Thursday, October 25, 2007

The pregnancy ultrasound overtesting scam

As an infertility specialist, I refer our patients to obstetricians for their antenatal care once they get pregnant. What's very alarming is the large proportion of our patients who are being subjected to unnecessary caesarean sections for their childbirth. Many of these women are healthy young women who are perfectly capable of giving birth normally. However, many doctors these days seem to prefer doing elective caesarean sections for them - a practise which is remunerative for the doctor, but harmful for the patient.

So how do they convince the patient to sign the dotted line and give "informed consent" for the surgery ? Doctors are cleverly misusing ultrasound testing to do so. While there is no doubt that ultrasound scanning is extremely helpful during pregnancy to confirm the well-being of the baby, the commonest racket is to get the ultrasonographer to over-report minor variations as abnormalities, and then scare the patient that the baby's welfare is at stake.

The number of "abnormalities" which are reported are mind-boggling for their creativity ! I have seen patients being subjected to caesarean sections for a huge range of normal findings , including:
1. nuchal cord . This is a condition in which the umbilical cord is near the neck. This is perfectly normal and safe, but they scare the patient by saying that this cord can tighten during delivery and strangle the baby, which is why a caesarean is much safer !
2. reduced amniotic fluid. It's common for the amniotic fluid volume to decline as the pregnancy progresses. Here, the scans are repeated frequently, and the sonographer "documents" a declining trend in the amount of fluid. This is "creatively interpreted" as suggesting "fetal distress" which requires a caesarean section !
3. oblique lie. Often the baby's head does not settle down into the pelvis until quite late during pregnancy. If it does not do so by 36 weeks, patients are told that this suggests that head is "too big" or the "pelvis is too small" and that a caesarean section is needed to prevent birth trauma !

The beauty of these "reported abnormalities" is that they are "soft findings" which are dynamic and therefore cannot be conclusively documented. Since a baby is a "high-investment" product, no patient wants to take chances, and they are happy to do what their doctor suggests.

What's even worse is that if they get a second opinion from another obstetrician, the new doctor will also most probably agree with the first one, since it's much more profitable for a doctor to do surgery, than to allow for a normal vaginal birth !

Interestingly, ultrasound over-reporting seems to be widely prevalent in gynecology as well. Patients who are infertile are "documented" to have small subserous fibroids ( of no clinical importance) and then advised to undergo laparoscopic surgery ( which is projected as being "minor surgery") to remove these. The other common "finding" is a small ovarian cyst ( which is extremely common) for which they are advised to undergo laparoscopy to "rule out and treat" endometriosis.

Similarly, older women with heavy menstrual bleeding are diagnosed as having fibroids or endometrial hyperplasia ( a fancy term for a "thick endometrium " ) and told that they need a hysterectomy !

It's becoming increasingly difficult for patients to protect themselves from this sort of overtesting and overdiagnosing which lead to unnecessary overtreatment ! The best bet is to find an ethical doctor who will guide you properly !

1 comment:

  1. Anonymous6:35 AM

    I agree whole heartedly, I overheard a conversation of 2 soon to be mothers recently and they were wanting a c-section because they didn't want their babies to have a cone head like so many other newborns, what would the other mother's think. I tryed to explain, but it was no use, I refered them to another physician right after they demanded they receive another ultrasound.


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