Prenatal Ultrasound: Friend or Foe?

“It could be nothing … or it could be … something.”

With those words so casually mentioned by my doctor after a recent regularly scheduled prenatal ultrasound, I was tossed headfirst into a place of uncertainty and anxiety. 

This one phrase caught me completely off guard. Perhaps it was the way the doctor brought it up; bustling into the room, everything seemingly normal like all my previous visits, until she started the conversation with that opening statement. Of course, in the back of my mind, there is always the implicit knowledge that each pregnancy has its own risks and chances of complications. But having had two previous low-risk pregnancies resulting in healthy full-term babies, I was naively assuming our third would be the same.

When a prenatal ultrasound is less than reassuring

For a few seconds I just stared at her, confused, as I tried to process what she said. Something could be wrong with the baby? But how? I had just seen the baby on the screen, heard her heart beating, watched all the usual measurements be taken. If our ultrasound technician spent a bit longer on the heart, she seemed to have a valid reason; this little babe was not one to stay still. 

After I recovered from the initial shock, I began to ask questions. Generalized at first, and then more specifics as I started getting a better understanding of what we may be facing. I was told the markers found indicated our baby could have Down Syndrome.

I left in a bit of a daze with some reassuring words from the doctor along with a referral to a maternal fetal medicine specialist. Not knowing much about the genetic disorder, I wasn’t sure if I should feel devastated over any potential health concerns and risks associated with having a child with Down syndrome or relieved that it wasn’t a more serious, life threatening condition. 

While I was wondering how upset I should be, I also began to worry about when and how I should tell my husband. He was under a lot of work stress and working long hours. He’s also a natural worrier; I knew he would be deeply upset by this news, regardless of the outcome. I am more prone to freak out when I have a better understanding of a situation. Fortunately, the maternal fetal specialist was able to fit me in the next day, so we would soon have a better idea of what we might be facing. 

While the visit from the specialist was initially less than encouraging — additional markers were found for a more serious genetic condition — we were able to have a full genetic panel screening done. This blood work screening ultimately provided the reassurance we were seeking. We were considered very low risk for any genetic conditions and based on the test results, no further testing, such as an amniocentesis, was recommended.  

After conducting my own research, I learned the various markers found in our ultrasound were extremely common, and often resulted in the birth of a completely normal, healthy baby. 

Prenatal ultrasounds are performed for a variety of reasons: They can confirm a pregnancy, help determine gestational age and the number of babies, and in general offer expectant parents insight into the health and gender of their growing baby or be used to investigate any pregnancy complications.

While prenatal ultrasounds can provide reassurance that everything looks “normal,” they also can be imprecise and cause more worry and anxiety than is sometimes necessary. When the due date doesn’t quite align with the date of a last menstrual period for example, or even the growth of the baby, we stress. False positives, or incorrect ultrasound diagnoses, are also a stressor.

Prenatal ultrasounds, no matter how frequently they are performed, are not a perfect science. 

Last year, Jimmy Kimmel and his wife Molly welcomed a baby boy, who was born with an undiagnosed congenital heart abnormality which required open heart surgery just a few days after birth. I’m sure the Kimmels, like many American families, had a prenatal ultrasound at some point in their pregnancy; if that is the case, the heart condition wasn’t found prior to birth. Technicians, technology and baby positioning can all play a limiting role in ultrasound accurateness. In fact, a study published in the New England Journal of Medicine found that routine prenatal ultrasounds actually only detect between 17 and 85 percent of the 1 in 50 babies that are born with major abnormalities.

Much of what I’m discussing here about prenatal ultrasound certainty and safety was learned after our own prenatal ultrasound came back without clear positive results. In addition to the limited capability of ultrasounds, I also learned that ultrasounds aren’t completely guaranteed to be risk free.

Although ultrasounds have become a routine part of prenatal care and are generally thought to be safe, there is not a 100 percent guarantee that there are no risks associated with the technology.

The American Congress of Obstetricians and Gynecologists states there is no reliable evidence that ultrasounds are harmful with no connecting links between ultrasound and birth defects; however, it does acknowledge that there is a possibility that potential negative effects could be identified in the future. The overall recommendation from the ACOG is that ultrasounds be preformed specifically for medical reasons by qualified health care providers.

Like many choices about prenatal care, birth and parenting, making the decision to have ultrasounds, whether elective or not, is a personal one.

For our family, we always valued the sneak peek into our baby’s secret world- the initial pregnancy confirmation, the anatomy scan and learning the gender  –  and the overall reassurance that we gained from knowing what to expect. If our baby ultimately did end up having a genetic condition, I doubt much would have changed about the rest of the pregnancy, except that my husband and I would have had time to research and prepare. We are both the type of people who like to know what lies ahead.

Ultimately, I’m grateful for the quick access to maternal specialists and the blood work results which helped ease our minds. While no other ultrasounds are required for this pregnancy, should the need to have one arise, my husband and I promised each other to not stress out if the next ultrasound isn’t 100 percent conclusive. Instead, we are choosing to be hopeful and positive and rely more on the accuracy of the blood work. 

And after all, we are already in love with our baby girl and can’t wait to meet her.