Should ultrasound scanning in pregnancy be routine?

Abstract

In the face of inconclusive evidence of the clinical benefits of routine obstetric ultrasound, a number of claims have been made about the psychological impact of the procedure. The Royal College of Obstetricians and Gynaecologists Working Party on Ultrasound Screening for Fetal Abnormalities reported in 1997 that the objectives of a routine ultrasound scan include 'psychological support'. This structured review of the literature, however, demonstrates, firstly, that there is no experimental evidence supporting the hypothesis that 'seeing the baby' on a real-time scan precipitates maternal-fetal attachment, and secondly, that attenuated anxiety and stress following ultrasound examination are likely to reflect increased anxiety in anticipation of the procedure rather than reassurance. Furthermore, although it is widely believed that ultrasound may promote the adoption of health recommended behaviours, no trial to date has shown significant decreases in maternal smoking attributable to maternal visualization of the fetus. There is, however, compelling evidence of the positive value women attach to being able to see the fetus on a real-time scan and this is enhanced by supportive interaction with the operator. Practitioners and decision makers should be wary of over-interpreting enjoyment of a procedure as evidence of its therapeutic power.