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Destination: Delivery / A Road Map Through Pregnancy
| Issue: Ultrasounds

Tools to Calm --or Warn--Parents-to-Be


For most expecting families, few experiences match the first glimpse of the baby through an ultrasound. For women, it's often a sign that the baby is fine. For fathers, it's sometimes the first concrete evidence that they are pegged for fatherhood. But as technology improves, ultrasounds are becoming more the diagnostic device they were intended to be, and parents are sometimes left stunned by the outcome.

Illina and Ed Maningo went in for an ultrasound when she was seven months pregnant with their second child. They went expecting a soothing look at their normal baby. Instead, the test vaulted them into shock and disbelief.

Illina admitted, "It wasn't very joyous."

Her obstetrician, after suspecting a problem, sent them to a radiologist, who told them the baby probably had a cleft lip and palate.

"I could see it in the ultrasound," Illina said. The baby had given them a rare look at his face.

"Of course, you're going to freak out," she said. "The first thing I was thinking was, is there anything else wrong with him?"

A cleft lip and palate, caused by the failure of the parts of a cleft to grow together, also can be associated with heart or brain damage. The Long Beach couple learned everything they could about the condition. They found a cosmetic surgeon. They prepared their close family and friends. In the middle of asking "Why did this happen?" they discovered an adult cousin of Ed's had a cleft palate that had been corrected. "We had met her once and didn't know," Illina said.

By the time Joshua was born, a plastic surgeon had walked his parents through the types of corrective surgery available. The Maningos changed hospitals so Illina could deliver at Miller's Children, the pediatric arm of Long Beach Memorial Medical Center, where a team of doctors was present to diagnose and help her baby.

Illina said knowing ahead of time helped prepare her for the initial hardships. Children with cleft lips and palates have difficulty feeding, and Joshua had to spend some time in intensive care.

And she says she was able to bond with him completely--a process, she has since learned, that can be stunted when a mother is faced with a baby with an unexpected problem.

Except for a cleft lip and palate, Joshua was normal. Illina thought, "It's only cosmetic; it's fixable."

Joshua had his first surgery in December. He will have seven more throughout his childhood. "He's so cute now," said his mother. "He's just so very smart."

An Accepted Standard for 10 Years

Ultrasounds, which create a picture of the fetus by beaming harmless sound waves into the body and reflecting them on a monitor, have been the standard of care for pregnant women for the last 10 years. But medicine is increasingly viewing ultrasounds as an important window to a baby's health. Indeed, two local medical centers are participating in a study to screen for Down syndrome through ultrasound and a test of a mother's blood.

"Everyone has agreed for more than 10 years that if an ultrasound is clinically indicated, you do it," said Dr. Frank A. Chervenak, chief of Maternal / Fetal Medicine at the New York Hospital-Cornell Medical Center. Chervenak is co-editor of a new report on ultrasound.

About 26 conditions define a "high-risk" pregnancy, including the age of the mother, the uterus size and the number of babies.

But, Chervenak said, even with low-risk women, "your risk of having a child with an anomaly . . . is 2 to 3%. That's pretty high."

Chervenak's study, called "Ultrasound Screening For Fetal Anomalies: Is It Worth It?," examined routine ultrasound screening in 14 European countries and found that 61% of structural anomalies were detected by ultrasound. This finding contrasts sharply with a 1993 National Institutes of Health study that found only 35% of structural anomalies were detected.

The discrepancies in the two studies could be because of "tremendous unevenness in this country in the quality of ultrasound being performed," said Chervenak, whose study was published in the Annals of the New York Academy of Sciences.

Ultrasounds are best performed between 18 to 20 weeks of pregnancy, he said. Done properly, they can help diagnose hydrocephalus, spina bifida, bowel problems, heart problems, skull deformities, and cleft palate and lip.

An ultrasound, says Chervenak, can reveal structural abnormalities, while amniocentesis diagnoses chromosomal abnormalities.

Ultrasounds showing defects can lead to early action: sometimes in utero surgery; medical treatment for the mother, such as drugs, extra oxygen and bed rest; mental preparation for the family; and, at times, delivering at a hospital with a full neonatal team.

Of course, most ultrasounds do show a healthy baby. That is what most parents expect, and Chervenak argued that's reason enough to do one. "The great good we do for most patients is reassurance, which is invaluable. . . . In this day of financial restraint, doctors need to be advocates for their patients and fight for this as an option for them."

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