Medical Experts Debate Value of In-Utero Photos
The images are irresistible, and there’s no mistaking what they show: sharp renderings of a sleeping baby’s face--except in this case it’s not a newborn, but a fetus.
Three-dimensional ultrasound is one of the latest technological additions to the obstetrician’s office, and it’s winning fans as parents-to-be clamor to picture their offspring in utero.
“Patients love it,” says Delores Pretorius, a professor of radiology at UC San Diego, and a pioneer in the technology.
It’s easy to see why. The photos show babies sucking their thumbs or sleeping with a tiny hand draped over an eye. They provide a look at profiles and facial features so clear that parents claim to recognize family traits.
“You can certainly get some very beautiful pictures of the fetal face and body,” says Barry Goldberg, director of diagnostic ultrasound at Thomas Jefferson University in Philadelphia.
Anyone who has struggled to fathom an unborn child’s image on a fuzzy, two-dimensional ultrasound picture will appreciate the vivid details and quality in this new type of photo.
“This is like the difference between seeing your baby in the doorway backlit where you can’t quite see the features and putting a light on the baby so suddenly it’s not a shadow,” says Craig Winkel, chairman of obstetrics and gynecology at Georgetown University Medical Center.
But if the 3-D images have surprising clarity, their medical value is still something of a blur. Skeptics see them as little more than a clever way to attract patients. “I have not seen the utility of these images,” says John Larsen, professor of obstetrics, gynecology and genetics at George Washington University Hospital. “They’re cute at medical conventions. They have good marketing potential, as in, ‘Hey, lady, give me some cash, and I’ll take a picture of your baby.’ But in truth, they don’t give a whole lot of medical information.”
Even those who have used the technology caution about over-promising what it can provide. “We’re still working on figuring out where this fits in the big picture,” adds Ulrike Maria Hamper, director of the division of ultrasound at Johns Hopkins University School of Medicine in Baltimore.
Ultrasound--the ability to use sound waves to “see” inside the body--was introduced experimentally to obstetrics in the late 1960s. It has gradually become a standard part of prenatal care. Today an estimated 80% of expectant women in the United States have ultrasound exams, according to the American College of Obstetrics and Gynecology.
The advantage of ultrasound is that it is fast and relatively cheap, costing as little as $50 per exam. Usually covered by health insurance, ultrasound exams are performed at about 10 to 14 weeks of the pregnancy and are considered the best way to gauge growth and anatomy before birth. Ultrasound can diagnose heart problems in the fetus, find neural tube defects including spina bifida and determine the position of the placenta.
And at its most basic, ultrasound is an important tool to simply confirm during a difficult pregnancy “whether the baby is alive or not,” says Goldberg.
While the blurry black-and-white pictures can be difficult for prospective parents to interpret, experienced radiologists have no such trouble--except when it comes to diagnosing cleft palate and other facial deformities. That’s where many experts believe 3-D may play an important role.
“The face is clearly seen a lot better with 3-D ultrasound,” says Pretorius, who has also diagnosed severe ear deformities on 3-D, something that she’s never done on 2-D. “I can detect a small chin on 3-D, which goes along with some genetic syndromes, and concavity of the upper face.”
There isn’t anything that can be done to correct these problems in utero, but knowledge can help doctors gauge the severity of the birth defect--and that information can then be used to help parents decide whether to plan for future medical treatment or to terminate the pregnancy.
3-D ultrasound is based on 2-D pictures that are run through a computer, an upgrade that adds about $50,000 to the cost of a standard ultrasound machine, which can run anywhere from $30,000 to $300,000. Unlike 2-D, which provides pictures in real time, streaming 3-D images have a kind of dreamy, delayed quality. Their most impressive advantage, however, is that doctors can rotate the 3-D images 360 degrees to see all sides of the fetus.
Another advantage of 3-D is its ability to identify some limb defects better than 2-D and to separate very rare deformities that are lethal from those that are not. Howard University’s chief of gynecology, Osborne Newton, has worked with international researchers “to make prenatal diagnoses of malformations that otherwise could not be confirmed until after birth,” Osborne says. “It really gives you a lot more information.”
Plus, 3-D’s sharper images make it easier to explain a deformity to parents--and pediatricians--in detail.
“Parents can understand the renderings from 3-D a lot better than 2-D ultrasound pictures, and that can also help them understand how these problems can be corrected,” says Nancy Budorick, director of abdominal ultrasound at Columbia University in New York.
April Holman of Encitas, Calif., was 12 weeks pregnant with her first child when a 2-D ultrasound scan suggested there might be a problem with the umbilical cord. Holman’s doctor referred her to Pretorius at UC San Diego for a follow-up 3-D scan that revealed more trouble. The fetus not only had a herniated umbilical cord but also a very rare birth defect that caused some of the organs to grow outside the abdomen.
“We knew we had some choices,” says Holman, a computer consultant. “And one of them was to terminate the pregnancy.”
Holman and her husband watched entranced as the 3-D test was done, and they quickly shifted from talking about a fetus to seeing their baby--a son--in motion. “I realized that there was no way we could interrupt the pregnancy,” Holman says.
After losing her first child to a rare birth complication in 1996, Shawn Fettel of San Diego entered a study of 3-D ultrasound at UC San Diego when she became pregnant again. The scans enabled doctors to monitor the baby and reassured Fettel. “It was amazing; you could see such incredible detail on this child,” she says. “I thought, ‘Oh, my gosh, I am not just pregnant, I have this thing in my body.”’
That’s a fact that has not been lost on those opposed to abortion. The Pope Paul VI Institute has produced several videotapes of 3-D ultrasound, called “Living Proof in 3-D: Putting a Face on the Unborn Human Person.” The images are also available on the Web sites of groups opposed to abortion.
Fettel delivered a healthy daughter. When she became pregnant again, she went back for more 3-D testing. “Again, everything looked fabulous, and my son was born healthy and whole,” she says.
Three-D ultrasound also can play another role: helping those whose pregnancies don’t end so happily. Holman, carrying the fetus with umbilical cord problem, continued 3-D ultrasound scans throughout her first pregnancy. She and her husband named their son Sean.
Doctors planned corrective surgery that was scheduled for shortly after his birth. But the night before Holman was due to have a cesarean section, Sean died in utero when his umbilical cord wrapped around his neck.
As devastating as her son’s death was, Holman says that she, her husband and her stepson take great comfort in the 3-D images they have of Sean.
“We really bonded with our baby,” says Holman, who now has a 11/2-year-old daughter and is pregnant again. “We have pictures of him on our walls. He is a part of our life.”
