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Ultrasound in Obstetrics and Gynecology

s this safe for my baby?” is a question almost everyone performing obstetric scans has heard. The answer that most will give is, “Of course, it is.” This may, in fact, be the correct answer. However, in most cases, this response is more intuitive than based on the examiner’s knowledge. Book chapters on ultrasound safety and bioeffects are largely ignored, and sessions on the subject at medical meetings are attended almost exclusively by “aficionados” and rarely by large numbers of end users. Although it is true that no known human epidemiologic data exist to show any deleterious effect of diagnostic ultrasound in patients in general and in pregnancy and neonates in particular over the last 45 years or more of clinical use, several caveats must be formulated, and several issues must be addressed. The purpose of this editorial is to briefly review the most recent literature, to present relevant evidence (if it exists), and to summarize the current knowledge in view of 3 articles in this issue of Journal of Ultrasound in Medicine.1–3 It is hoped that this synopsis will alert the reader to the bioeffects of ultrasound and increase awareness of safety issues. The following are the major points to consider: Does ultrasound cause effects in insonated tissues? Can these effects be harmful? Are there demonstrable fetal effects? Should there be special restrictions for first-trimester scanning, more particularly, regarding certain modalities, such as Doppler sonography? Can the end user manipulate the ultrasonic scanner in a way that output energy may become excessive and therefore potentially dangerous? Should there be scanning restrictions when no clear medical indication for the scan exists? Should the existing limits on permissible output be removed? Some of these topics have been discussed in excellent reviews.4–8