# of ultrasounds--question

annafine wrote:

I'm 35 weeks pregnant and have only had 2 ultrasounds. The first was
at 10 weeks and the second at 18 weeks. I've been asking my OB about
another, but she won't request one unless she feels it medically
necessary.

My question is, how many ultrasounds have you had, and when (# of
weeks) did you have them?

Lets see, I had:
7w4d: to date the pregnancy (which was totally unnecessary because
I chart and knew when I ovulated, but I wanted it because of a previous
miscarriage, and I wanted the reassurance).

18w: Level II routine US

26w: check placenta position because it was low at the 18 w

And a late one (38 or 39 w) to check baby size. Really wish I hadn't
agreed to this one, because it just fed the whole fear of "big baby"
atmosphere that surrounded the end of my pregnancy.

Next time, I'll refuse the dating US, although I'll probably do the
anatomy one at 20 w. I may try and do one late to look at the
thickness of my c-section scar if I go for a VBAC, have to look
into that.

Mary

My question is, how many ultrasounds have you had, and when (# of
weeks) did you have them?

Thanks,
Anna
EDD #1 October 18, 2003

With #1, I didn't have any. My OB at the time felt that if he was doing his
job, the u/s wouldn't tell him anything he didn't already know. And he only
did u/s if he felt there was a reason for a concern, and didn't do routine u/s.
He had delivered over 5000 babies, and was awesome, but unfortunately retired
after my DS was born.

With #2, I had three u/s. A quick peak at 14 weeks, because the OB couldn't
find a hb and while she said she could hear the baby moving around on the
doppler, took pity on me because I was a bit worried and we did a quick u/s. I
also had them at 18 weeks and 35 weeks, routine for that OB.


Amanda

annafine wrote:
I'm 35 weeks pregnant and have only had 2 ultrasounds. The first was
at 10 weeks and the second at 18 weeks. I've been asking my OB about
another, but she won't request one unless she feels it medically
necessary.

My question is, how many ultrasounds have you had, and when (# of
weeks) did you have them?

Thanks,
Anna
EDD #1 October 18, 2003


With my 1st, I had 1 at 11.5 weeks because I had a CVS. Didn't have
any others.

With #2, I had 3 - 1 at about 8 or 9 weeks to verify that it was a
viable pregnancy - my 2 previous pregnancies ended in early
miscarriages. I had one at 15.5 weeks for an amnio, and one at 20
weeks. The one at 15.5 weeks was the only necessary one (necessary
given that I was having an amnio, that is).

Clisby

My question is, how many ultrasounds have you had, and when (# of
weeks) did you have them?


I had one ultrasound. I was about 6 weeks along, and there was suspicion of
multiples (fertility treatments.) Since there was only one, and I never had a
medical indication for another, I never had another. I could have had one (my
OB practice did do routine scans), but I declined them, because I couldn't see
any point.

(2 sounds more than sufficient to me, esp. since the ACOG doesn't recommend any
at all, unless there are medical indications.)

Any particular reason you were hoping to have more? By this point, the only
thing they'd be likely to be scanning for is fetal size/weight/lie, and the
latter can be determined by feeling your abdomen, while u/s is EXTREMELY
innaccurate in determining the former. (In fact, you should probably be pleased
that your OB is not doing a late one for that reason. Too many women find
themselves being pressured into unnessessary inductions, or even c-sections
because a late u/s finds that the baby is "too big"


Naomi
CAPPA Certified Lactation Educator

(either remove spamblock or change address to to e-mail
reply.)

With #1 I had 3. The first at 6 weeks because I had a minor problem, one at
16 weeks (routine) and one at 8 mos by our choice because we HAD to know the
sex

With #2 I had 3 also. The first at 6 weeks (routine) 2nd at 24 weeks
(routine) and the last at 35 weeks because I had slight placenta previa at
the 24 week scan and they wanted to make sure it had fixed itself.

With #3 I've had 1. It was at 20 weeks, a routine scan but also because I
had a high AFP result, I had it a few weeks earlier than I otherwise would
have. I dont suspect I will have another scan at this point.

Kari
mom to Kaylie (7) Noah (4) and #3 due in 2 weeks!


"annafine" wrote in message
om...
I'm 35 weeks pregnant and have only had 2 ultrasounds. The first was
at 10 weeks and the second at 18 weeks. I've been asking my OB about
another, but she won't request one unless she feels it medically
necessary.

My question is, how many ultrasounds have you had, and when (# of
weeks) did you have them?

Thanks,
Anna
EDD #1 October 18, 2003

Thought you might be interested in this article.

Mary G.

EVIDENCE MATTERS

Efficient Prenatal Ca Fewer Visits, Fewer Sonograms

Effective Clinical Practice, May June 1999
In this issue of ecp, Evidence Matters focuses on obstetric care and
how it might be done more efficiently. The goal of prenatal care is to
ensure delivery of a healthy baby to a healthymother. The standard
regimen of care that most obstetric providers have been trained to use
is intense—14 visits during a 40-week pregnancy and a myriad of
screening tests. Many recommended aspects of prenatal care have not
been shown in clinical trials to improve outcomes, but more tests and
visits must be better, right? The studies presented in this issue of
ecp show the opposite—that more visits and, at least in the case of
routine ultrasonography, more tests are not necessarily better.
Neither increases the number of healthy babies delivered to healthy
mothers.

The first study presented here was designed to put the recommendations
of the Expert Panelon the Content of Prenatal Care1—a
multidisciplinary panel convened by the Public HealthService—to the
test of a randomized, controlled trial. This trial, conducted in the
Coloradoregion of Kaiser Permanente, found that reducing the number of
prenatal visits had no adverse effects on outcome or patient
satisfaction. That the intensity of prenatal care can safely be
reduced has been confirmed by randomized trials in Britain2 and
Zimbabwe.3 By paying
attention to what we do in fewer prenatal visits, we can improve the
efficiency of prenatal care while satisfying our patients and
maintaining excellent pregnancy outcomes. Obstetric providerscan use
the results of these randomized trials to safely reduce the intensity
of routine prenatal care and continue to deliver healthy babies to
healthy mothers.

Performing ultrasonography at least once and often twice or more
during pregnancy has seemingly become routine. This practice was based
on the belief that such screening would improve outcomes. However, the
RADIUS trial, presented here and in another paper4 examining the
impact of routine screening ultrasonography on maternal management
andoutcomes, demonstrated that routine ultrasonography does not reduce
adverse perinatal outcomes or obstetric interventions.

Keeping in mind the caveat that these trials examined care given to
low-risk obstetric patients,it seems clear that in prenatal care, more
is not necessarily better. Indeed, when equivalent or better outcomes
result from less intense care, resources become available for use
elsewhere.To me that means that less—not more—is better.

References

1. Public Health Service Expert Panel on Prenatal Care. Caring for our
Futu The Content ofPrenatal Care. Washington, DC: Public Health
Services, US Dept of Health and Human
Services; 1989.

2. Sikorski J, Wilson J, Clement S, Das S, Smeeton N. A randomised
controlled trial comparing two schedules of antenatal visits: the
antenatal care project. BMJ.1996;312:546-53.

3. Munjanja SP, Lindmark G, Nyström L. Randomized controlled trial of
a reduced-visits programme of antenatal care in Harare, Zimbabwe.
Lancet. 1996;348:364-9.

4. LeFevre ML, Bain RP, Ewigman BG, et al. A randomized trial of
prenatal ultrasonographicscreening: impact on maternal management and
outcome. Am J Obstet Gynecol. 1993; 169:483-9.


McDuffie RS, Beck A, Bischoff K, Cross J, Orleans M. Effect of
frequency of prenatal care visits on perinatal outcome among low-risk
women. A randomized controlled trial. JAMA.1996;275:847-51.

QUESTIONS. Does reducing the number of routine prenatal visits
increase adverse maternal orperinatal outcomes? Are patients satisfied
with a reduced number of prenatal visits?

DESIGN. Randomized, controlled trial.

PATIENTS. Healthy, pregnant, adult women with no past or current
high-risk obstetricconditions who presented for their first intake
visit in the first trimester. All patients were enrolled in a
nonprofit, group model, health maintenance organization (the Colorado
region of Kaiser
Permanente).

INTERVENTION. 1165 women were randomly assigned to receive fewer
routine prenatal visits.They were to be seen at 8, 12, 16, 24, 28, 32,
36, 38, and 40 weeks of gestation. For parous women, a telephone call
was scheduled at 12 weeks instead of an office visit. 1163 women were
randomly assigned to attend the usual schedule and number of visits.
They were to be seen every 4 weeks from 8 to 28 weeks, every 2 weeks
until 36 weeks, and weekly thereafter.

RESULTS. On average, women assigned to fewer visits had three fewer
visits per pregnancy. There were no significant differences between
the groups in any maternal outcome (Table 1). Other outcomes with no
significant differences included mild preeclampsia; preterm
labor;cesarean section for fetal distress; preterm, premature rupture
of membranes; gestational diabetes; multiple births; choriamaniotitis;
abruptio placenta; and postpartum hemorrhage.

There were no significant differences between the two groups in any
perinatal outcome (Table 1). In addition, there were no significant
differences in mean gestational age, mean birthweight, number of
babies born small for gestational age, or number of babies with APGAR
scores below 7 at 5 minutes.

Patients were questioned about satisfaction with their prenatal care.
The only significant difference was that more patients in the
fewer-visits group rated the number of prenatal visits as "just right"
(89.2% in the fewer-visits group vs. 82.8% in the usual visits group,
P= 0.002; NNT, 16; 95% CI, 10 to 44). The two groups were equivalent
in all other measures of patient satisfaction.

CONCLUSION. In low-risk obstetric patients, reducing the number of
routinely scheduledprenatal visits from a target of 14 to 8 or 9
visits has no adverse effect on maternal or perinatal outcomes and may
increase patient satisfaction.


Ewigman BG, Crane JP, Frigoletto FD, et al. Effect of prenatal
ultrasound screening on perinatal outcome. N Engl J Med.
1993;329:821-7.

QUESTION. Does routine ultrasonography (U/S) on two occasions reduce
perinatal morbidity and mortality?

DESIGN. Multicenter randomized, controlled trial.

PATIENTS. Women at low risk for adverse pregnancy outcomes and no
clinical indication forU/S. All centers were in the United States.
Academic centers, HMOs, and private practices wereincluded.

INTERVENTION. 7812 women were randomly assigned to receive two routine
U/S
examinations during pregnancy. The first examination was to be
scheduled at 18 to 20 weeksof gestation; the second was to be
scheduled at 31 to 33 weeks. 7718 women were randomly assigned to have
no routine U/S examinations.

RESULTS. The rates of adverse perinatal outcomes were equivalent
between the screened and unscreened groups. Analysis of the 11
predefined adverse outcomes indicating severe morbidity and of the 8
adverse outcomes indicating moderate morbidity revealed no differences
between the screened and unscreened groups. There were no differences
in rates of preterm births or postdate births between the two groups.
Rates of fetal or neonatal death were equivalent in the two groups.
Selected outcomes are presented in Table 2.

Women assigned to no screening averaged 0.6 U/S examinations; 55% had
no U/S examinations. Women assigned to routine screeningaveraged 2.2
U/S examinations.

CONCLUSION: A policy of routine ultrasonography in low-risk pregnant
patients does notimprove perinatal outcomes.

Key Evidence

In low-risk obstetric patients, reducing the number of routinely
scheduled prenatal visits has no adverse effect on maternal or
perinatal outcome.Reducing the number of prenatal visits does not
impair, and may modestly improve,patient satisfaction with prenatal
care. In low-risk obstetric patients, routine prenatal ultrasonography
does not improve perinatal outcomes.

"annafine" wrote in message
om...
I'm 35 weeks pregnant and have only had 2 ultrasounds. The first was
at 10 weeks and the second at 18 weeks. I've been asking my OB about
another, but she won't request one unless she feels it medically
necessary.

My question is, how many ultrasounds have you had, and when (# of
weeks) did you have them?

Thanks,
Anna
EDD #1 October 18, 2003

#1 - one per trimester
#2 - about 9 or 10 weeks, Level 2 u/s at 26 weeks, starting at 30 weeks one
u/s a week (suspected complications)
#3 - one at 12 weeks

--
Sophie -
TTC #4

I had 3- 1st at 8 weeks 2nd about 4-6 weeks later and the next was at 21 or
22 weeks. The reason I had 3 however is my first U/S showed bleeding and
last year I had a miscarriage. 2 is usually the most someone with no worries
has.
Shannon
3 days overdue

DD1: One at around 20 weeks and one quick looke when I went into labor at
the hospital to make sure that she was head down and no placenta previa.
DD2: One around 20 weeks and one later in the pregnancy to make sure there
were no abnormalities (medical problems with first baby).
DD3: One around 20 weeks and one when I went into labor, just to see if she
was head down.

You really don't need any more ultrasounds. They have not been medically
proven safe and really don't change the results, unless it is peace of mind
that you are looking for.
--
Sue
mom to three girls

annafine wrote in message
om...
I'm 35 weeks pregnant and have only had 2 ultrasounds. The first was
at 10 weeks and the second at 18 weeks. I've been asking my OB about
another, but she won't request one unless she feels it medically
necessary.

My question is, how many ultrasounds have you had, and when (# of
weeks) did you have them?

Thanks,
Anna
EDD #1 October 18, 2003

(annafine) wrote in message . com...

My question is, how many ultrasounds have you had, and when (# of
weeks) did you have them?

I didn't have any at all. My midwives, and research confirmed this,
don't order one unless they suspect something is amiss, OR the parents
want one. Whereas an U/S is cool, especially around 20 weeks when it
can pick up the sex, it wasn't worth the extra pocket money to do it
just for the sex. So we trusted the midwives and didn't get one. So
it was a surprise at her birth that our hoped-for girl was indeed a
girl, and that was fun.

Cathy Weeks
Mommy to Kivi Alexis 12/01