After pregnancy, many B-ultrasound examinations have to be performed, of which the most important and most worrying one is [large malformation screening].
There will be many questions about [screening for large deformities]. Please listen to me carefully.
[Large Deformity Screening] Check what?
[Large malformation screening] is a popular term, and the standard term is [systematic prenatal ultrasound examination during the second trimester], and the English name corresponding to [large malformation screening] is Anomaly Scan.
Ultrasound examination during the second trimester of pregnancy not only looks at the general conditions of fetal growth and development, placenta and amniotic fluid, but also carries out detailed examination on various organs and systems of the fetus in order to understand whether the fetus has large structural defects, so it is called [large malformation screening].
As for specific examination items, interested people can refer to the “Guidelines for Prenatal Ultrasound Examination” formulated by the Ultrasound Physicians Branch of the Chinese Medical Association or the relevant guidelines formulated by ISUOG (International Institute of Obstetrics and Gynecology Ultrasound).
[Large Malformation Screening] Why should it be done at 20 ~ 24 weeks of pregnancy?
There are two main reasons for arranging [large malformation screening] at this time period.
First, most of the fetal structural abnormalities can be found during this period of time. If the fetus is done too early, the fetus is relatively small, and the corresponding organs are not well developed, so the corresponding structural abnormalities cannot be found.
The second is to consider the termination of pregnancy. If you do it late and find a large malformation, the fetus has entered a viable stage. If you terminate the pregnancy again, there will be complicated ethical problems. Moreover, the termination of pregnancy in the first week of pregnancy will bring both physical and psychological blows to the mother.
Careful people will find that in ISUOG’s guidelines, the time for [large malformation screening] is 18-22 weeks. The main reason is that the latest time for termination of pregnancy due to large structural malformation of fetus in many developed countries in Europe and the United States is not more than 24 weeks. In addition, the level of ultrasound doctors in these countries is generally relatively high.
The Ultrasound Physicians Branch of the Chinese Medical Association has set the [screening for large malformations] at 20-24 weeks, which is determined by taking full account of the actual situation in our country.
What is the detection rate of [large malformation screening]?
You must not expect too much from [large malformation screening], because the following factors will affect the detection rate of structural abnormalities:
- Thickness of abdominal fat in pregnant women, body position of fetus, amniotic fluid volume, doctor’s experience and level
According to international experience, the average detection rate of [large malformation screening] can reach about 80%, which is already a relatively high level. It is unreasonable to blame ultrasound doctors for missed diagnosis of fetal malformation.
Adults may not be able to find out 100% of the problems when they are ill and have ultrasound examination. What’s more, the fetus is in the mother’s womb and so small. Doctors are not God and cannot see all the problems.
In order to let everyone have a more intuitive understanding of the detection rate of [large malformation screening], the prenatal ultrasound detection rates of some fetal malformations reported in domestic and foreign literatures are listed as follows for reference:
- Anencephaly: more than 87% diaphragmatic hernia: about 60% Fallot tetralogy: 14% ~ 65% digestive tract malformation: 9.2% ~ 57.1% fetal limb malformation: 22.9% ~ 87.2%
Don’t ask the ultrasound doctor questions when doing [screening for large malformations]
1. Want [by the way] to know whether the fetus is male or female?
Doctors cannot tell you, because the country has laws and regulations that sex identification cannot be carried out by ultrasound or other methods without special medical indications.
2. Want to know if there is any problem with the fetus?
According to the current regulations of our country, ultrasound doctors are doctors in auxiliary departments and cannot communicate with patients about fetal abnormalities.
TA can only write down the diagnosis, but the discussion and treatment of the disease still need to go back to the obstetrician.
3. Then why can it be abroad?
Because foreign countries stipulate that obstetricians can do ultrasound and write ultrasound reports by themselves, TA can communicate with patients while doing ultrasound. It seems that China is the only country that does not allow clinicians to make ultrasound reports.
Therefore, when doing ultrasound examination, you ask the ultrasound doctor a question. If TA does not answer you, don’t blame TA. It’s not a bad attitude, it’s hard to say what the regulations are, and it doesn’t count if you say it.
[Large Deformity Screening] What if there is a problem?
First of all, [screening for large malformations] finding problems is not necessarily a big problem, and not finding problems does not mean there is no problem.
After finding the problem, the most important thing is to choose the right doctor to see a doctor. Not every obstetrician has the corresponding ability. For complex problems, it may require a team of doctors from different specialties to consult together.
Compared with single malformation, fetuses with multiple malformations have a higher risk of chromosomal abnormalities and need further examination.
For fetal central nervous system abnormalities, fetal MRI (magnetic resonance) examination can be considered if conditions permit, because fetal MRI can provide more information and is conducive to improving the detection rate of fetal central nervous system abnormalities.
For large and complicated fetal malformations, it is best to go to a prenatal diagnosis center (fetal medical center) with follow-up treatment capability.
[Large Malformation Screening] Consultation Principles for Abnormalities
When encountering [large malformation screening] abnormalities, real professional prenatal diagnosis (fetal medicine) specialists will neither simply say YES or NO, nor give some ambiguous statements.
Specialists help patients make decisions, not make decisions for patients.
Patients should be provided with as much correct Information as possible so that patients can choose the appropriate treatment plan according to the situation, instead of making Non-direct decisions for them.
So don’t always ask: What would you do if it were you, doctor? Because the doctor is not you, [three views] are different, education and family backgrounds are different, how can there be a consistent view?
In addition, doctors in professional status and doctors who become patients have different ways of thinking, so their decisions will be different. If you still feel unclear or uneasy after one consultation, you can change to a doctor or a hospital to listen to the Second Opinion.
Learn to accept imperfect babies
In the past, everyone hoped to have a perfect baby, so when encountering fetal structural abnormalities, many people would choose to terminate pregnancy even for small structural abnormalities.
With the progress of social civilization, people’s ideas have gradually changed, and more and more people are willing to accept an imperfect baby.
There was a case in our hospital, The mother of the baby is Chinese, My father was an American, They knew in advance that the baby was a defective child with Down’s syndrome, but they still decided to give birth to the baby. After the child was born, our colleagues were very worried and did not know how to communicate with the parents of the child. The father of the child held the child in his arms and gave candy to our colleagues. He was cheerful and his eyes were full of love when looking at the child.
He said, Thank you for your hard work and the joy in my life. You see how beautiful she is, just like a little angel!
Our colleagues were instantly melted, and they were all happy that the child was born in this family.
The article was reprinted by Clove Garden authorized by the author.