Safety aspects of ultrasound in prenatal diagnosis

Abstract

Ultrasound was used for the first time in pregnancy in the 1960 s and then found broader clinical application in the 70 s and particularly in the 80 s, thereby revolutionizing obstetrics and ultimately resulting in the development of a new subspecialty: prenatal diagnosis and perinatal medicine. This means that ultrasound has been used for more than 40 years in pregnancy to examine fetuses. This development was facilitated on the one hand by the ease of use of the method and the resulting broad availability and on the other hand by the fact that ultrasound is an imaging method that does not require the use of physical radiation. This resulted in early differentiation from diagnostic radiology (classic abdominal X-ray, pelvic X-ray, amniofetography) and later also from computed tomography. Magnetic resonance imaging (MRI) has the potential to supplement ultrasound for targeted issues but is still very cost-intensive and has numerous limitations. Despite this success story, concerns regarding the safety of ultrasound in prenatal diagnosis have arisen again in 2020. Why? What happened? Ultrasound-mechanical vibrations in a medium (mechanical waves)was designated as non-ionizing radiation in recent years. The term radiation induces anxiety in many pregnant women. Biological effects of mechanical waves (non-ionizing radiationultrasound) are dependent on threshold values, while biological effects of electromagnetic waves (X-ray radiation, gamma radiation) are always present regardless of threshold values. A regulation regarding the use of non-ionizing radiation for non-medical purposes was also recently enacted in Germany. Although it primarily does not apply to prenatal diagnosis, § 10 states: "Use of ultrasound in a pregnant person. Fetal exposure must be avoided when using ultrasound for non-medical purposes" [1]. This wording has caused renewed uncertainty among both pregnant women and physicians. A huge response was seen on

Effects of 3D ultrasonography and 3D printed images on maternal-fetal attachment and its correlation with overall smoking within pregnancy: A pilot study

“…This recommendation has its roots in the "as low as reasonably achievable" (ALARA) principle. Interestingly, these organizations emphasize that ultrasound is a safe and risk-free method for prenatal diagnosis as "the literature does not include a single study reporting a risk to the fetus as a result of ultrasound" (15). While the responsible use of fetal ultrasound is important the chilling effect these recommendations have on the use of ultrasonography is a slippery slope.…”

Retrospective analysis of 2054 cases from 24 hospitals underwent ultrasonic consultation in a tertiary prenatal diagnosis center in Beijing, China

“…Ultrasound, an imaging method, does not require physical radiation and is less expensive than magnetic resonance imaging. It is widely used in prenatal screening and diagnosis and does not involve the risk of miscarriages 2–4 . Antenatal ultrasound detects various fetal malformations and appendage abnormalities with varying detection rates 5–8 .…”

Is ultrasound in pregnancy perhaps dangerous after all? A never-ending discussion for over 40 years!

“…In spite of the lack of risks of ultrasound when applied properly, it is importantas already discussed in the editorial of the 2/2020 issue of the European Journal of Ultrasound [13] for every person performing medical ultrasound examinations in pregnancy to know the safety aspects of ultrasound in prenatal diagnosis. Therefore, we wrote a two-part CME article providing a comprehensive overview of ultrasound safety in pregnancy.…”

“…Trotz aller Unbedenklichkeit ist eswie bereits im Editorial von Heft 2/2020 von Ultraschall in der Medizin aufgeführt [13] wichtig, dass jeder, der medizinische Ultraschalluntersuchungen in der Schwangerschaft durchführt, die Sicherheitsaspekte des Ultraschalls in der pränatalen Diagnostik kennt. Aus diesem Grund haben wir einen CME-Artikel in 2 Teilen vorbereitet, der einen umfassenden Überblick über das Gebiet der sonografischen Sicherheit in der Schwangerschaft vermittelt.…”