Are routine scans necessary in pregnancy?

Ultrasound scans in pregnancy have become almost routine as part of antenatal care. Affordability and availability also continue to improve. Ultrasound scanning technology has evolved over time, and 2D imaging is slowly being overtaken by 3D and 4D imaging. Fetal images obtained with modern machines are so real that a blur now exists between scanning for medical reasons, and purely as a fad.

Couples should be aware of the most important times to have a scan. The very first scan is advised at about 11 to 13 weeks of pregnancy. This is referred to as a booking scan, and is useful in dating the pregnancy and also detailing the nature of twins if a multiple pregnancy is found. Some abnormalities can picked this early, and other interventional measures advised. In the presence of bleeding or pain very early in pregnancy, it’s advisable to have a scan at the earliest opportunity, but usually after 6 weeks. Such a scan confirms the location of the pregnancy, and if it is viable. Very early scans may sometimes be inconclusive. In such cases, and if the mum is stable, there’s hardly any reason for rushed interventions. A blood test to check the pregnancy hormone level can give additional information, and repeating the scan in another two weeks usually clarifies the situation.

The next important scan is referred to as ‘anomaly screening’, recommended between 18 and 22 weeks of the pregnancy. This is a detailed scan that aims to identify any developmental abnormalities in the fetus. Majority of babies will not have any abnormalities. But if any abnormalities are identified, specific plans for subsequent care can be made. Or if the degree of abnormalities was deemed incompatible with life, couples can choose to terminate the pregnancy on medical grounds.

In uncomplicated pregnancies, further scans do not add value to care and decision making. The cost of such routine and unnecessary scans can add up to huge bills, and contribute to the rise in medical insurance premiums. Any subsequent scans should be on a selective basis, and for specific Obstetric reasons. Pregnancies complicated by high blood pressure, diabetes or poor fetal growth are among some of the reasons why serial scans become necessary for more objective monitoring.

The quality of scanning in pregnancy is paramount to aiding decision making. Pregnancy scans must be done by qualified and certified individuals. And the ultrasound machines must be of good quality, antiquated machines generate very poor images. Ultrasound misinterpretations and misdiagnoses can lead to misdirected interventions and unwanted pregnancy outcomes. Couples must ask questions about the quality of ultrasound services in the facilities they attend, and if the scanner is certified. If a scan is offered at every antenatal visit, this should always be followed by questions. Is it necessary, and at what cost?