Donald School Journal of Ultrasound in Obstetrics and Gynecology

Register      Login

VOLUME 2 , ISSUE 4 ( October-December, 2008 ) > List of Articles


Bioeffects and Safety of 2D and 3D/4D Ultrasound in Obstetrics—Is there a Place for “Parental Bonding” Scans?

Jacques S Abramowicz

Keywords : Ultrasound,bioeffects,safety,maternal-fetal bonding

Citation Information : Abramowicz JS. Bioeffects and Safety of 2D and 3D/4D Ultrasound in Obstetrics—Is there a Place for “Parental Bonding” Scans?. Donald School J Ultrasound Obstet Gynecol 2008; 2 (4):17-21.

DOI: 10.5005/jp-journals-10009-1074

License: CC BY-NC 4.0

Published Online: 01-12-2009

Copyright Statement:  Copyright © 2008; The Author(s).


Ultrasound is widely used in daily clinical obstetrical practice. Many medical indications exist for performing a sonographic examination but, in addition, several researchers have published information on the importance of patients watching the ultrasound monitor during the examination, particularly during three- and fourdimensional (3D/4D) scanning, for maternal-fetal bonding. Furthermore, a certain form of ultrasound, called “entertainment” or “keepsake” ultrasound has flourished, particularly in the United States. While ultrasound is assumed to be completely safe, it is a form of energy and, as such, has effects in tissues it traverses (= bioeffects). The two most important mechanisms for effects are thermal and non-thermal. Nonthermal mechanisms include cavitation, streaming, and even release of free radicals. These two major mechanisms are indicated on-screen by two indices: The thermal index (TI) and the mechanical index (MI). It is important to be aware of these effects to be able to prevent potential harm. Ultrasound machine controls can alter the instrument acoustic energy and hence the exposure but different machines behave differently. Therefore each clinician should know how this occurs in his/her own machine. Unfortunately, it appears the general knowledge in this area is poor and an effort should be made to educate the endusers. Whether 3D/4D enhances parental-fetal bonding is still a matter of discussion.

PDF Share
  1. Safety studies with ultrasonic Doppler technic. A clinical follow-up of patients and tissue culture study. Obstet Gynecol 1969;34:707-09.
  2. The safety of using sonar. Dev Med Child Neurol 1974;16:90-92.
  3. Safety and potential hazards in the current applications of ultrasound in obstetrics and gynecology. Ultrasound Med Biol 1979;5:307-20.
  4. Biological effects of ultrasound. Women Health 1982;7:65-81.
  5. How safe is diagnostic ultrasonography? Can Med Assoc J 1984;131:307-11.
  6. Acoustic cavitation and the safety of diagnostic ultrasound. Ultrasound Med Biol 1987;13:597-606.
  7. The safety of obstetric ultrasonography: Concern for the fetus. Obstet Gynecol 1990;76:139-46.
  8. Diagnostic ultrasound: Bioeffects and safety. Ultrasound Obstet Gynecol 1992;2: 366-74.
  9. A review of in vitro bioeffects of inertial ultrasonic cavitation from a mechanistic perspective. Ultrasound Med Biol 1996;22:1131-54.
  10. Obstetric ultrasonography: A biophysical consideration of patient safety— the “rules” have changed. Am J Obstet Gynecol 1998;179: 241-54.
  11. Biophysical aspects of diagnostic ultrasound. Ultrasound Med Biol 2000;26 Suppl 1:S68-70.
  12. Ultrasound in obstetrics and gynecology: Is this hot technology too hot? J Ultrasound Med 2002;21:1327-33.
  13. Effects of repeated prenatal ultrasound examinations on childhood outcome up to 8 years of age: Followup of a randomised controlled trial. Lancet 2004;364:2038-44.
  14. J Obstet Gynaecol Can 2005;27:572-80.
  15. Prenatal exposure to ultrasound waves: is there a risk? Ultrasound Obstet Gynecol 2007;29:363-67.
  16. Are prenatal ultrasounds safe for the developing brain? Pediatr Res 2007;61:265-66.
  17. Hazards, risks and safety of diagnostic ultrasound. Med Eng Phys 2008.
  18. Ultrasound-biophysics mechanisms. Prog Biophys Mol Biol 2007;93:212-55.
  19. Exposure Criteria for Medical Diagnostic Ultrasound: II. Criteria Based on All Known Mechanisms. Report No. 140. Bethesda, MD, 2002.
  20. American Institute of Ultrasound in Medicine and the National Electrical Manufacturers’ Association: Standard for Real-Time Display of Thermal and Mechanical Acoustic Output Indices on Diagnostic Ultrasound Devices, 1992.
  21. WFUMB Symposium on Safety and Standardization in Medical Ultrasound: Issues and Recommendations regarding Thermal Mechanisms for Biological Effects of Ultrasound. Ultrasound Med Biol. Ultrasound Med Biol 1992;18:748.
  22. Implementation of the Principle of as Low as Reasonably Achievable (ALARA) for Medical and Dental Personnel. Report No. 107. Bethesda, MD: National Council on Radiation Protection and Measurements,. Report No. 107. Bethesda, MD: National Council on Radiation Protection and Measurements, 1990.
  23. Threshold for nonthermal bioeffects: Theoretical and experimental basis for a threshold index. Ultrasound Med Biol 1998;24 Suppl 1:S41-49.
  24. A new perspective on hyperthermia-induced birth defects: The role of activation energy and its relation to obstetric ultrasound. J Therm Biol 2005;30:400-09.
  25. Rationale and derivation of MI and TI—a review. Ultrasound Med Biol 1999;25:431-41.
  26. Surface heating of diagnostic ultrasound transducers. Br J Radiol 1989;62: 1005-13.
  27. Surface heating by transvaginal transducers. Ultrasound Obstet Gynecol 2007;29:427-32.
  28. Models and regulatory considerations for transient temperature rise during diagnostic ultrasound pulses. Ultrasound Med Biol 2002;28:1217-24.
  29. Doppler proof of the presence of intervillous circulation. Ultrasound Obstet Gynecol 1996;7: 463-64.
  30. Doppler ultrasonography and implantation: A critical review. Fetal Diagn Ther 2001;16:327-32.
  31. Doppler evidence of intervillous circulation during the first trimester of pregnancy. Placenta 1998;19:445.
  32. Uteroplacental hemodynamics during early human pregnancy: A longitudinal study. Gynecol Obstet Invest 2004;58:49-54.
  33. Doppler study of the embryonic heart in normal pregnant women. J Matern Fetal Neonatal Med 2007;20:533-39.
  34. First-trimester fetal cardiac function. J Ultrasound Med 2008;27:379-83.
  35. The output display standard: has it missed its target? Ultrasound Obstet Gynecol 2005;25:211-14.
  36. What do clinical users know regarding safety of ultrasound during pregnancy? J Ultrasound Med 200726319-25. quiz 326-27.
  37. Mechanical bioeffects of ultrasound. Annu Rev Biomed Eng 2004;6:229-48.
  38. First-trimester sonography: Is the fetus exposed to high levels of acoustic energy? J Clin Ultrasound 2007;35:245-49.
  39. Acoustic output as measured by mechanical and thermal indices during routine obstetric ultrasound examinations. J Ultrasound Med 2005;24:1665-70.
  40. An increased thermal index can be achieved when performing Doppler studies in obstetric sonography. J Ultrasound Med 2007;26:71-76.
  41. A comparison between acoustic output indices in 2D and 3D/4D ultrasound in obstetrics. Ultrasound Obstet Gynecol 2007;29:326-28.
  42. Is an excessive number of prenatal echographies a risk for fetal growth? Early Hum Dev 2005;81:689-93.
  43. Fetal thermal effects of diagnostic ultrasound. J Ultrasound Med 200827541-59. quiz 560-63.
  44. Fetal ultrasound: mechanical effects. J Ultrasound Med 2008;27:597-605; quiz 606-06.
  45. Conclusions regarding epidemiology for obstetric ultrasound. J Ultrasound Med 2008;27:637-44.
  46. Psychosocial issues in reproductive genetic testing and pregnancy loss. Fetal Diagn Ther 1993;8:164-73.
  47. Pre-examination and postexamination assessment of parental-fetal bonding in patients undergoing 3-/4-dimensional obstetric ultrasonography. J Ultrasound Med 2006;25:1411-21.
  48. Parental artistic drawings of the fetus before and after 3-/4-dimensional ultrasonography. J Ultrasound Med 2007;26:301-08.
  49. Psychological aspects of ultrasound imaging during pregnancy. Can J Psychiatry 1988;33:530-36.
  50. [Psychological aspects of diagnostic methods in pregnancy]. Zentralbl Gynakol 1989;111:368-75.
  51. Maternal bonding in early fetal ultrasound examinations. N Engl J Med 1983;308:392-93.
  52. Effect of fetal movement, ultrasound scans, and amniocentesis on maternal-fetal attachment. Nurs Res 1989;38:81-84.
  53. Gravidas’ responses to realtime ultrasound fetal image. JOGN Nurs 1980;9:77-80.
  54. Through a glass darkly: Ultrasound and prenatal bonding. Birth 1990;17:214-17.
  55. The impact of two-dimensional versus three-dimensional ultrasound exposure on maternal-fetal attachment and maternal health behavior in pregnancy. Ultrasound Obstet Gynecol 2006;27:245-51.
  56. Effects of ultrasound on maternal-fetal bonding: A comparison of two and three-dimensional imaging. Ultrasound Obstet Gynecol 2005;25:473-77.
  57. Two-dimensional vs. two-plus four-dimensional ultrasound in pregnancy and the effect on maternal emotional status: A randomized study. Ultrasound Obstet Gynecol 2005;25:468-72.
  58. Twoversus three-dimensional ultrasound in the second and third trimester of pregnancy: Impact on recognition and maternalfetal bonding. A prospective pilot study. Arch Gynecol Obstet 2007;276:475-79.
  59. The psychological impact of diagnostic ultrasound. Obstet Gynecol 1987;70:673-76.
  60. Psychological reactions to ultrasound. Examination during pregnancy. Psychother Psychosom 1988;50:1-4.
  61. Three-and four-dimensional ultrasonography for the structural and functional evaluation of the fetal face. Am J Obstet Gynecol 2007;196:16-28.
PDF Share
PDF Share

© Jaypee Brothers Medical Publishers (P) LTD.