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*~Sofia~*
07-23-2007, 06:38 PM
salams all

i had a question: are muslim women allowed to carry out an ultrasound on theirr unborn child during their pregnancy? and are they allowed to find out the gender of the unborn baby?

ive always been told that it's not allowed.. but i always thought this was untrue..

does anyone know if it's allowed or not? and why? maybe have some evidence to support their answer?

would be very much appreciated :D
jazakallah in advance!

wasalams
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جوري
07-23-2007, 06:50 PM
I can't imagine why it wouldn't be allowed?
I am not an Islamic scholar, but will tell you this much.. Allah indeed will ask us of our health as it is one of the gifts he bestowed upon us... An ultrasound is crucial in every pregnancy to find out everything from Polyhydramnios and Oligohydramnios to Placenta Previa & Placenta Accreta, to Uterine leiomyomas which could potentially grow in pregnancy, to the position of the baby if you have a breech baby it might warrent a c/section.. as a matter of fact it is one of the single greatest inventions we have in medicine... if someone tells you it is haram please let them bring forth the proof.. as for the sex of the baby which is really a very ancillary finding, some parents like to be surprised while others like to prepare ahead of time, it is a matter of preference... there is much utility for that machine irregardless of finding out the sex of the baby, I think no woman should go throughout her pregnancy without it... Imagine carrying a dead baby for a few days, and not knowing about it, do you know of the ramifications of that?.. I can write volumes of the benefits of that machine but I believe you get the pic insha'Allah...
Everybody is a grand mufti, even when giving advise of harm-- sob7an Allah

:w:
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*~Sofia~*
07-23-2007, 07:14 PM
^^ jazakallah sister, what you say is true, that's what i was thinking too. but when i heard people saying it was not allowed i was quite confused!
jazakallah for replying to the thread sis :thumbs_up:

wasalam
x
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جوري
07-23-2007, 07:41 PM
People can say whatever they want.. I don't think anyone should speak out of ignorance.. that is why we ask ahel il3ilm.. and I have admitted that I am not an Islamic scholar in the beginning of my post... but I don't think I need to be.. I know there is a hadith about necessity overriding even almo7ramat (forbidden) pls don't take my word for that.. perhaps bros. Qatada can share the hadith with us..
even in suret al-baqara when Allah forbids us from certain things he says
إِنَّمَا حَرَّمَ عَلَيْكُمُ الْمَيْتَةَ وَالدَّمَ وَلَحْمَ الْخِنزِيرِ وَمَا أُهِلَّ بِهِ لِغَيْرِ اللّهِ فَمَنِ اضْطُرَّ غَيْرَ بَاغٍ وَلاَ عَادٍ فَلا إِثْمَ عَلَيْهِ إِنَّ اللّهَ غَفُورٌ رَّحِيمٌ {173}
[Pickthal 2:173] He hath forbidden you only carrion, and blood, and swineflesh, and that which hath been immolated to (the name of) any other than Allah. But he who is driven by necessity, neither craving nor transgressing, it is no sin for him. Lo! Allah is Forgiving, Merciful. ..

And these are actual harmful things.. let alone things of actual use which have so much potential in preserving the well being of the mother and the child...
I personally am very grateful for the advances in modern science women used to die in child birth for trivial reasons, things that we have a better handle on today.. just two centuries ago in Vienna there was a 20% mortality rate post partum (women who gave birth) just because the doctors didn't wash their hands...
So whomever tells you whatever, let them bring their proof or keep silent..
:w:
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Dynasty
07-25-2007, 07:08 PM
Ultra sound is defenitly not haram.
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asiya45
08-20-2007, 09:59 PM
:sl:
Is finding out the gender of the baby is that Haram ??
i was told it was:?
:w:
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S_87
08-20-2007, 10:04 PM
:sl:

^^ i found this on islamqa

We put this question to Shaykh Muhammad ibn Saalih al-‘Uthaymeen, may Allaah preserve him, who answered as follows:

There is nothing wrong with that, unless it involves great expense. It could be said that it is a waste of money because there is no need to know the or sex of the baby except for the purposes of merely feeling happy because one knows whether it is a boy or a girl. If finding out could not be achieved without spending a lot of money then it is a waste of money and is not permitted. And Allaah knows best.
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Pk_#2
08-20-2007, 10:06 PM
That is a sensible reason :D
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جوري
08-20-2007, 10:52 PM
format_quote Originally Posted by asiya45
:sl:
Is finding out the gender of the baby is that Haram ??
i was told it was:?
:w:
ultrasound is very cheap... compared to other tests one can run for instance Karyptyping, amniocentesis, or Chorionic villus sampling, there are of course others much more invasive and more expensive. an Ultra Sound is a must for every pregnant woman to ensure her well being and that is of her baby's... the test is simply not done just to look at the sex of the child, in fact many would rather not be told and surprised at the time of delivery, others simply want to prepare in advance ( I can't imagine a harm in wanting to know how to prepare a room or what clothes to buy) but it certainly not the most pressing call, when you are measuring Nuchal folds, head circumference, place of implentation, placental or fetal anamolies, or positioning, I am sure the baby's sex though an ancillary finding will be noted out as well. This is not luxury testing I assure you! I can't imagine why some people want to make life so difficult? but that is just me!
:w:
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ravenous
08-21-2007, 04:24 AM
This is an interesting discussion because there has recently been controversy in the medical community as to the validity and necessity of the ultra sound. It is considered by some to be an expense that can be foregone, since it's been proven to be of dubious accuracy. Others insist that is a valid tool and and a necessity to the health of both mother and child.

The primary reason of the ultrasound, is not, as ambrosia points out, to reveal gender, but to assess the growth and health of the baby. You will find that in the first ultrasound, the technician will take numerous measurements, particularly of the head and the curvature of the spine. another purpose is to ensure that the baby's digits are forming in a normal fashion.

While it is true that we must always refer to the scholars when we are in doubt, Allah has blessed us with intellect which there is no harm in using. In Islam, it is known that we do our utmost to preserve life and prevent harm to the innocent. That being said, there is no harm towards the baby or the mother by the ultrasound. In fact, it can be an indicator of health, and source of comfort and security to the mother. Many mothers describe it as their first experience of bonding with their child, fathers as well find it to be an uplifting experience. And in a religion that promotes the closeness and strength of the family, there is certainly no problem with that.

In some communities in the UK, the gender of the baby is not revealed during an ultrasound because of the unfortunate cultural practice of preferring baby boys over baby girls, and the fear that a revelation of the birth of a girl may lead some women to abort or bring on miscarriage. This unfortunate preference for males has been refuted many times by Allah and his Messenger (SAW) and I don't need to go into detail on that. Nonetheless, this is a valid reason for the gender of the baby not to be revealed. If there is a fear of such, it is best to advise against revealing or asking about gender.

It is interesting to note how many ultrasounds have been proven wrong. I myself was told that my baby was dangerously small in the last trimester, based on ultrasound reports, and my baby was a very healthy weight, masha Allah tabaarakAllah. Subhanallah, It is true when Allah says that is only He who knows what is concealed in the womb, and it is He who chooses what to reveal of it to us, even with the eye of science.

Wallahu 'aalam
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جوري
08-21-2007, 04:47 AM
an Ultra sound is not the most accurate (sensitivity) or (specificity) wise, but it is the least harmful of other methods I mentioned.. It isn't meant as helpful tool not a diagnostic or preventative in many cases, sort of like a road map and not just to the womb as that isn't the only useage of a US... certainly it can only be as little as 20% accurate in such cases as placental abruption.. hopefully a clinician relies on his critical judgement and the clinical presentation of the patient.. but an ultra sound will be with us for a very long time I suspect of all the sophisticated machines we have this still has the lowest risk of harm to either mother or child!
:w:
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syilla
08-21-2007, 05:16 AM
When i was pregnant, i was asked to be a model for their ultrasound for their phd students.

and i was paid rm50 for it :D and got free hampers and gifts.

I did it three times excluding my own ultrasound. and now my son is lefthanded...
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Al-Zaara
08-21-2007, 12:55 PM
format_quote Originally Posted by syilla
When i was pregnant, i was asked to be a model for their ultrasound for their phd students.

and i was paid rm50 for it :D and got free hampers and gifts.

I did it three times excluding my own ultrasound. and now my son is lefthanded...

So? :? What has any of what you said to do with your son being left-handed, sis?
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syilla
08-21-2007, 01:04 PM
i'm not sure whether is being proven but someone told too much ultrasound will affect the brain wave and make the child lefthanded.

but left handers tend to use both side of their brain so its kinda good too.
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*~Sofia~*
08-21-2007, 01:45 PM
format_quote Originally Posted by asiya45
:sl:
Is finding out the gender of the baby is that Haram ??
i was told it was:?
:w:
salam sister,

yeh this is what i have been told too, but im not sure about it's authenticity.
sorry wasn't much help!

w'salam :)
Reply

*~Sofia~*
08-21-2007, 01:47 PM
salams,

yeh i guess there's nothing wrong with being left-handed, both my brother and cousin are left-handed. the only trouble they have with it, is that my cuz sometimes accidently eats with her left hand :X
havn't really heard bout ultrasound affecting the brain..

w'salam
Reply

جوري
08-21-2007, 03:11 PM
format_quote Originally Posted by syilla
i'm not sure whether is being proven but someone told too much ultrasound will affect the brain wave and make the child lefthanded.

but left handers tend to use both side of their brain so its kinda good too.
:confused: I'd love to see research on that ;D.. I think people go to great length to make up stories unfortunately I am not sure for what purpose?... there is no affect on brain or any other part of the body whatsoever that has been reported in a reputable medical journal.. 10% of the population is left handed.. it doesn't mean they use both brains, it just means the dominant lobe of their brain is the right one, where as for most of us it is the left..the left and right hemispheres have designated different functions, just depends on which hemisphere is dominant-- there are 2% who are ambidextrous and get to use both hands with the same dexterity.. simply because they weren't born with a corpus callosum which is a longitudal fissure that connects the left and right cerebral hemispheres.. obviousely it isn't good to lose it later on in life, when born that way there is no problem, if lost due to a space occupying lesion or whatever, there are serious ramifications.. but an ultra sound has no affect whatsoever on which hand is the dominant hand.. these are all just variations.. variety is the spice of life :okay:
:w:
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syilla
08-22-2007, 01:10 AM
I found this...

it seems what i've been told is true :uuh:

http://www.newscientist.com/article.ns?id=dn1670

The results suggest that some men who genetically would have been expected to be born right-handed had actually grown up to be left-handed. Kieler says this could be due to a disruption of their brain development in the womb: "It's commonly known among neuropsychiatrists that right-handed people can become left-handed by slight damage to the brain."
From wikipedia

Ultrasound theory: A popular theory is that ultrasound scans may affect the brain of unborn children, causing higher rates of left-handedness in mothers who have ultrasound scans compared to those who do not. This is probably based on a few studies [12][13] where this relation is studied. In one of these the authors claim that "...we found a possible association between routine ultrasonography in utero and subsequent non-right handedness among children in primary school." However later in the same article the authors state that "Thus the association ... may be due to chance" and "The result was not significant, suggesting that the study had insufficient statistical power to resolve the relationship between ultrasonography and subsequent left handedness in the child"
12“Routine ultrasonography in utero and subsequent handedness and neurological development”, K.A. Salvesen, L.J. Vatten, S.H. Eik-Nes, K. Hugdahl, L.S. Bakketeig, British Medical Journal, Vol. 307, 1993,159-64.
13“Routine ultrasound screening in pregnancy and children’s subsequent handedness.” H. Kieler, O. Axelsson, B. Haglund, S. Nilsson, K.A. Salvesen, Early Human Development, Vol. 50, 1998, 233-45.
My next pregnancy i think i'm interested in the 3D ultrasound (don't mind me, i'm just dreaming, guess i'm never going to learn).

Anyway, on the using both of the sides of the brain, what i meant was the artistic (creativity) and science skills. I remember once when i'm in the university taking art class as an elective, my lecturer told us start the class by drawing our face using our left hand. :hmm: which of course will turn to be a beautiful abstract design.

When i said, the lefthanders tend use both side of their brains, this is because they are forced to use utensils or tools that are only suitable for the right handers. For example scissors, fridge or door handler.

Connections between the left and right hand sides or hemispheres of the brain are faster in left-handed people, a study in Neuropsychology shows.

The fast transfer of information in the brain makes left-handers more efficient when dealing with multiple stimuli.

Experts said left-handers tended to use both sides of the brain more easily.

Study leader Dr Nick Cherbuin from the Australian National University measured transfer time between the two sides of the brain by measuring reaction times to white dots flashed to the left and right of a fixed cross.

This seems to go with evidence that left-handers use both sides of the brain for language
Dr Steve Williams


He then compared this with how good participants were at carrying out a task to spot matching letters in the left and right visual fields, which would require them to use both sides of the brain at the same time
source

But i'm right handed and mostly too lazy to use my left hand.
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جوري
08-22-2007, 01:44 AM
Most doctors will argue the only way you can cause any harm to someone's brain from an ultra sound is to hit the patient with it on the head!
NS and especially not wikipedia aren't reliable nor reputed journals when it comes to health care...
Allah knows best!
:w:
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syilla
08-22-2007, 02:11 AM
but did any of the doctors do a research on it?

maybe this is much a reliable source

http://aapgrandrounds.aappublication...nt/16/6/65.pdf
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جوري
08-22-2007, 02:43 AM
here is the latest research as of 2007
Indications for diagnostic obstetrical ultrasound examination
Jeffrey L Ecker, MD
Michael F Greene, MD



UpToDate performs a continuous review of over 375 journals and other resources. Updates are added as important new information is published. The literature review for version 15.1 is current through December 2006; this topic was last changed on December 29, 2006. The next version of UpToDate (15.2) will be released in June 2007.

INTRODUCTION — Ultrasound imaging has dramatically changed the practice of obstetrics by enabling visualization of the fetus and fetal environment. In the United States and many other countries, ultrasound is a routine component of prenatal care.

The degree to which ultrasound improves pregnancy care and outcome is controversial and depends upon whether the procedure is used as a diagnostic or screening test. As a diagnostic procedure, ultrasound is used to address defined clinical questions and helps to make or exclude diagnoses suggested clinically (eg, placenta previa in a gravida with vaginal bleeding). As a screening test, ultrasound is employed in low-risk patients to identify pregnancies that might benefit from further testing or intervention (eg, karyotype or termination for an unsuspected fetal anomaly). The use of sonography as a screening tool is reviewed separately. (See "Routine prenatal ultrasonography as a screening tool").

An overview of diagnostic obstetrical ultrasound examination will be presented here. Specific topics are discussed in depth within individual topic reviews on each subject.

DIAGNOSTIC ULTRASOUND — A consensus development workshop convened by the National Institute of Child Health and Human Development in 1984 concluded there were over two dozen indications for ultrasonography during pregnancy [1]. This list is shown in the table, with the addition of a few updated indications from the American College of Radiology (show table 1) [1,2].

Nonmedical use of obstetric ultrasonography, such as to provide "baby pictures" or videos for parents or to determine fetal sex when there is no medical indication for this knowledge, has been discouraged by both the American College of Obstetricians and Gynecologists (ACOG) and the American Institute of Ultrasound in Medicine (AIUM) [3]. These organizations are concerned that nonmedical ultrasound examinations can be misinterpreted by patients and could be falsely concerning or falsely reassuring.

Components of a basic examination

  First trimester — The goals of the first trimester examination are to [4]: Confirm the presence of an intrauterine (or evaluate suspected extrauterine) pregnancy Determine if fetal cardiac activity is present Assess gestational age Determine whether a multiple gestation is present, and its chorionicity/amnionicity Evaluate maternal pelvic organs for congenital or acquired abnormalities.

  Second or third trimester — A basic second or third trimester ultrasound examination, which will suffice for most patients, provides the following information [4,5]: Fetal number Fetal presentation Documentation of fetal cardiac activity, including heart rate Placental location Assessment of amniotic fluid volume Fetal biometry for assessment of gestational age and weight Survey of fetal anatomy (show table 2) Evaluation of maternal pelvic organs

There are several methods of amniotic fluid volume assessment, which are discussed elsewhere. (See "Assessment of amniotic fluid volume").

In addition, the American College of Radiology has recommended that the cervix and lower uterine segment be imaged in every second trimester examination to look for funneling or a short cervix [6], although the clinical utility of such evaluation in a general population remains controversial. (See "Prediction of prematurity by transvaginal ultrasound assessment of the cervix").

The AIUM also recommends visualization of the umbilical cord, its insertion site in the fetal abdomen, and evaluation of the number of cord vessels, when possible [4].

When fetal abnormalities are detected, a more detailed or comprehensive examination by a sonologist with training in evaluating such pregnancies is indicated.

Limited ultrasound examinations can be performed to address specific questions in patients who have been previously evaluated by a complete examination. Examples of appropriate use of limited studies include confirmation of the presence or absence of fetal cardiac activity, checking fetal presentation, and assessment of amniotic fluid volume in conjunction with nonstress testing.

Procedure — (See "Ultrasound examination in obstetrics and gynecology: Procedure").

Safety — (See "Physics and safety of diagnostic ultrasound in obstetrics and gynecology").

FIRST TRIMESTER BLEEDING — Vaginal bleeding complicates approximately 20 to 40 percent of early pregnancies. The major differential diagnoses of bleeding during this period of pregnancy are related to ectopic pregnancy and spontaneous abortion. Gestational trophoblastic disease is also a consideration. (See "Overview of the etiology and evaluation of vaginal bleeding in pregnant women").

Suspected ectopic pregnancy — Ectopic implantation, most commonly in the fallopian tube, occurs in 1.6 percent of all pregnancies and is a significant cause of maternal morbidity and mortality. An untreated tubal pregnancy can result in tubal rupture with potentially life threatening hemorrhage; thus, clinicians should always have a high index of suspicion for this entity whenever a woman presents with bleeding and/or abdominal pain early in gestation. (See "Incidence, risk factors, and pathology of ectopic pregnancy").

A woman rarely has both an intrauterine and concomitant extrauterine gestation (ie, heterotopic pregnancy 1/30,000 spontaneous conceptions), therefore the identification of an intrauterine pregnancy effectively excludes the possibility of an ectopic in almost all cases. However, pregnancies conceived with assisted reproductive technology are an exception, since the incidence of heterotopic pregnancy may be as high as 1/100 to 1/3000 pregnancies [7]. (See "Incidence, risk factors, and pathology of ectopic pregnancy", section on Heterotopic pregnancy).

The combined use of transvaginal sonography of the uterus/adnexa and serum hCG levels allows a definitive diagnosis in the vast majority of cases at a very early stage, when there is a high likelihood of successful conservative (medical) treatment.

The clinical manifestations and diagnosis of ectopic pregnancy are discussed in detail separately. (See "Clinical manifestations, diagnosis, and management of ectopic pregnancy", section on Diagnostic evaluation).

Suspected spontaneous abortion — Bleeding early in pregnancy may also be due to a threatened, missed, incomplete, or complete spontaneous abortion. Fifteen to 30 percent of recognized pregnancies end in early pregnancy loss; ultrasound can help in diagnosis of such losses. (See "Spontaneous abortion: Risk factors, etiology, clinical manifestations, and diagnostic evaluation", section on Ultrasonography).

ESTIMATION OF GESTATIONAL AGE — Ultrasound is used to estimate gestational age and thereby calculate the expected date of delivery (EDD). Sonographic estimation may be particularly important when menses are irregular, the LMP is unknown, or in patients conceiving while taking oral contraceptive pills. Ultrasound may also establish a pregnancy's duration when the uterine size estimated on physical examination differs from that predicted by menstrual dating. Some causes for a discrepancy between the actual uterine size and that expected by LMP include uterine fibroids, uterine malposition (eg, retroverted uterus), and multiple gestation. Use of ultrasound examination to assess gestational age is discussed in detail separately. (See "Prenatal assessment of gestational age and fetal weight").

MULTIPLE GESTATION AND ZYGOSITY — Ultrasound is indicated to establish the number and zygosity of fetuses when multiple gestation is suspected. Assisted reproductive technology, family history of twins (or higher multiples), and uterine size larger than that expected by menstrual dating are risk factors for multiple gestation. The number of fetuses can be clearly established by visualizing the number of fetal poles with distinct cardiac activity. An image that includes a cross-section of all fetal poles within a single frame should be obtained to reduce the possibility that a fetus will be counted more than once if it is imaged from a different angle.

Establishing the zygosity of such pregnancies is more difficult, but should be performed because monochorionic multiple gestations pose special risks that may require expert management during pregnancy. Sonographic signs that can be used to help determine amnionicity and chorionicity include counting the number of fetal yolk sacs, determining fetal sex, assessing placental position and separation, and evaluating the presence and appearance of any inter-twin membranes [8-11]. (See "Antepartum assessment of twin gestations", section on Amnionicity and chorionicity).

CONGENITAL ANOMALIES — Fetal anatomy is generally best evaluated by ultrasound examination between 16 and 24 weeks of gestation. Some anomalies are best visualized near the end of this range while others can be identified even earlier; it may be possible to document normal or abnormal structures in the first trimester, but fetal size and development limit optimal visualization. Transvaginal imaging may be useful if early visualization is needed either because a patient is at increased risk for an anomaly or because transabdominal images suggest an abnormality. Later in pregnancy, fetal position and movement, maternal abdominal scars or obesity, and abnormalities in amniotic fluid volume may pose technical limitations to anatomic evaluation.

Structural abnormalities that can be reliably diagnosed by an ultrasound examination include hydrocephalus, anencephaly, myelomeningocoele, dwarfing syndromes, spina bifida, omphalocele, gastroschisis, duodenal atresia and fetal hydrops, cleft lip, clubfoot, many urinary tract and renal abnormalities, and a variety of congenital cardiac abnormalities (see individual topic reviews).

First trimester ultrasonic markers for chromosomal abnormalities such as increased fetal nuchal translucency are used together with serum analytes to help with detection of Down syndrome fetuses. (See "The sonographic diagnosis of fetal aneuploidy" and see "First trimester screening for Down syndrome and trisomy 18").

Ultrasound may be able to identify congenital abnormalities in pregnancies in which either exposure to teratogens, a family's medical history, or prenatal screening tests raise specific concerns for an anomaly. As an example, the risk of recurrence for Meckel Gruber Syndrome is as high as 25 percent; the diagnosis should be suspected prenatally if there is sonographic visualization of occipital cephalocele, bilateral polycystic kidneys, and/or post-axial polydactyly.

The performance characteristics of ultrasound for detecting congenital abnormalities varies depending upon the specific anatomic defect, the gestational age at the time of the procedure, the skill of the ultrasonographer, and whether the population is at high or low risk for anomalies [12-15].

The routine use of ultrasound for screening low risk populations for fetal anomalies is discussed separately. (See "Routine prenatal ultrasonography as a screening tool", section on Detection of congenital anomalies).

SECOND AND THIRD TRIMESTER BLEEDING — The major placental causes of second and third trimester bleeding are placenta previa and abruptio placentae. Other obstetrical causes of bleeding in late pregnancy include cervical change associated with cervical insufficiency, rupture of membranes, or labor and vasa previa.

Placental localization — An obstetric ultrasound examination to identify placental location is useful in pregnancies in which there is second or third trimester bleeding (show ultrasound 1). Transvaginal technique to visualize the cervix and placental edge can be performed safely even when placenta previa is present and may provide detailed images important in making a diagnosis of placenta previa [16]. (See "Placenta previa and vasa previa", section on Ultrasonography).

Abruptio placentae — Placental separation (ie, abruptio placenta) is another cause of bleeding in late pregnancy. It may be associated with uterine pain, painful contractions, coagulopathy, abdominal trauma, hypertension, or use of cocaine. The diagnosis of placental abruption is primarily based upon the presence of characteristic clinical manifestations and the absence of a placenta previa on ultrasound examination. Sonographic evaluation will detect placental separation in only 30 percent of abruptions that are either suspected clinically or later recognized on pathologic examination of the placenta [17]. Therefore, a normal ultrasound examination should not change a clinical diagnosis of abruption. (See "Clinical features and diagnosis of abruptio placentae", section on Sonography).

Placenta accreta — Ultrasound may be of value for predicting the presence of placenta accreta, increta, or percreta [18]. Uterine scarring resulting from prior surgery such as cesarean section, myomectomy, or treatment of Asherman syndrome are risk factors for abnormal placentation. Visualization of a clear border between the placenta and the underlying myometrium suggests that the placenta has not invaded to or beyond the myometrium. In contrast, an indistinct border between the chorion and the myometrium is suggestive of a placenta that has grown through the myometrial wall into surrounding visceral structures. Occasionally, placental tissue can be seen growing directly into the adjacent bladder. This information is important in planning an approach to operative delivery. (See "Diagnosis and management of placenta accreta", section on Ultrasonography).

ASSESSMENT OF FETAL WEIGHT — Investigators have developed several formulas using a variety of sonographically obtained biometric measurements (eg, head circumference, femur length, abdominal circumference, cerebellar diameter, subcutaneous adipose tissue) to estimate fetal weight in the late second and the third trimester. In general, most formulas focus on measurement of biparietal diameter and abdominal circumference. Fetal weight estimates obtained from these equations are then compared to distributions normalized for gestational age and, ideally, a patient's individual ethnic background. However, all such formulas have a large range of error in estimation of fetal weight.

Techniques for sonographic estimation of fetal weight are discussed in detail separately. (See "Prenatal assessment of gestational age and fetal weight").

Intrauterine growth restriction — Fetal growth limiting disorders are more likely when the uterine size is less than appropriate for gestational age, a prior pregnancy has been affected by growth restriction, or in the presence of maternal risk factors such as hypertension. Ultrasound is employed to diagnose fetal growth restriction and to assess growth in pregnancies with multiple gestations, as these fetuses are at risk for growth restriction late in pregnancy and are difficult to assess by physical examination.

A sonographic finding of a physically small fetus does not distinguish those fetuses that are constitutionally small from those that are pathologically so (eg, from uteroplacental insufficiency). It is useful to know the etiology of the growth disturbance since some problems are progressive and likely to benefit from close monitoring and possible early intervention. Decreased amniotic fluid volume, a lower than expected amount of interval growth, and evidence of abnormal blood flow through the umbilical cord (Doppler flow studies) can increase the positive predictive value of a diagnosis of utero-placental insufficiency [19].

Clinicians should be circumspect about making the diagnosis of growth restriction when gestational age is uncertain. While it may be tempting in such cases to conclude that the menstrual dating is in error, particularly if other testing such as amniotic fluid volume and umbilical artery Doppler studies are normal, practitioners should treat such fetuses as possibly growth restricted and obtain fetal surveillance and follow-up ultrasound examinations, as indicated.

The sonographic diagnosis of fetal growth delay is discussed in detail separately. (See "Fetal growth restriction: Diagnosis").

Macrosomia — Ultrasound examination can also be unreliable in estimating fetal weight at the upper percentile for gestational age. The value of obtaining ultrasound examination for suspected macrosomia has been widely debated in the obstetric literature [20]. Decision analysis examining the utility of ultrasound for the prediction of macrosomia in the general obstetric population argues that it is neither clinically useful (sensitivity 60 percent, specificity 90 percent), nor cost effective [21]. (See "Fetal macrosomia: Diagnosis").

However, there may be some patients in whom the risk for birth trauma due to macrosomia is so great that intervention based upon the sonographic diagnosis of macrosomia may be appropriate. Many practitioners, as an example, offer prophylactic cesarean delivery to women with diabetes in whom sonographic estimation of fetal weight is greater than 4500 grams or women without diabetes in whom the estimated weight is greater than 5000 grams [22]. (See "Diagnosis and management of pregnancies at risk for shoulder dystocia").

ASSESSMENT OF FETAL WELL-BEING — The goals of antepartum fetal assessment are to avoid unnecessary interventions (especially preterm delivery) when the fetus appears to be healthy and to facilitate timely intervention when the fetal status is not reassuring, and thereby reduce morbidity/mortality.

There are a number of situations in which ultrasound is used alone or in combination with other tests (eg, nonstress test) to assess fetal well-being. Some examples of these situations include: Fetal conditions such as congenital anomalies, suspected infection, or hydrops fetalis Intrauterine growth restriction Maternal medical conditions such as diabetes mellitus, chronic hypertension, renal disease, hemoglobinopathy, collagen vascular disease, and antiphospholipid syndrome Oligohydramnios Complications of pregnancy such as bleeding or preeclampsia Decreased fetal movement Postterm pregnancy Isoimmunization

The urgency and frequency of testing depends upon the underlying condition. The advantage of sonography over antepartum fetal heart rate testing is that it provides information about fetal growth and amniotic fluid volume, parameters of particular importance when uteroplacental insufficiency is suspected.

Biophysical profile — The biophysical profile (BPP) refers to the sonographic assessment of four fetal parameters: fetal breathing motion, fetal activity, fetal muscular tone, and amniotic fluid volume (show table 3). Each parameter is scored by the sonographer with either zero or two points. A reactive nonstress test is often incorporated as an additional two point measurement, making a score of 10 the maximum possible points in the panel (normal score is 8 to 10). This series of measurements was selected, in part, because they are easily obtained by ultrasound examination and they mirror subsequent postnatal evaluation of neonatal well-being, such as Apgar scores. (See "The fetal biophysical profile").

Modified biophysical profile — The modified BPP was developed to simplify the examination and reduce the time necessary to complete testing by focusing on those components of the profile that are most predictive of outcome. Assessment of amniotic fluid volume and nonstress testing appear to be as reliable a predictor of longterm fetal well-being as the full BPP [23]. A normal modified biophysical profile will occur in 90 percent of pregnancies tested, thus it is necessary to proceed with a full biophysical evaluation in only a minority of patients [24]. (See "The fetal biophysical profile", section on Modified biophysical profile).

Doppler velocimetry — Fetal well-being may also be assessed by measuring umbilical artery blood flow via Doppler velocimetry. The underlying principle for such measurements is that fetuses with placental vasculopathy will demonstrate decreased umbilical artery flow during fetal diastole due to increased resistance (or high impedance) in fetal villus vessels. Umbilical artery flow is described quantitatively as the quotient of systolic/diastolic flow or by using other similar ratios. (See "Doppler ultrasound of the umbilical artery for fetal surveillance").

Doppler flow studies are especially useful in pregnancies complicated by growth restriction. (See "Fetal growth restriction: Evaluation and management").

Doppler measurement of flow in the fetal middle cerebral artery is a reliable substitute for more invasive measurements of fetal anemia [25]. (See "Diagnosis and management of Rhesus (Rh) alloimmunization", section on Doppler velocimetry).

Evaluation of cardiovascular status by arterial Doppler alone is inadequate in fetal disorders with impaired cardiac function since cardiac function is not accounted for in arterial waveform analysis. Extending Doppler ultrasound assessment to the fetal venous circulation overcomes this limitation. (See "Venous Doppler for fetal assessment").

HYDROPS FETALIS — Hydrops fetalis refers to the accumulation of fluid in fetal tissues or body cavities (eg, skin edema, ascites, pleural or pericardial effusions). It is the end result of a number of immune and nonimmune mediated fetal pathologic conditions. Serial ultrasound examinations appear to be useful for following pregnancies at risk for developing hydrops or to evaluate the effects of treatment on the course of the disorder. (See "Nonimmune hydrops fetalis").

DETERMINATION OF FETAL PRESENTATION AND POSITION — Fetal presentation, the part of the fetus overlying the maternal cervix, is easily determined by ultrasound examination. Practitioners may suspect a noncephalic presentation based upon physical examination (Leopold maneuvers) (show figure 1), a history of uterine anomaly, or palpation of the fetal breech or extremity at the time of cervical examination. Recognition of a breech presentation prior to labor is valuable, in part, because external cephalic version decreases the number of noncephalic presentations at term and the number of cesarean deliveries performed for this indication [26]. (See "Approach to breech presentation").

The position of the fetus (eg, occiput posterior) can also be determined sonographically. Studies have consistently shown that ultrasound examination of fetal position is more accurate than vaginal or abdominal examination [27-30]. As an example, one study assessed fetal presentation clinically and by ultrasound in 1633 nonlaboring women with singleton pregnancies at 35 to 37 weeks of gestation [31]. Ultrasonography identified noncephalic presentation in 130 women (8 percent); the sensitivity of clinical examination for detecting noncephalic presentation was 70 percent (95%CI 62-78) and specificity was 95 percent (95%CI 94-96). (See "Abnormal labor: Protraction and arrest disorders", section on Occiput posterior position).

EXAMINATION OF THE CERVIX — The cervix may be imaged and its length measured using ultrasound. Transvaginal technique is recommended to improve accuracy and reproducibility of such measurements [32]. The appearance of the amniotic membranes in relation to the internal cervical os and endocervical canal may also be evaluated. Membranes that protrude through an opened internal os are described as funneling. Both a short cervix and the presence of funneling on second and early third trimester ultrasound examination are associated with an increased risk of preterm delivery. (See "Prediction of prematurity by transvaginal ultrasound assessment of the cervix").

Routine ultrasound measurement of cervical length is not recommended in asymptomatic or otherwise low-risk women, at least in part because no intervention has been proven to improve maternal or fetal outcome in women in whom cervical ultrasound demonstrates an increased risk for preterm delivery. Cervical length measurement may be more useful in the evaluation and management of women who present with symptoms of preterm labor (eg, deciding if risk of preterm delivery is such that admission, tocolysis or treatment with betamethasone are appropriate). Other screening tools (eg, fetal fibronectin) and or physical examination may also be useful in evaluating such patients. (See "Tests for prediction of preterm labor and delivery").

EXAMINATION OF OTHER PELVIC ORGANS AND STRUCTURES — Ultrasound is a safe and effective imaging modality for evaluating abdominal organs during pregnancy. As an example, ovarian cysts that either predate pregnancy or are discovered at the time of an obstetrical ultrasound examination can be followed to exclude rapid growth or an appearance worrisome for malignancy. As another example, the myometrium can be examined to identify uterine leiomyoma in women with unusual pelvic pain or uterine size greater than that expected by menstrual dates [33]. In addition, abdominal ultrasound examination can be used to evaluate pregnant women for multiple medical or surgical problems such as appendicitis, renal obstruction, and gallbladder or liver disease and is generally preferable to studies using ionizing radiation. (See individual topic reviews).

ULTRASOUND AS AN ADJUNCT TO INVASIVE PROCEDURES — Real-time ultrasound imaging allows experienced practitioners to guide needles, catheters, and other instruments into the fetus or adjacent structures for diagnosis or treatment. Some examples of sonographically guided procedures are listed in the table (show table 4). (See individual topic reviews on these procedures).


Use of UpToDate is subject to the Subscription and License Agreement. REFERENCES 1.  US Department of Health and Human Services. Diagnostic ultrasound in pregnancy. National Institutes of Health publication number 84-667. National Institutes of Health, Bethesda, Maryland 1984. Available online at: consensus.nih.gov/cons/041/041_statement.htm.
2.  American College of Radiography. www.acr.org. (Accessed 3/7/05).
3. ACOG Committee Opinion #297: Nonmedical Use of Obstetric Ultrasonography. Obstet Gynecol 2004; 104:423.
4.  American Institute of Ultrasound in Medicine. AIUM Standards and Guidelines. www.aium.org/provider/standards/standards.asp (Accessed 3/7/05).
5.  ACOG Practice Bulletin #58: Ultrasonography in Pregnancy. Obstet Gynecol 2004; 104:1449.
6.  Expert Panel on Women's Imaging. Premature cervical dilatation. American College of Radiology, Reston, Virginia 1999. www.acr.org/dyna/?id=appropriateness_criteria.
7. Molloy, D, Deambrosis, W, Keeping, D, et al. Multiple-sited (heterotopic) pregnancy after in vitro fertilization and gamete intrafallopian transfer. Fertil Steril 1990; 53:1068.
8. Bromley, B, Benacerraf, B. Using the number of yolk sacs to determine amnionicity in early first trimester monochorionic twins. J Ultrasound Med 1995; 14:415.
9. Barss, VA, Benacerraf, BR, Frigoletto, FD Jr. Ultrasonographic determination of chorion type in twin gestation. Obstet Gynecol 1985; 66:779.
10. Sepulveda, W, Sebire, NJ, Hughes, K, et al. Evolution of the lambda or twin-chorionic peak sign in dichorionic twin pregnancies. Obstet Gynecol 1997; 89:439.
11. Filly, RA, Goldstein, RB, Callen, PW. Monochorionic twinning: sonographic assessment. AJR Am J Roentgenol 1990; 154:459.
12. VanDorsten, JP, Hulsey, TC, Newman, RB, Menard, MK. Fetal anomaly detection by second-trimester ultrasonography in a tertiary center. Am J Obstet Gynecol 1998; 178:742.
13. Vintzileos, AM, Ananth, CV, Smulian, JC, et al. Routine second-trimester ultrasonography in the United States: A cost-benefit analysis. Am J Obstet Gynecol 2000; 182:655.
14. Yagel, S, Achiron, R, Ron, M, et al. Transvaginal ultrasonography at early pregnancy cannot be used alone for targeted organ ultrasonographic examination in a high-risk population. Am J Obstet Gynecol 1995; 172:971.
15. Garne, E, Loane, M, Dolk, H, et al. Prenatal diagnosis of severe structural congenital malformations in Europe. Ultrasound Obstet Gynecol 2005; 25:6.
16. Leerentveld, RA, Gilberts, EC, Arnold, MJ, Wladimiroff, JW. Accuracy and safety of transvaginal sonographic placental localization. Obstet Gynecol 1990; 76:759.
17. Nyberg, DA, Cyr, DR, Mack, LA, et al. Sonographic spectrum of placental abruption. AJR Am J Roentgenol 1987; 148:161.
18. Finberg, HJ, Williams, JW. Placenta accreta: Prospective sonographic diagnosis in patients with placenta previa and prior cesarean section. J Ultrasound Med 1992; 11:333.
19. Lin, CC, Sheikh, Z, Lopata, R. The association between oligohydramnios and intrauterine growth retardation. Obstet Gynecol 1990; 76:1100.
20. Sandmire, HF. Whither ultrasonic prediction of fetal macrosomia?. Obstet Gynecol 1993; 82:860.
21. Rouse, DJ, Owen, J, Goldenberg, RL, Cliver, SP. The effectiveness and costs of elective cesarean delivery for fetal macrosomia diagnosed by ultrasound. JAMA 1996; 276:1480.
22.  American College of Obstetricians and Gynecologists. Fetal macrosomia. ACOG practice bulletin no. 22, American College of Obstetricians and Gynecologists, Washington, DC 2000.
23. Nageotte, MP, Towers, CV, Asrat, T, Freeman, RK. Perinatal outcome with the modified biophysical profile. Am J Obstet Gynecol 1994; 170:1672.
24. Miller, DA, Rabello, YA, Paul, RH. The modified biophysical profile: antepartum testing in the 1990s. Am J Obstet Gynecol 1996; 174:812.
25. Mari, G, Deter, RL, Carpenter, RL, et al. Noninvasive diagnosis by Doppler ultrasonography of fetal anemia due to maternal red-cell alloimmunization. Collaborative Group for Doppler Assessment of the Blood Velocity in Anemic Fetuses. N Engl J Med 2000; 342:9.
26. Hofmeyr, GJ, Kulier, R. External cephalic version for breech presentation at term. Cochrane Database Syst Rev 2000; :CD000083.
27. Chou, MR, Kreiser, D, Taslimi, MM, et al. Vaginal versus ultrasound examination of fetal occiput position during the second stage of labor. Am J Obstet Gynecol 2004; 191:521.
28. Kreiser, D, Schiff, E, Lipitz, S, et al. Determination of fetal occiput position by ultrasound during the second stage of labor. J Matern Fetal Med 2001; 10:283.
29. Akmal, S, Kametas, N, Tsoi, E, et al. Comparison of transvaginal digital examination with intrapartum sonography to determine fetal head position before instrumental delivery. Ultrasound Obstet Gynecol 2003; 21:437.
30. Sherer, DM, Miodovnik, M, Bradley, KS, Langer, O. Intrapartum fetal head position II: comparison between transvaginal digital examination and transabdominal ultrasound assessment during the second stage of labor. Ultrasound Obstet Gynecol 2002; 19:264.
31. Nassar, N, Roberts, CL, Cameron, CA, Olive, EC. Diagnostic accuracy of clinical examination for detection of non-cephalic presentation in late pregnancy: cross sectional analytic study. BMJ 2006; 333:578.
32. Andersen, HF. Transvaginal and transabdominal ultrasonography of the uterine cervix during pregnancy. J Clin Ultrasound 1991; 19:77.
33. Bernhard, LM, Klebba, PK, Gray, DL, Mut
here are all the uses of an ultra sound each its own huge page.. I believe it will be with us for a long time, it is one of the safest and most effective methods for correctly diagnosing many a disorders
• Ultrasound
• Ultrasound contrast agents
• Ultrasound enhanced thrombolysis
• Ultrasound guided compression repair
• Ultrasound therapy
• Ultrasound thrombolysis, Coronary
• Ultrasound, 3 D
• Ultrasound, Abdominal
• Ultrasound, Bone
• Ultrasound, Brachial artery
• Ultrasound, Breast
• Ultrasound, Cardiac
• Ultrasound, Carotid duplex
• Ultrasound, Color Doppler
• Ultrasound, Complete lower extremity duplex
• Ultrasound, Compression
• Ultrasound, Continuous wave Doppler
• Ultrasound, Contrast cardiac
• Ultrasound, Contrast hepatic
• Ultrasound, Cranial
• Ultrasound, Doppler
• Ultrasound, Doppler (Doppler echocardiography)
• Ultrasound, Ductus venosus doppler
• Ultrasound, Endorectal
• Ultrasound, Endoscopic
• Ultrasound, Fetal venous Doppler
• Ultrasound, Hepatobiliary
• Ultrasound, High frequency catheter endoscopic
• Ultrasound, Hydrocolonic
• Ultrasound, Intracoronary
• Ultrasound, Intraductal
• Ultrasound, Intraoperative
• Ultrasound, Joint
• Ultrasound, Jugular vein
• Ultrasound, Kidney
• Ultrasound, Laparoscopic
• Ultrasound, Ocular
• Ultrasound, Ophthalmic
• Ultrasound, Orbital
• Ultrasound, Pancreatic
• Ultrasound, Parathyroid
• Ultrasound, Pelvic
• Ultrasound, Prenatal
• Ultrasound, Pulsed Doppler
• Ultrasound, Scrotal
• Ultrasound, Secretin
• Ultrasound, Thyroid
• Ultrasound, Transcranial Doppler
• Ultrasound, Transmission
• Ultrasound, Transvaginal
• Ultrasound, Vascular
• Ultrasound Screening Study, Serum Urine and
:w:
Reply

syilla
08-22-2007, 03:02 AM
Wow... no wonder they have courses just to be a radiologist.

Is there any research on the risk of using the ultrasound?
Reply

جوري
08-22-2007, 03:24 AM
compared to many other tests avaliable this is the safest, no risk attributed can be anything more or less than chance alone.. the same way many people tend to think that vaccinating their child with MMR is related to Autism, they just happen to coincide around the same time-- but people whose children are affected really can't find a way to understand the rise in autism, and want to blame it on the vaccines, in fact the American Academy of pediatric is being challanged in court right now.. people will present their evidence and the case is likely to be thrown out as is usually the outcome.. 10% of the population will be left handed, I am sure their mothers had sonogram, but you will seldom find a pregnancy that has gone through without a sonogram (US) unless the mother didn't receive any medical attention, and they have perfectly right handed people.. plus prior to the US people were born left handed anyway like beethoven he is the one I can think off, the top of my head now, so those are what you'd call confounders.. you don't know if it happened due to chance alone or due to a sonogram.. the way I look at it, is will the benefits outweigh the risk? the answer is yes.. a thousand complication can be found and aided through the use of this machine.. having a lefy child is hardly a catastrophe so, I mean the choice is ultimately up to the mother...

BTW radiographic technicians and radiologists are two seperate career paths, a radiologist is a medical doctor and will have to go to medical school and then complete a five year residency after s/he is done with the 8 years of medicine.. and a very difficult residency to get into here in the unites states.. only the elite few get it.. I know it sounds shocking but they are even better thought of than suregeons.. in their branch of medicine there is Diagnostic Radiology, Interventional Radiology, Therapeutic Radiology... some of the most delicate procdures that surgeons can't perfom are done by them with their ultra high tech machines-- it is a surprise that most people tend to think the on floor doctor the most sophsiticated type, but in fact pathologists, anesthesiologists and radiologist are some of the most difficult career paths in medicine and the most sophisticated.. but I think that health is the greatest gift of all, if you never have to meet with any of those three types of doctors, it is probably a very good sign =)

:w:
Reply

Woodrow
08-22-2007, 09:58 PM
format_quote Originally Posted by PurestAmbrosia
Most doctors will argue the only way you can cause any harm to someone's brain from an ultra sound is to hit the patient with it on the head!
NS and especially not wikipedia aren't reliable nor reputed journals when it comes to health care...
Allah knows best!
:w:
I agree with that. The sound used in an ultrasound scan is at such a low amplitude and for such a short duration I would suspect that an unborn baby receives a much higher dosage every time the mother is near a telephone ringing or any other sound for that matter.
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