or place.
Seems harmless enough, right? But when does the desire for the ultimate keepsake cross over into a health hazard?
This past week, the U.S. Food and Drug Administration released a revised consumer update against the medically unnecessary use of fetal ultrasounds to create “keepsake” images and the over-the-counter sale and use of fetal heartbeat monitors to listen to a baby’s heart in utero.
“Having a baby, particularly a woman’s first, is one of life’s most amazing life experiences. It’s only natural to want to document the event in a special way,” said Rima Mehta, MD, of director of Gynecology at Pennsylvania Hospital (PAH). “Thanks to modern technology, people are finding much more creative ways to do just that. On the flip side, there is always going to be someone who will find a way to exploit that desire and profit from it. It’s basic marketing: find a niche and fill it.”
To prove Mehta’s point, one only has to take to the Internet.
First, it was just a natural extension of the use of social media: Women filming themselves as they discover the results of their pregnancy test and posting it to YouTube creating the “womb tube” trend, adding “expecting” as a life event to their Facebook profiles, and then posting sonogram images to their page.
Then things got more revealing. We have: free-standing imaging centers offering ultrasounds – some in 3D or 4D dynamic - just so parents can have amazingly detailed images of a fetus in utero. There are “gender reveal parties,” where ultrasound technicians offer their services for anywhere from $100-$350 a pop for expectant parents to have a sonogram performed in their home amongst a gathering of friends and family. Ultrasound parties, basically just a take-off from the gender reveal parties where parents want to share a more extensive sneak peek at a baby surrounded by loved ones, are also popular. And parents-to-be are purchasing over the counter Doppler heart monitors to keep tabs on baby’s heartbeat at home.
“These satellite facilities where you can have an ultrasound that has nothing to do with medicine and these ultrasound parties are not health care. I classify them as 'medutainment,'” said Peter Gearhart, MD, also of Penn Ob/Gyn & Midwifery Care at PAH. “It's the use of medical technology for entertainment purposes.”
An ultrasound exam is a diagnostic procedure that uses high-frequency sound waves to scan a woman’s abdomen and uterus to produce a picture - or sonogram - of the fetus. “It is a diagnostic tool” said Mehta, “not a recreational visual aid.”
Most people probably don’t realize there are seven different kinds of ultrasound procedures. There are transvaginal scans, which are used during the earliest stages of pregnancy and to detect ectopic pregnancies. Standard ultrasound is atraditional exam done over the abdomen to generate two dimensional images of a developing fetus. Advanced ultrasound, similar to a standard, uses more sophisticated equipment and targets suspected problems. Doppler ultrasound measures changes in the frequency of ultrasound waves as they bounce off moving objects such blood cells (used to monitor blood flow and detect the narrowing of veins and arteries). 3-D ultrasound uses specially designed probes and computer software to generate 3-D images of a developing fetus, while 4-D or dynamic 3-D ultrasound uses specially designed scanner to observe the face and movements of a fetus. Fetal echocardiography uses ultrasound waves to assess fetal heart anatomy and function and is used to help detect suspected congenital heart defects.
“Ultrasounds are performed in the first trimester to confirm a viable pregnancy and heartbeat,” said Mehta, “but are also performed during the second and third trimester to monitor baby’s growth, determine if a woman is carrying multiples, check on the position of the placenta and, if the need arises, to detect abnormalities and other conditions.”
According to the National Institutes of Health, the miscarriage rate for first-time pregnancies is 15 to 20 percent. “What do you do if an ultrasound being performed at one of these parties picks up a serious fetal defect? Or if it doesn’t pick up a heartbeat? That is hardly the proper environment for a mother to receive the care and counseling she requires,” said Mehta. “Even if the technician performing the exam agrees to scan a woman only after her physician says the pregnancy is progressing normally – something could still happen. Why take that chance?”
According to the FDA consumer report, some commercial ultrasonic imaging sessions to make fetal keepsake videos can run as long as an hour. There is no control on how long a single imaging session will last during the process of creating a keepsake video, how many sessions will occur, or whether the ultrasound systems will be operated properly. While the FDA recognizes that fetal imaging can help strengthen the bond between parents and an unborn baby, such opportunities are already provided during routine prenatal care.
Mehta’s colleague Gearhart agrees. “The proper use of ultrasound during pregnancy – in the context of a medical evaluation by a trained professional – has been well studied over many years and has been deemed a categorically safe diagnostic tool,” said Gearhart. “However, we simply do not know the effects of increased use or long-term use. Women shouldn’t risk the chance of exposing herself and her baby to possible harm for the sake of pretty pictures”
The FDA has similar concerns surrounding the over-the-counter sale and use of Doppler ultrasound heartbeat monitors and warns that, “These devices, which are used for listening to the heartbeat of a fetus, are legally marketed as ‘prescription devices,’ and should only be used by, or under the supervision of, a health care professional.”
Ultimately, the bottom line is the same for the in-home use of fetal heartbeat monitors as with extraneous ultrasounds: “There is simply no medical benefit from this additional exposure which in fact, may actually cause more harm than good,” said Mehta.