3D ultrasound question.

My insurance is being a big pain this time around and it looks like we are
being made to pay a good portion of things that were 100% covered with DD.
The cost has gone up HIGHLY- with DD all we paid was a deductible of $200
and every test, ever *everything* was covered. Our insurance is still the
same company provided my husband's job which has not changed but the
coverage has declined for all employees every year, so much so that people
are complaining. It's pretty bad but what can you do about it?? But for
example, literally everything was covered- the blood screens, the AFP test,
2 ultrasounds routinely and then any ultrasound that a doctor deemed
medically necessary (this time around even my 9 week u/s was not fully
covered and I have been told the partial coverage for that one is the ONLY
coverage! And IMO 2 u/s should be covered- the first one, IMO, is valid to
date a pregnancy but also to make sure it's viable- that's the only way you
get a heartbeat until you are far enough along for Doppler- and also it's
the only way to make sure the preg. is not ectopic, and to see if it's
higher risk (twins etc). I'm probably preaching to the choir I guess....and
then I consider the second u/s crucial not because they can possibly
determine gender, but because it's L2 and they are checking for things
wrong. I think we have to pay for the 2nd one in full.

My husband said since the insurance is being so horrid about covering the
u/s anyway and we are going to have to pay anyway, why don't we consider
getting a 3D u/s. We opted not to have any additional "recreational" u/s
with DD..we had the 2 necessary ones and that was it. We even told them if
they didn't get the gender we were not going to come back and pay out of
pocket later just for that, we'd just wait.

My husband wants to know do they do 3D u/s at 18-20 weeks. I don't know but
I told him probably not because I don't think the 3D shows any of the
details they scan for to make sure everything is ok, right? I told him we'd
need to just go get the Level II so they can check the heart chambers and
all that..right?

I just wanted to make sure that there is no 3D u/s technology that's being
done in place of the regular Level IIs they do. Then that brings me to one
more question...is there any medical value to a 3D u/s done later in
pregnancy, say 35 weeks or so? I know it's not necessary...and I know it's
mostly done so parents can see what their baby looks like, for
recreation...but I have started to wonder if we chose to pay for one, would
it help even a little? If I have it done late enough, can they use it to
double check and see if they see anything wrong, or to take note of the
baby's position or measure the baby, etc??

beyond the pale wrote:
And IMO 2 u/s should be covered- the first one, IMO, is valid to
date a pregnancy but also to make sure it's viable- that's the only way you
get a heartbeat until you are far enough along for Doppler- and also it's
the only way to make sure the preg. is not ectopic, and to see if it's
higher risk (twins etc). I'm probably preaching to the choir I guess....and
then I consider the second u/s crucial not because they can possibly
determine gender, but because it's L2 and they are checking for things
wrong. I think we have to pay for the 2nd one in full.

Frankly, I'm not so sure you're on solid footing there.
There's very little evidence that routine ultrasound is necessary.
Even the ACOG's official position at this time is that there
shouldn't be *any* routine ultrasounds, only medically indicated
u/s (i.e., there's reason to believe something unusual might be
happening). I had no ultrasounds whatsoever in my first two
pregnancies, and only had two at the end of my last pregnancy in
conjunction with an external cephalic version. There is little
evidence that routine ultrasound leads to better outcomes.


I just wanted to make sure that there is no 3D u/s technology that's being
done in place of the regular Level IIs they do. Then that brings me to one
more question...is there any medical value to a 3D u/s done later in
pregnancy, say 35 weeks or so? I know it's not necessary...and I know it's
mostly done so parents can see what their baby looks like, for
recreation...but I have started to wonder if we chose to pay for one, would
it help even a little? If I have it done late enough, can they use it to
double check and see if they see anything wrong, or to take note of the
baby's position or measure the baby, etc??

Not only is it unnecessary without any medical indication,
but it could well turn up spurious information leading to unnecessary
intervention.

Best wishes,
Ericka

On Thu, 12 Jul 2007 13:32:17 -0400, "beyond the pale"
wrote:

My insurance is being a big pain this time around and it looks like we are
being made to pay a good portion of things that were 100% covered with DD.
The cost has gone up HIGHLY- with DD all we paid was a deductible of $200
and every test, ever *everything* was covered. Our insurance is still the
same company provided my husband's job which has not changed but the
coverage has declined for all employees every year, so much so that people
are complaining. It's pretty bad but what can you do about it?? But for
example, literally everything was covered- the blood screens, the AFP test,
2 ultrasounds routinely and then any ultrasound that a doctor deemed
medically necessary (this time around even my 9 week u/s was not fully
covered and I have been told the partial coverage for that one is the ONLY
coverage! And IMO 2 u/s should be covered- the first one, IMO, is valid to
date a pregnancy but also to make sure it's viable- that's the only way you
get a heartbeat until you are far enough along for Doppler- and also it's
the only way to make sure the preg. is not ectopic, and to see if it's
higher risk (twins etc). I'm probably preaching to the choir I guess....and
then I consider the second u/s crucial not because they can possibly
determine gender, but because it's L2 and they are checking for things
wrong. I think we have to pay for the 2nd one in full.

I know it's commonly thought that u/s are/should be routine, but that
is not correct. You can date a pregnancy without exposing your baby
to the u/s. The viability argument just isn't valid, either. Your
pregnancy is going to be viable or not. An u/s won't improve that, it
will only cost you money you don't need to spend.

If I were in your place, with a previous healthy, uncomplicated
pregnancy and delivery, I'd opt not to have any u/s. It's an
unnecessary expense.

Nan

Ericka Kammerer wrote:

Not only is it unnecessary without any medical indication,
but it could well turn up spurious information leading to unnecessary
intervention.

In addition, it cannot be assumed that ultrasound is absolutely 100%
safe. *High* doses are known to destroy brain cells. Now, the doses
that have been shown to destroy cells are much higher than the doses
you'd get in a routine ultrasound, and I did not let this put me off my
two ultrasounds, as I wanted the information they could give me. But we
can't be absolutely sure, on current data, of where the safe threshold
is, and I would be very wary of having a 3D ultrasound, since it
involves so much extra in the way of ultrasound dose.


All the best,

Sarah
--
http://www.goodenoughmummy.typepad.com

"That which can be destroyed by the truth, should be" - P. C. Hodgell

Nan wrote:

I know it's commonly thought that u/s are/should be routine, but that
is not correct. You can date a pregnancy without exposing your baby
to the u/s. The viability argument just isn't valid, either. Your
pregnancy is going to be viable or not. An u/s won't improve that, it
will only cost you money you don't need to spend.

Medically, an ultrasound for viability doesn't make a difference to the
outcome. However, I really wouldn't want to be in the situation of
finding out my pregnancy was non-viable only when I was several months
into the pregnancy and had already told people about it. For me, that
would make it far harder to deal with the inevitable sadness of a
non-viable pregnancy. There is no way I'd want to go through that.
Whether that counts as a medical necessity that can be funded by others
is open to debate. But I paid for an ultrasound at the end of my first
trimester in order to establish viability, and, while that may not have
been money I *needed* to spend in the life-or-death sense, it was money
I considered well spent.

Similarly, I would have paid for my mid-pregnancy ultrasound had the
local trust not funded it (they did), because if my baby had had some
defect so severe it wasn't going to survive long after birth, I wanted
to know that and be prepared. Maybe there would be nothing I could *do*
if an ultrasound had shown anencephaly or renal agenesis or the like,
but at least I would know and could start preparing myself, and thinking
about the heartbreaking decision of whether I wanted to continue that
pregnancy to term or not. (Also, if I did carry to term in that
situation, it might affect my decisions in labour - I would be unlikely
to opt for a Caesarean section for fetal distress if I knew the baby
wasn't going to survive anyway.)

On the other hand, I wouldn't really want ultrasounds for reasons that
didn't boil down to "I want to find out whether this baby's going to
live or die so that I can be prepared." I know some people feel the
same way about diagnosing Down's syndrome, and opt for a nuchal fold
ultrasound for that reason. I wouldn't want to do that, because, for
me, Down's falls into the category of "I'll deal with that when and if",
and I wouldn't consider it sufficient reason to expose the baby to the
extra ultrasound. (In fact, Down's is something I would actively prefer
*not* to find out about until after birth, because I would find it
easier to come to terms with Down's in a baby who was already there than
in a hypothetical baby, IYSWIM.)


All the best,

Sarah
--
http://www.goodenoughmummy.typepad.com

"That which can be destroyed by the truth, should be" - P. C. Hodgell

I know it's commonly thought that u/s are/should be routine, but that
is not correct. You can date a pregnancy without exposing your baby
to the u/s. The viability argument just isn't valid, either. Your
pregnancy is going to be viable or not. An u/s won't improve that, it
will only cost you money you don't need to spend.

I think it's a bit more complex than that, the overall results in the
various studies tend to show no benefit, but it's not because it isn't
changing individual outcomes, sometimes it might be the only flag for a
problem with the baby that might change how you do things (there are
numerous things were timing, mode, place etc of delivery can change
outomes, but probably less common than doctors would have us believe),
but that's balanced out by the number of interventions or doing things
differently that cause worse outcomes.

Cheers
Anne

As Ericka has said, the ACOG doesn't recommend routine ultrasound at any
stage in pregnancy. For various reasons I was looking up stuff about
late ultrasound a few weeks ago and found nothing positive about it, if
anything, it worsen outcomes, when 2nd trimester ultrasound comes up
around even. The thing is, these studies look at outcomes, they don't
consider the fact that some people respond differently to the results,
if you'd abort a foetus with a serious defect, then ultrasound as a
screening tool is reasonably valid - as long as you remember it's just
that, a screening tool, not a diagnostic test.

It's very easy to convince yourself of a whole set of finding something
doing something else and the whole thing having a good outcome, all
because of that one ultrasound, but realistically, how many of those
would show no symptoms later, for example you could say "isn't it great
that ultrasound showed placenta previa, so we could do a c-section prior
to labour", but the vast majority of cases of placenta previa will cause
bleeding in the 3rd trimester and even when there isn't, those postive
outcomes will be balanced by the numbers who have marginal placenta
previa, are not followed up by transvaginal ultrasound, don't present
any symptoms, but end up with a c-section (when vaginal delivery would
have been possible) due to the anxiety of the care provider.

So you have to ask yourself several questions about if you have a 20ish
week ultrasound, why you'd be having it, would you abort if certain
anomolies were found? If you would, then you should probably go for the
ultrasound, in conjunction with the AFP test, if you wouldn't then what
other reasons would you have to go for it - Sarah mentioned her own
anxiety, I don't think that's an unreasonable consideration, when the
risk of ultrasound is pretty low (not non existant), but though some
doctors and insurance companies wouldn't see it that was, anxiety is a
medical issue, if mum/dad would have high levels of anxiety without the
ultrasound, particularly after they are fully informed about it, then to
me, that's a good enough reason to go ahead.

However, I do think that late ultrasounds are a pretty bad idea unless
there is a physical indicator to do so. It flags up so many things, such
as potentially big baby, or potentially small baby that lead to early
induction or straight to c-section that there are just too many risks,
it's better not to know. A true IUGR baby will almost always be obvious
from the outside (I had one that was borderline IUGR and even then it
was completely obvious without ultrasound this was the case - though
once it is diagosed ultrasound is a useful tool, not for measureing this
size, but for checking blood flow and determining if early delivery
really is necessary). The position of the baby at a late ultrasound
doesn't have that much bearing on what it actually is when it comes to
the day of the birth and regular examination will pick it up with a
reasonable degree of accuracy and if there is doubt, it often is checked
via ultrasound. Many other emergencies that arise in labour simply
cannot be predicted by ultrasound information.

As to whether you go for the regular one or a 3D one, some have
mentioned that 3D is higher doses, and I think it may go on a little
longer too, but when comparing those doses to the doses from the various
heart rate monitors, I'm pretty sure those are higher still, but only
used for brief periods of time (other than continuous monitoring during
labour - yet another thing that actually harms outcomes, unless there is
clear medical reason for it). I think there may also be little
standardisation as to what dosages are used so you could avoid a 3D one
which is using a low dose than the 2D one you have as an alternative!
The other thing to consider is who does the 3D one, if it's just another
service offered by the same technologist that you'd get a regular one
with and the cost is reasonable, that's a different ball game to having
it from a company who just do the 3D ones and had you a video, even if
they do look for anomolies, they are not likely to be so experienced at
finding them and responding to them, so what you really want is an
experienced technician.

I found this article, I tend to find "Mothering" can be a bit over to
one side of the arguement, but this article seems pretty balanced,
unfortunately the numbers for the footnotes have lost there supertext
formatting, so there are numbers littered through the text and as there
are other numbers included in the text, it doesn't make the reading that
easy - but I think it covers things pretty well. The one thing it
doesn't cover is if you would abort for a non fatal anomoly.

http://www.mothering.com/articles/pr...und-risks.html


Cheers
Anne

Anne Rogers wrote:

I know it's commonly thought that u/s are/should be routine, but that
is not correct. You can date a pregnancy without exposing your baby
to the u/s. The viability argument just isn't valid, either. Your
pregnancy is going to be viable or not. An u/s won't improve that, it
will only cost you money you don't need to spend.

I think it's a bit more complex than that, the overall results in the
various studies tend to show no benefit, but it's not because it isn't
changing individual outcomes, sometimes it might be the only flag for a
problem with the baby that might change how you do things (there are
numerous things were timing, mode, place etc of delivery can change
outomes, but probably less common than doctors would have us believe),
but that's balanced out by the number of interventions or doing things
differently that cause worse outcomes.

Well, I suspect there are getting to be *some* changes
to the equation. The studies I've seen didn't show significant
differences in outcomes, largely because:

- There was or would have been a medical indication for an u/s,
so it would have been found then
- There wasn't anything that could have been done about it anyway
- Even if the condition wasn't detected, it's something that could
be dealt with equally effectively on the fly

There probably is some movement on some of those factors, as
medical advancements allow us to do something about some conditions
prior to birth that couldn't have been done before. This affects
only a very tiny fraction of the population, but it's probably
growing.

Also, while the studies didn't show worsening outcomes,
they *did* show that more pregnancies were terminated with routine
u/s. Therefore, while it may not have affected outcomes, it
apparently *did* affect parents' decision making, in that they
made a decision that didn't affect the ultimate outcome, but
did affect how they went through that process.

So, I think there is probably a very tiny (but perhaps
growing) fraction of cases where outcomes might actually be
improved, and there is a larger group of cases where it might
affect parents' decision making without changing the ultimate
outcome. Then, you weigh that against the small possibility
that u/s could cause some harm that we don't yet understand.
So far, apparently the ACOG comes down on the side of not
doing u/s without an indication, but obviously most members
don't agree, as that recommendation is routinely flouted.
Or, if you're cynical, their bank accounts tip the balance
for at least those who do the u/s in house ;-)

Best wishes,
Ericka

On Jul 13, 3:32 am, "beyond the pale"
wrote:

My husband wants to know do they do 3D u/s at 18-20 weeks. I don't know but
I told him probably not because I don't think the 3D shows any of the
details they scan for to make sure everything is ok, right? I told him we'd
need to just go get the Level II so they can check the heart chambers and
all that..right?

I just wanted to make sure that there is no 3D u/s technology that's being
done in place of the regular Level IIs they do. Then that brings me to one
more question...is there any medical value to a 3D u/s done later in
pregnancy, say 35 weeks or so? I know it's not necessary...and I know it's
mostly done so parents can see what their baby looks like, for
recreation...but I have started to wonder if we chose to pay for one, would
it help even a little? If I have it done late enough, can they use it to
double check and see if they see anything wrong, or to take note of the
baby's position or measure the baby, etc??

Quite apart from any of the other answers, I wouldn't recommend trying
to get a 3D ultrasound late in pregnancy unless it was actually
necessary. When I was pregnant with my last baby I had an ultrasound
at around 33 weeks to check my fluid levels because I thought I'd been
leaking and I'd had the previous baby after spontaneous rupture of
membranes at 33.5w. The ultrasound was done at a specialist foetal
medicine centre and she offered to do a 3D scan since I was there
anyway. It didn't work very well because my baby's head was too far
down in my pelvis to get a good view of her face. The further along
you are the more likely it is that your baby's head won't be very
visible.

Cheryl

"Ericka Kammerer" wrote

There is little
evidence that routine ultrasound leads to better outcomes.


I agree with you; it's, for some reason, the "standard" around here.
Absolutely everyone I've ever encountered gets the same 2 ultrasounds. 8-9
weeks and another at 18-20. I've talked with numerous OBs at 3 different
groups, and they all say that's what they do unless someone declines, and
not many decline. I'm sure someone declines occasionally, but of everyone
I've known to have babies in the past 10 years this is how it is.

It's not that I think it should be this way, or it has to be this way, or is
better this way than not. OBs probably encourage it for the money, to some
extent. I personally feel ok about having 2 u/s, and I might be wrong on
this one but I do feel somehow ...you know, that having the 2 u/s is not
*necessary* but it somehow makes me feel like everything *looks* pretty much
ok. I don't take it as a guarantee or higher probability of things being ok,
but just sort of like "I feel better because I can have a doctor look it
over, and doctors do it routinely". If this makes sense....I do not disagree
with you. But I don't mind the way things are..I just sort of take it as an
assumption that doctors want to schedule 2 ultrasounds.