Overview

Ultrasounds have revolutionized prenatal care, and it is incredible that we have technology that allows us to see a baby inside the womb. Ultrasound technology began with 2D black-and-white pictures and has advanced to include 3D, 4D, and even 5D images and video. While prenatal care providers sometimes use 3D ultrasounds, most are elective ultrasounds for parents to see their baby and get keepsake images and videos. While this has become popular, the medical community has raised concerns about elective ultrasounds. Learn about 3D ultrasounds, the evidence on safety, potential risks, and tips for making an informed decision.

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Transcript and Resources

Your podcast has been a tremendous help to me throughout my pregnancy, and I recommend it to everyone. I’m currently 28 weeks, and I really want to get a 3D ultrasound so I can see my baby and have a 3D picture before they’re born. However, my doctor doesn’t offer 3D ultrasounds in her office and has advised against unnecessary ultrasounds, so now my husband thinks it’s a bad idea too. I’m feeling torn because I still want to go for it. Are 3D ultrasounds safe and what are the downsides? Thank you so much for your help.

-Emilia

3D, 4D, and 5D Ultrasounds

Ultrasound technology has come a long way since it was first invented in the 1950s. An ultrasound emits sound waves at a specific frequency and captures the returning echoes. Depending on their density, different tissues, fluids, and structures reflect waves at varying speeds. A computer converts the reflected sound wave patterns into visual images. The image created is called a sonogram, and although the terms ultrasound and sonogram are technically different, they are often used interchangeably.

A standard ultrasound exam generates a 2D sonogram; this is the traditional flat, black-and-white picture. A 3D Ultrasound combines multiple images from different angles to create a still, 3D image. This shows more depth and detail and is colored using software or editing. A 4D ultrasound is similar to 3D but includes real-time motion, so you see a live video of your baby moving in 3D. Some elective ultrasound clinics are now offering 5D ultrasounds. Despite the name, 5D ultrasounds don’t add another dimension beyond 4D. 5D images are higher quality and more realistic and detailed. These are marketed as a way to see an even more lifelike view of your baby.

The Purpose of 3D and 4D Ultrasounds

A doctor or midwife could recommend a 3D ultrasound for more detailed images than a standard 2D ultrasound. This could include assessing things like fetal anomalies or further investigating something discovered on a 2D ultrasound. You can request a picture if you get a medically indicated 3D ultrasound.

Most 3D ultrasounds are not prescribed by a doctor and are elected by parents to see pictures of their baby and get keepsake photos. There is a lot of appeal in 3D, 4D, or even 5D ultrasounds. You get to see a somewhat realistic view of your baby’s appearance before birth. It is fun to see whose facial features they have or compare whether your baby looks more like mom or dad. For many parents, seeing their baby is reassurance that they are okay and healthy. Some parents find this helps them bond with their baby. Plus, you can take home pictures or videos to add to your baby book or share with friends and family.

Ultrasound Safety 

Ultrasounds have an excellent safety record. They have been used in obstetrics for decades with no proven harmful effects. The consensus is that an ultrasound is a non-invasive procedure that, when used properly, has not demonstrated fetal harm. However, the long-term effects of repeated ultrasound exposure on the fetus are not fully known. 

Some cautions regarding the use of ultrasound come from animal research. Some animal studies have linked ultrasounds to adverse outcomes. One study found fetal exposure to diagnostic ultrasound can alter typical social behaviors in young mice that may be relevant for autism. Another animal study has shown that ultrasound can cause damage to developing fetal and neonatal tissues.

We know ultrasound has the potential to heat tissues. Therapeutic ultrasound harnesses the thermal effects to increase blood flow, relax muscles, or relieve pain. Therapeutic ultrasound can also stimulate tissues through the pressure from the sound waves and cavitation (formation and collapse of tiny gas bubbles). Heating tissues can be used therapeutically, but it can also be an unintended side effect when performing an ultrasound for imaging purposes.

Guidance from Professional Organizations

The general consensus in the medical community is against the use of elective ultrasounds. The American Institute of Ultrasound in Medicine advocates the responsible use of diagnostic ultrasound and strongly discourages the nonmedical use of ultrasound. The use of ultrasound without a medical indication to view the fetus, obtain images of the fetus, or identify the fetal external genitalia is inappropriate and contrary to responsible medical practice.

The FDA states ultrasound waves can heat the tissues slightly. In some cases, it can also produce small pockets of gas in body fluids or tissues (cavitation). The long-term consequences of these effects are still unknown. Because of the particular concern for effects on the fetus, organizations such as the American Institute of Ultrasound in Medicine have advocated prudent use of ultrasound imaging in pregnancy. Furthermore, the use of ultrasound solely for non-medical purposes, such as obtaining fetal ‘keepsake’ videos, has been discouraged. Keepsake images or videos are reasonable if they are produced during a medically indicated exam and if no additional exposure is required.

The American College of Obstetricians and Gynecologists states that currently, there is no 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 healthcare professionals.

These guidelines set by organizations like the AIUM, FDA, and ACOG are likely why your doctor discouraged getting a 3D ultrasound.

Making an Informed Decision

Like any decision during pregnancy, this is a matter of weighing the risks and benefits to make the right decision for you. While the general consensus is that elective 3D ultrasounds are discouraged, the risks are not fully known. It is one thing to have a one-time elective ultrasound and another to do this multiple times during your pregnancy. Risks likely increase with increased exposure and you may want to elect for a shorter session to limit your exposure. As for the benefits, you need to consider how much of a benefit this experience is for you and how important it is for you to have those keepsake photos.

Talk to Your Doctor or Midwife

I love that you brought this up with your doctor, and you can always ask them for more information or have another discussion. Ultimately, it would be ideal to have your care provider on board, but you do have the option to go against their advice. It is also great that your partner is invested in making decisions with you. I would have another conversation with your doctor and your partner and be open to hearing their concerns. You should also advocate for yourself if this is something that is important to you. I hope you can come to a decision that you are confident in.

Tips for 3D Ultrasounds

If you do decide to move forward with getting a 3D ultrasound, I would explore all of your options and choose a reputable business. You can seek out a company whose sonographers are registered by the American Registry for Diagnostic Medical Sonographers or the American Institute of Ultrasound in Medicine. You should know that health insurance does not cover elective ultrasounds since they are not deemed medically necessary. The good news is that they are relatively inexpensive, with packages generally ranging between $100-200. I would prioritize a company with a good reputation over saving money.

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