My doctors are pushing me to take the 5-month sonogram…
Question:
They say there is a lot that they can prepare for if Chas V’Sholom something is wrong.
My friends are being told that it is okay to take it.
You have told us in the past to take a sonogram only if necessary. Can I take it? Also wondering what the source is, so I can explain to them my decision.
Dr. told me it’s been done for at least 40 years and there is no radiation, it is just sound waves like a regular Doppler.
Answer:
There are several issues with a sonogram, primary among them is the medical concern. The Rebbe was of the position that routine sonograms could potentially be harmful Chas V’Sholom to the fetus. Never mind, some in the medical field also question the idea of routine sonograms and its potential effect on the baby’s health.
I’m referring to mainstream medical organizations (Chocrane; American Pregnancy association; AIUM; ACOG, Etc. See below). All agree that it should not be done for non-medical reasons, conceding somewhat that there could be some potential risk.
Medically, most experts – who are mainstream – admit that there is no tangible benefit from regular ultrasound in a low-risk pregnancy. The study of Chocrane (one of the largest in the analysis of all the various studies in an objective manner) is particularly noteworthy. Although acknowledging that up to date studies have not demonstrated that there are negative results from ultrasound, they suggest not to use it unless there is a definitive medical cause. This is more applicable with regards to the usage of a Doppler – which in their opinion is more serious and may have negative results.
Thus:
A. There are no serious studies to date that have actually demonstrated a serious risk of ultrasound.
At the same time, recently there are those who contend with this premise – see here. Not everything written there must be taken at face value, but there are there many links to recent studies.
B. There are no serious studies that show a real benefit in ultrasound in low-risk pregnancy.
Another point to note: while fetal ultrasound in humans has never been shown to cause harm, nearly all research supporting its safety was conducted using equipment made before 1992, when the procedure produced about one-eighth the acoustic energy it is allowed to emit today and when fetal-ultrasound scanning was far less frequent.
As to the the claim that in certain cases it is defined as useful – is not medically relevant at all, because in terms of the laws of probability (statistics) in order to recommend a specific invasive test, a defined amount of benefit must be specified in a defined percentage of the population. See also שיעורי תורה לרופאים 4:149 a letter from DR. Snuani that the percentage is very small where something can be done.
As for the claim that by examination it is possible to identify whether the pregnancy is of high risk – this is indeed the issue they studied. These studies reached the conclusion that even if this the case:
- Sometimes there may be other tests to verify the level of risk.
- Additionally, there is little practical benefit even if there is a risk.
- Moreover, in some cases there were errors in the examination that caused other complications.
- It was not proven that measures were taken that would not have been taken had it not been for the examination. And so forth.
It is also known that there are many false positives that may have far reaching consequences results as well as false negatives which can cause the same.
Moreover, regarding using the doppler – which is more severe than ultrasound, see details below – Chocrane has shown that there is some possibility of a certain risk.
Nonetheless, rumor has it that in the fifth month, or the second trimester, the Rebbe allowed it if the doctor insists and the women really wishes to do it. (Hiskashrus 440). When Nshei in EY pressed the Rebbe on this matter, the Rebbe directed them to Rabbonim in EY and told them to stop asking him repeatedly. There are other people that testified similarly about receiving positive answers from the Rebbe in cases where the doctor said it was necessary. However, I don’t wish to take the acharayus for any of this.
References:
Here is a quote from APA:
There is not a recommended number of ultrasounds that should be performed during routine prenatal care. Because ultrasound should only be used when medically indicated, many healthy pregnancies will not require ultrasound. The average number of ultrasounds varies with each healthcare provider. Additional ultrasounds might be ordered separately if your healthcare provider suspects a complication or problem related to your pregnancy.
And from ACOG:
Currently, there is no reliable evidence that ultrasound is harmful to a developing fetus. No links have been found between ultrasound and birth defects, childhood cancer, or developmental problems later in life. However, it is possible that effects could be identified in the future. For this reason, it is recommended that ultrasound exams be performed only for medical reasons by qualified health care providers.
And Cochrane Database Syst Rev. 2010 Aug 4; (8):CD001450. doi: 10.1002/14651858.CD001450.pub3):
Existing evidence does not provide conclusive evidence that the use of routine umbilical artery Doppler ultrasound, or combination of umbilical and uterine artery Doppler ultrasound in low-risk or unselected populations benefits either mother or baby.
The U.S. Food and Drug Administration stated in December 2014:
“Ultrasound can heat tissues slightly, and in some cases, it can also produce very small bubbles (cavitation) in some tissues . . the long-term effects of tissue heating and cavitation are not known.”
Doppler:
The handheld device that doctors and midwives routinely use to hear the heartbeat is commonly called a “doppler” or a “dop-tone.” This device uses a relatively low level frequency of ultrasound technology. Concerns about ultrasound technology primarily focus on the potential for increasing heat in the uterine environment, a phenomenon which has been proven to occur, although it is unclear how much exposure over how much time is required to reach a level which may pose a danger to the fetus. Dop-tones are typically used for less than a minute at a prenatal visit, and thus exposure is assumed to be minimal.
The dop-tone is distinct from spectral or color doppler, however, which is sometimes used to examine blood flow in the course of an ultrasound examination. This type of technology uses a higher frequency and thus poses a higher potential for risk to the fetus. The International Society for Ultrasound in Obstetrics and Gynecology issued a statement in 2011 that “Pulsed Doppler (spectral, power and color flow imaging) ultrasound should not be used routinely.”
The amount of time color doppler is used during a given exam will vary depending on the preferences of the sonographer and the goals of the exam. For example, doppler studies are commonly performed in cases of existing or suspected intrauterine growth restriction (IUGR). In some complex cases, these studies are essential to leading to the best outcome for mother and baby. However, as mentioned above, this should be reserved for specific situations.
Any woman having an ultrasound can certainly discuss with her provider and/ or sonographer whether color doppler will be used, and if so the rationale for its use.
In this way, women may be able to reduce their baby’s unnecessary exposure.
Aiken CE, Lees CC. Long-term effects of in utero Doppler ultrasound scanning–a developmental programming perspective. Med Hypotheses. 2012 Apr;78(4):539-41. doi: 10.1016/j.mehy.2012.01.030. Epub 2012 Feb 10. PMID: 22325988.
Salvesen, K., Lees, C., Abramowicz, J., Brezinka, C., Ter Haar, G., Maršál, K. and (2011), ISUOG statement on the safe use of Doppler in the 11 to 13 +6-week fetal ultrasound examination. Ultrasound Obstet Gynecol, 37: 628-628. https://doi.org/10.1002/uog.9026
(Links for above citations)
https://obgyn.onlinelibrary.wiley.com/doi/10.1002/uog.9026
https://pubmed.ncbi.nlm.nih.gov/22325988/
See also:
Halacha2go.com article #63: Ultrasound
https://www.ynet.co.il/articles/0,7340,L-3288532,00.html
ראה בארוכה שיעורי תורה לרופאים ד סימן רלא-ב.
במענה ה׳ טבת תשמ״ט, נדפס גם בליקוט מענות מילואים ע׳ 11, לגב׳ חנה סגל עבור נשי ובנות חב״ד כפר חב״ד: כהוראת רבנים באה״ק ובודאי לא תשאלנה עוד הפעם ועוד הפעם. אזכיר על הציון.
בחשש תאומים – ראה ליקוט מענות תשמ״ו מענה רסט (לחיוב). תשנ״ב שעט (לשלילה. אבל שם בתחילת ההריון, ולא הי׳ נוגע למעשה אז, כתובן המענה).
וראה ליקוט מענות מילואים ב ע׳ 87 מענה מי״ט שבט תשמ״ז, במצב שהרופאים אומרים שהכרחי לבדוק פעמיים בהריון ואין שום ספק סכנה: [שסימן בעיגול התיבות] ״ולפי דבריהם זה הכרחי [והוסיף] א״כ יעשו כן״. וראה ליקוט מענות תשל״ח ע׳ 35.
#1134
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