How will a 20-week ultrasound change what we do?
October 8, 2013 10:58 AM Subscribe
Is there anything that will show up on a fetal anatomical survey that will materially influence what we do for the rest of the pregnancy and/or delivery? We don't care about things like missing fingers or feet, or cleft lips and we don't want to know the child's sex before birth. There's a blood test for spina bifida and the early risk assessment showed a very low risk of chromosomal abnormalities. Can we just skip this ultrasound?
I'm not you, but I would want to know about significant variations (a missing or short arm or leg, a cleft palate) in advance so I could plan ahead to have any supportive services my child would need cued up.
posted by Sidhedevil at 11:05 AM on October 8, 2013 [6 favorites]
posted by Sidhedevil at 11:05 AM on October 8, 2013 [6 favorites]
There are definitely heart abnormalities that will show during the anatomy scan which will absolutely have, if nothing else, an impact on the kind of prenatal care you will need between now and delivery.
Why would you want to skip the anatomy scan? NT scan, sure, whatever floats your boat, but the anatomy scan? There are no real downsides.
Also, talk to your OB, some practices make it mandatory regardless of insurance coverage.
posted by lydhre at 11:05 AM on October 8, 2013 [1 favorite]
Why would you want to skip the anatomy scan? NT scan, sure, whatever floats your boat, but the anatomy scan? There are no real downsides.
Also, talk to your OB, some practices make it mandatory regardless of insurance coverage.
posted by lydhre at 11:05 AM on October 8, 2013 [1 favorite]
What about missing kidneys, organs growing on the outside of the body, major heart defects, ancepheoly? All of those things are very unlikely, but they are things that a 20w ultrasound will find.
posted by peep at 11:06 AM on October 8, 2013 [4 favorites]
posted by peep at 11:06 AM on October 8, 2013 [4 favorites]
Yeah, go, and go together or with someone if possible. Probably it will be fine but if a problem shows up it can be bad. I know someone who was told that there was a major brain-development problem at that scan - turned out ok but still - and someone who was told there was a kidney problem - which is fairly common, and fixable but it's the kind of thing where you would want to deliver the baby in a place with a NICU or where they had the ability to do a corrective surgery.
posted by LobsterMitten at 11:07 AM on October 8, 2013 [1 favorite]
posted by LobsterMitten at 11:07 AM on October 8, 2013 [1 favorite]
Placenta previa is looked for at 20 weeks or later, and would have a major impact on labor and delivery decisions. There are also some fetal defects that, if present, would essentially mean that the baby would be going directly into surgery, or would have a very difficult time during delivery. (An acquaintance's baby had a large ovarian cyst in utero which was putting pressure on her other organs. While it's possible that they would have figured this out eventually without the ultrasound, the parents and medical team were fully prepared.)
I'd say the 20 week ultrasounds' the most important one. Earlier and later ones usually have other ways to get at the same information, or are more for peace of mind.
posted by tchemgrrl at 11:08 AM on October 8, 2013 [11 favorites]
I'd say the 20 week ultrasounds' the most important one. Earlier and later ones usually have other ways to get at the same information, or are more for peace of mind.
posted by tchemgrrl at 11:08 AM on October 8, 2013 [11 favorites]
Have you discussed this with your provider? They can tell you exactly what they'll be looking for. It isn't just superficial stuff. It's things like "is the baby's heart functioning properly?" And "are the organs where they're supposed to be?" And "does the baby have a brain?" And "is the placenta behaving as expected?" At the very least, you can emotionally prepare if there are some abnormalities.
posted by chiababe at 11:10 AM on October 8, 2013 [2 favorites]
posted by chiababe at 11:10 AM on October 8, 2013 [2 favorites]
Four things come to mind:
(1) The anatomy ultrasound will be better at determining whether the child has a chromosomal abnormality like Down Syndrome. Although this may not influence your decision to continue the pregnancy, it would help with mental preparation for you and your partner.
(2) Heart and other defects that can be repaired in utero (at least, so I've heard), or, at the very least, will impact your delivery (making sure you are in the right place in terms of NICU).
(3) Conditions like placenta previa that are almost always very dangerous for mother and baby. You'll want to know about this.
(4) Baby's growth with respect to conditions influenced by your medicine, if applicable - such as the thyroid. This may indicate that you need to take more or less medicine.
I didn't find out the sex, either, and I also debated the anatomy ultrasound. I ended up doing it just to put my mind at ease. Congrats on your baby!
posted by juliagulia at 11:11 AM on October 8, 2013 [1 favorite]
(1) The anatomy ultrasound will be better at determining whether the child has a chromosomal abnormality like Down Syndrome. Although this may not influence your decision to continue the pregnancy, it would help with mental preparation for you and your partner.
(2) Heart and other defects that can be repaired in utero (at least, so I've heard), or, at the very least, will impact your delivery (making sure you are in the right place in terms of NICU).
(3) Conditions like placenta previa that are almost always very dangerous for mother and baby. You'll want to know about this.
(4) Baby's growth with respect to conditions influenced by your medicine, if applicable - such as the thyroid. This may indicate that you need to take more or less medicine.
I didn't find out the sex, either, and I also debated the anatomy ultrasound. I ended up doing it just to put my mind at ease. Congrats on your baby!
posted by juliagulia at 11:11 AM on October 8, 2013 [1 favorite]
I would not personally opt out of ultrasounds. A friend of mine ended up with an emergency C-section as a result of laboring for a very long time with her baby presenting Frank Breach (think taco) because what everyone who felt her belly was certain the baby's head was pointing down. It was actually the baby's butt. The family could have been saved a whole lot of trauma. Another friend of mine DID have to have in utero heart surgery for her baby, which was scary, but the baby is a happy healthy 4 year old now.
The plural of anecdote is not data, but while there may not be much to "gain" in getting an ultrasound, there's a whole lot to lose in not doing it.
So, while the 20 week ultrasound won't tell you about the position of the baby at delivery, it may tell you if the baby has defects that will require surgery immediately after birth. It may also tell you if the baby has other life threatening issues.
posted by bilabial at 11:14 AM on October 8, 2013 [3 favorites]
The plural of anecdote is not data, but while there may not be much to "gain" in getting an ultrasound, there's a whole lot to lose in not doing it.
So, while the 20 week ultrasound won't tell you about the position of the baby at delivery, it may tell you if the baby has defects that will require surgery immediately after birth. It may also tell you if the baby has other life threatening issues.
posted by bilabial at 11:14 AM on October 8, 2013 [3 favorites]
My homebirth midwives required a level II ultrasound in order to plan for a homebirth, if that tells you anything. Every single other test was optional, but not that one.
In addition to placenta previa, which can make a C-section anywhere from a good idea to an absolute necessity, there can be anatomical issues which could necessitate having specialized staff on hand or a C-section, stuff like an omphalocele or kidney reflux or a septal-atrial defect or what have you. And if everything's fine, then hey, you know that too!
posted by KathrynT at 11:17 AM on October 8, 2013
In addition to placenta previa, which can make a C-section anywhere from a good idea to an absolute necessity, there can be anatomical issues which could necessitate having specialized staff on hand or a C-section, stuff like an omphalocele or kidney reflux or a septal-atrial defect or what have you. And if everything's fine, then hey, you know that too!
posted by KathrynT at 11:17 AM on October 8, 2013
We found out that one of our children had an unusually short umbilical cord at the 20 week which allowed us, in conjunction with our doctor(s), to determine a game plan for the birth in case it was too short to deliver vaginally. (Turns out not to have been an issue, but worth knowing about for baby and mother's health.)
posted by JohnnyGunn at 11:19 AM on October 8, 2013
posted by JohnnyGunn at 11:19 AM on October 8, 2013
If you are going to have only one scan during pregnancy, the 20 week scan is the most critical. Do not skip.
posted by tafetta, darling! at 11:22 AM on October 8, 2013 [1 favorite]
posted by tafetta, darling! at 11:22 AM on October 8, 2013 [1 favorite]
My good friend's baby was born with a club foot, which can frequently (but not always) be spotted on ultrasound. She would have preferred to know in advance, because going through labor and delivery and having the second thing out of the doctor's mouth (after "it's a girl") be "call ortho for a consult" was extremely stressful and suddenly they were thrown into a world not just of having a new baby, but of learning all about treatments -- because treatment for club foot begins basically immediately. If they had known in advance, they could have met with the pediatric orthopedist, learned about treatments, known what to expect, and made plans for it. As it was, it was a pretty frantic first couple of weeks with lots of extra doctor's appointments. They would have planned dad's leave time slightly differently, and the grandmas' stays to help with the baby slightly differently. There are also some unique baby clothing and bathing issues when you have a newborn in a cast up to her thigh, so they would have gotten more of certain types of clothes and less of others, and found some of the specialized care tools they needed.
Club feet are a totally minor abnormality these days, about which you can do nothing in utero, and which are generally easily treated upon birth even when you don't know in advance -- and like you, my friends didn't care a BIT how many fingers and toes the baby had as long as she was healthy! (Baby is now 18 months old and if you didn't know she'd had a club foot, you wouldn't know from seeing her.) But my friend has commented several times that they wished they'd had the diagnosis in utero just so they could have learned about the treatment and their first several days with the baby would have been like, "YAY BABY! Oh, and by the way, club foot treatment" instead of "OH MY GOD WHAT IS WRONG WITH MY BABY AND HOW CAN I PROCESS THIS COMPLEX MEDICAL INFORMATION THAT REQUIRES ME TO MAKE CARE DECISIONS ABOUT A NEWBORN I JUST MET TWO HOURS AGO AFTER THIRTY HOURS OF LABOR AND WHEN CAN I EVER SLEEP AGAIN AAAAAAAAAAAH?"
posted by Eyebrows McGee at 11:29 AM on October 8, 2013 [19 favorites]
Club feet are a totally minor abnormality these days, about which you can do nothing in utero, and which are generally easily treated upon birth even when you don't know in advance -- and like you, my friends didn't care a BIT how many fingers and toes the baby had as long as she was healthy! (Baby is now 18 months old and if you didn't know she'd had a club foot, you wouldn't know from seeing her.) But my friend has commented several times that they wished they'd had the diagnosis in utero just so they could have learned about the treatment and their first several days with the baby would have been like, "YAY BABY! Oh, and by the way, club foot treatment" instead of "OH MY GOD WHAT IS WRONG WITH MY BABY AND HOW CAN I PROCESS THIS COMPLEX MEDICAL INFORMATION THAT REQUIRES ME TO MAKE CARE DECISIONS ABOUT A NEWBORN I JUST MET TWO HOURS AGO AFTER THIRTY HOURS OF LABOR AND WHEN CAN I EVER SLEEP AGAIN AAAAAAAAAAAH?"
posted by Eyebrows McGee at 11:29 AM on October 8, 2013 [19 favorites]
I found out at a 20 week ultrasound that the fetus I was carrying had no brain and only a rudimentary brain stem. If I carried to term (which was unlikely,) the baby would have died within hours or days of being born.
There is no treatment anencephaly. However, the window for late term abortions for insurmountable defects such as these is very, very short. You need to find out as soon as possible.
posted by headspace at 11:30 AM on October 8, 2013 [24 favorites]
There is no treatment anencephaly. However, the window for late term abortions for insurmountable defects such as these is very, very short. You need to find out as soon as possible.
posted by headspace at 11:30 AM on October 8, 2013 [24 favorites]
My homebirth midwives required a level II ultrasound in order to plan for a homebirth, if that tells you anything. Every single other test was optional, but not that one.
This was my experience also. I had a very, very, very low intervention pregnancy and delivery (in a birth center (by choice) vs than at home), and the 20 week ultrasound was pretty much the only test my midwife insisted on.
posted by anastasiav at 11:37 AM on October 8, 2013 [1 favorite]
This was my experience also. I had a very, very, very low intervention pregnancy and delivery (in a birth center (by choice) vs than at home), and the 20 week ultrasound was pretty much the only test my midwife insisted on.
posted by anastasiav at 11:37 AM on October 8, 2013 [1 favorite]
I came in to say placenta previa as well. I had a pretty hippie midwife and like KathrynT the ultrasound was the one thing she really did emphasize she wanted to see before proceeding with a (potential) home birth. I would not have decided to terminate the pregnancy due to anything I found, and I skipped the genetic screening and such, but physical abnormalities are something I would absolutely want to know and prepare for in advance regardless.
posted by celtalitha at 11:40 AM on October 8, 2013
posted by celtalitha at 11:40 AM on October 8, 2013
At the 20 week sonogram the doctor thought my son had Trisomy 13, 18 (he didn't, a follow-up sonogram showed everything was fine). That's something we would have very much wanted to know about before birth, and not just for emotional reasons.
posted by The corpse in the library at 12:19 PM on October 8, 2013
posted by The corpse in the library at 12:19 PM on October 8, 2013
It's also an incredibly beautiful experience. I saw every tiny detail of my son's body, the veins and arteries moving blood to and from his kidneys, the folds in his brain, each chamber of his heart. He became much more of a specific person rather than an abstract "baby" to me at that moment and I'll remember it always.
posted by judith at 12:44 PM on October 8, 2013 [7 favorites]
posted by judith at 12:44 PM on October 8, 2013 [7 favorites]
It's less about changing what you do about the things you don't care about, than being aware of them, if they are an issue, and having the time and opportunity to become informed about how those things might impact what you need to account for and to gather any useful resources for understanding/better handling those outcomes. Does there need to be a surgery shortly/immediately after birth, how does caring for an infant with cleft lip/Down Syndrome/what not differ from what you know about caring for an infant without those features, etc.
The first few months after birth are complicated and exhausting enough, and some of the issues that can be spotted early by ultrasound give you the opportunity to not fly by the seat of your pants anymore than you absolutely have to already.
posted by susanbeeswax at 2:31 PM on October 8, 2013 [3 favorites]
The first few months after birth are complicated and exhausting enough, and some of the issues that can be spotted early by ultrasound give you the opportunity to not fly by the seat of your pants anymore than you absolutely have to already.
posted by susanbeeswax at 2:31 PM on October 8, 2013 [3 favorites]
I found out that my fetus had a 100% fatal defect at the 20-week scan. Whether or not you would terminate the pregnancy, this is the kind of thing you will probably want to know about ahead of time for preparatory reasons.
posted by feathermeat at 2:41 PM on October 8, 2013 [6 favorites]
posted by feathermeat at 2:41 PM on October 8, 2013 [6 favorites]
judith: "It's also an incredibly beautiful experience. I saw every tiny detail of my son's body, the veins and arteries moving blood to and from his kidneys, the folds in his brain, each chamber of his heart."
Quoted for truth. Forgive me for waxing poetic, but you know those moments you have when you're staring up at the stars and you're suddenly struck by the immensity of the universe and your brain turns inside out? When we had the 20-week ultrasound and I saw my son's tiny four-chambered heart beating in perfect synchrony, I was absolutely overcome with awe at the majesty of the universe -- the millions of years of evolution that created this marvelous machine that is the four-chambered heart, the hundreds of years of human ingenuity that created the marvelous machine that is the ultrasound, and all of it in service of this wholly human, wholly animal task of creating new life. My throat closed up and tears were running down my face and I felt this incredible moment of grace and wonder that I had the privilege of life in such an amazing universe.
BELLY RADAR THAT CAN SEE ALL FOUR CHAMBERS OF A FETAL HEART BEATING IN SEQUENCE, MAN. WE LIVE IN THE FUTURE.
posted by Eyebrows McGee at 3:58 PM on October 8, 2013 [8 favorites]
Quoted for truth. Forgive me for waxing poetic, but you know those moments you have when you're staring up at the stars and you're suddenly struck by the immensity of the universe and your brain turns inside out? When we had the 20-week ultrasound and I saw my son's tiny four-chambered heart beating in perfect synchrony, I was absolutely overcome with awe at the majesty of the universe -- the millions of years of evolution that created this marvelous machine that is the four-chambered heart, the hundreds of years of human ingenuity that created the marvelous machine that is the ultrasound, and all of it in service of this wholly human, wholly animal task of creating new life. My throat closed up and tears were running down my face and I felt this incredible moment of grace and wonder that I had the privilege of life in such an amazing universe.
BELLY RADAR THAT CAN SEE ALL FOUR CHAMBERS OF A FETAL HEART BEATING IN SEQUENCE, MAN. WE LIVE IN THE FUTURE.
posted by Eyebrows McGee at 3:58 PM on October 8, 2013 [8 favorites]
We're currently in the NICU for a premature birth, but our baby had a roommate for a day, one with a Diaphragmatic Hernia.
The baby was brought in for breathing problems, and then they figured out what the real problem was, and had to urgently run all their lines, etc., at the NICU bed. If the OB had known about this problem ahead of time, the NICU team would have been ready in the delivery room, rather than being surprised by this emergency. Further, they probably would have recommended delivering at the Level 4 NICU at the affiliated children's hospital, rather than having the baby transferred there after the fact. There was a question of that baby needing ECMO, which is something they can't do at this NICU.
posted by chengjih at 4:14 PM on October 8, 2013 [3 favorites]
The baby was brought in for breathing problems, and then they figured out what the real problem was, and had to urgently run all their lines, etc., at the NICU bed. If the OB had known about this problem ahead of time, the NICU team would have been ready in the delivery room, rather than being surprised by this emergency. Further, they probably would have recommended delivering at the Level 4 NICU at the affiliated children's hospital, rather than having the baby transferred there after the fact. There was a question of that baby needing ECMO, which is something they can't do at this NICU.
posted by chengjih at 4:14 PM on October 8, 2013 [3 favorites]
I definitely recommend a 20-week scan to all my patients, for all the reasons that other comments have been mentioning, but just to play devil's advocate, there's also the possibility of picking up something called a soft marker, which is basically one of a set of ultrasound findings that might be a sign of a serious condition, but might not (15% of normal fetuses have one or more of these). Finding these can cause undue anxiety and fear of the unknown, especially since most of the time they end up being red herrings and the fetus is just fine.
posted by greatgefilte at 5:33 PM on October 8, 2013
posted by greatgefilte at 5:33 PM on October 8, 2013
Response by poster: Thank you all for your answers! We'll get the ultrasound.
posted by santry at 6:54 PM on October 8, 2013 [6 favorites]
posted by santry at 6:54 PM on October 8, 2013 [6 favorites]
This thread is closed to new comments.
posted by roomthreeseventeen at 11:04 AM on October 8, 2013 [10 favorites]