Refusing prenatal ultrasound

[2curlygirls]

Can someone please explain the rationale of this to me? I realize I'm very biased being a NICU nurse in a level III surgical/cardiac center but?????

Thanks

curly

[traumaRUs, MSN, APRN]

I am not a NICU nurse but just in the ER, folks are generally getting away from invasive procedures and interventions during a normal pregnancy. I'm probably going to open up a can of worms here but I personally don't see the need for pre-natal ultrasounds unless there is a suspicion of problems. Pregnancy is a normal state, not a sick state.

[fergus51]

My friend declined prenatal us because she felt pregnancy was a healthy state and that test was unecessary since she was low risk. I wouldn't call it an invasive procedure, but she didn't want anything done that wasn't medically necessary. Unfortunately I use the past tense there because it turned out that her child had a lethal birth defect that would have been detected on us early in the pregnancy but wasn't picked up until her 7th month when other signs led them to consider an us necessary. She had us with her subsequent pregnancy and fortunately they were healthy.

[2curlygirls]

My friend declined prenatal us because she felt pregnancy was a healthy state and that test was unecessary since she was low risk. I wouldn't call it an invasive procedure, but she didn't want anything done that wasn't medically necessary. Unfortunately I use the past tense there because it turned out that her child had a lethal birth defect that would have been detected on us early in the pregnancy but wasn't picked up until her 7th month when other signs led them to consider an us necessary. She had us with her subsequent pregnancy and fortunately they were healthy.

OY! Poor thing. Do you know what the defect was?

[traumaRUs, MSN, APRN]

So sorry for your friend Fergus. However, I stand by my statement that pregnancy is healthy. The caveat to this is that the pt must realize that unseen birth defects might not be detected. Few birth defects however can be corrected in utero though so I fail to see how early detection would have helped? Can someone enlighten me - as I stated, I'm certainly not the expert in this area?

[fergus51]

Trauma, I am not saying pregnancy is not normally a healthy state. You're reading more into my post than you need to. I also feel pregnancy is usually a healthy condition. The key word being "usually". I was just explaining why she didn't want us in her first pregnancy.

Curly, it had to do with the skull's formation. I don't know the exact defect, this was before I became a nurse. The reason it would have helped her to know earlier Trauma, is that she would have been able to deal with it earlier. A D&C at 8 weeks is preferable to some women than having to be induced and deliver a dead baby lady partslly at 7+ months. She would never have had to explain any of it to her kindergarten class if that were the case. She wouldn't have been at the point where she was producing milk yet. The other reason I am in favor of a routine us or 2 is that even if the defect isn't operable, at least the woman and her healthcare providers can prepare for the birth. You can't imagine how many undiagnosed defects I've seen born at small hospitals that weren't equipped to deal with them. That can have serious health consequences for the baby and emotional consequences for the parents. Parents who know ahead of time do much better emotionally in my experience because they are already past the shock.

Again, I realize most births are healthy. I just personally don't see much harm in doing an ultrasound to rule out health problems because I think the benefit far outweighs any risks. It's like PKU testing. We know very few babies will have that disorder, but we screen all babies anyways because it's so simple to do and will save the small number of babies that do have that particular disorder.

[2curlygirls]

Though few can be corrected in utero (more and more can, We have two surgeons that perform in utero surgeries-cardiac and general) It is definitely more for the parents. They can choose their surgeon, tour the unit, make necessary arrangements for work, childcare.

My good friend (an adult CVICU nurse with zero risk factors) recently delivered a son with interrupted aortic arch. Because she knew, she researched cardiac surgeons, the defect itself, long term prognosis etc. Arranged for family with her. Though the experience was traumatic, she was very pleased with how smoothly it went and how much control (perceived or otherwise) she felt she had.

[Gompers, BSN, RN]

I am not a NICU nurse but just in the ER, folks are generally getting away from invasive procedures and interventions during a normal pregnancy. I'm probably going to open up a can of worms here but I personally don't see the need for pre-natal ultrasounds unless there is a suspicion of problems. Pregnancy is a normal state, not a sick state.

But ultrasound isn't an invasive procedure, so that's why I wonder how anyone can want to refuse it.

I'm biased, too, as a NICU nurse. I've seen way too many babies born lady partslly with huge omphalaceles, myelos, gastrosceisis, huge cysts, etc. Had they known prenatally, some would have been elective c-sections to limit trauma to the tissues. Plus we'd be ready in the delivery room to deal wth those tissues and support the baby. It seems to help the parents deal with it better if they know prenatally as well, instead of finding out after delivery and then everything is a big blur. There is time prenatally to talk to surgeons, neonatalogy, etc.

[2curlygirls]

From what I've gathered it's because "we would worry too much if there was a false positive" and "it might lead to more testing". I guess I just NEED to have all information possible in every situation but that's just me.

[IWANT2BE]

[EVIL][/EVIL]Lawyers...Money...Malpractice[EVIL][/EVIL]

My wife and I did not see the need for what we felt were excessive ultrasounds for our last pregnency. She was 35 yrs. old and considered at higher risk for many complications, however, she never showed any signs of extra stress or health issues. I think we ended up having three(maybe-four)

ultra sounds. This was our second child. The first pregnency was text book. I believe the health care system pushes for these procedures in order to help them against potential liabilities in the future. Like, "Hey doc, why doesn't my kid have blonde hair? I think I might have to sue you for this obvious over-sight! You really should have prepared me better. I had absolutely no idea. Blonde hair? Just wait until my lawyer gets a hold of this one!"

By the way. The second child was the daughter my Wife had always wanted, and wouldn't you know it she was a red head. That doctor should have given me a little warning with that one!:rotfl:

[BittyBabyGrower, MSN, RN]

Many people don't do it because if there is a problem, lethal or not, it wouldn't change what they would do with the pregnancy. Many people refuse quad screens for the same reason.

[caroladybelle, BSN, RN]

Again, I realize most births are healthy. I just personally don't see much harm in doing an ultrasound to rule out health problems because I think the benefit far outweighs any risks. It's like PKU testing. We know very few babies will have that disorder, but we screen all babies anyways because it's so simple to do and will save the small number of babies that do have that particular disorder.

Some people dislike excess interventions, regardless.

Perhaps, what should be assessed is how the information will be used and whether it will make a difference in the family's actions.

In my family's case, the vast majority would not undergo abortion, even if there was a serious defect/certain death of the infant involved. As such, having the test would just prolong stress of the family, and the results would change very little what we do.

I have declined to be tested for heredity colon/breast ca. As I would not consider having a prophylactic mastectomy/oopherectomy or colectomy, based on the results, and I already undergo the preferred surveillance, and I have no blood sisters or children, there is little value to the test other than to make me fret.

PKU is really not an adequate comparison, because it is easily treatable, while many of the defects seen by US are not. PKU testing is also mandated by law in many places.