ARTICLES

We Can Show Them the Heart, Fingers, Toes

WILL THREE-D ULTRASOUND HELP OR HARM PRO-LIFE EFFORT?

By Tracy Moran

Used to be, when proud parents would show off their baby's first picture, the snapshot would reveal an infant swaddled in a soft blanket, eyes squinting against the glare of the camera's flash.

But today, baby's first pictures are often taken even before he's born. The black and gray shadows on slips of waxy paper, images from an ultrasound scan, require some explanation from the parents: "See, there's his little hand and there's his spine." These ultrasound images may not evoke "ahhs" and "how sweet," but they do provide a visual link to the new baby growing inside his mom.

Ultrasound scanning, which has been used in obstetrics for 35 years, has become standard procedure to help doctors determine a pregnancy's viability, placental location, and a fetus's gestational age. As a pregnant woman lies on her back, the doctor squirts conducting gel onto the mom-to-be's belly, then moves a transducer across it. The transducer, which emits very high frequency sound waves, can be thought of as a "flashlight" as it moves around the outside of the abdomen, revealing the contents inside via the ultrasound beams reflected back and recomposed into a picture on a monitor screen.

As anyone knows who has seen these scans, the grainy picture on the screen can be indecipherable. But thanks to sophisticated computer technology and the research being done at the University of California San Diego, ultrasound technology is making quantum leaps, and three-dimensional ultrasound may be the wave of the future.

"When we get good pictures, patients can recognize them easier," says clinical radiologist Dolores Pretorius, who, along with physicist Thomas Nelson, has headed UCSD's 3D Ultrasound Imaging Group for nearly a decade. In essence, three-D ultrasound enables a doctor to view an internal object, be it a fetus or a heart, almost as if he were holding it in his hand.

UCSD's husband-and-wife team of Nelson and Pretorius are among the front-runners in developing and advancing the technology. Pretorius predicts that three-dimensional ultrasound -- which last year gained approval from the Federal Drug Administration -- will replace two-dimensional ultrasound in a few years.

Dr. Pretorius says three-D owes a nod to the entertainment industry: it's been used for years in the motion picture industry -- remember when people would wear colored three-D glasses to see films? -- and some recent Hollywood special effects technology has helped advance the ultrasound technology as well.

"Three-D ultrasound is becoming more widespread now," Pretorius says. She estimates it's used commercially in eight to ten places in the United States. The major ultrasound equipment companies are working on developing three-D units. The cost, says Pretorius, is comparable to a high-end, two-D ultrasound machine -- between $200,000 and $300,000. Some two-D ultrasound machines come as cheap as $15,000 to $25,000, she says, but this equipment is used mostly to make measurements.

How will three-dimensional ultrasound, with its clarity and more life-like images, affect the abortion debate?

"Families relate and bond to the pictures much more and they recognize the picture easier than with two-D, which is abstract," says Pretorius.

One concern voiced by some in the pro-life community is the technology's ability to more readily detect fetal abnormalities, which may persuade some women to abort. Dr. Joseph S.K. Woo addresses this point in his web page dedicated to ultrasound.

"A large volume of literature and documentation is expected to come out in the coming years and the diagnosis of congenital anomalies could experience a revolution," Woo writes. "Present evidence has already suggested that even small defects such as spina bifida, cleft lips/palate, and polydactyl can be more lucidly demonstrated. Other more subtle features such as low-set ears, facial dysmorphia or clubbing of feet can be better assessed, leading to more effective diagnosis of chromosomal abnormalities. The ability to obtain a good three-D picture is nevertheless still very much dependent on operator skill, the amount of [amniotic fluid] around the fetus, its position and the degree of maternal obesity, so that a good image is not always readily obtainable."

However, the technology can also rule out suspected abnormalities detected during a two-D scan. After a two-D ultrasound on a fetus seemed to indicate a cleft lip, Pretorius used three-D imaging to show there was no anomaly.

"Three-D should help make better, more accurate diagnoses," she says, adding that some research suggests intrauterine surgery to help correct clefts will be possible.

Tom Glessner, president and general counsel for the National Institute of Family and Life Advocates, predicts the imagery in three-D ultrasound "will have a tremendous impact on abortion-minded women." The only problem he sees is making it available to most women who are contemplating an abortion.

He would be happy if such women would see even a standard, two-D ultrasound image of their unborn baby. That's why his organization, which supplies legal consultation, education, and training to pregnancy help centers, has been assisting its member centers in converting to clinics, where ultrasound is one of the procedures available.

Crisis pregnancy centers, Glessner says, are becoming social service agencies and are failing to reach women considering abortion, because the centers can't legally answer the one question a woman in a crisis pregnancy has: "Am I pregnant?"

"There have been lawsuits in California over that," Glessner says. "When a center tells a client she's pregnant, then that's illegal practice of medicine." The best the centers can do is have the client take a self-pregnancy test. If it's positive, the woman can be referred to a physician. By converting to a clinic, the facility can offer more services and attract more abortion-minded women.

"This is the next step that centers have to go," Glessner says, "and they're having a tremendous impact in those communities where they're located."

In Escondido, one of Glessner's member centers, Alternatives Crisis Pregnancy Center, is in the process of converting to a clinic. Director Dana Serrano says they already have a two-D ultrasound machine, which they will be able to use once the state government processes the paperwork.

"We'll have to recruit doctors and nurses to do the ultrasound," she says, "but that's not a problem because they are out there." The hard part is getting government approval, especially in California, says Glessner.

"A center in California must go through a whole lot more detail to convert to a clinic than a center in most other states," he says, "because California has detailed regulations regarding clinics."

Anita Krifik directs the Ramona Pregnancy Care Clinic, which successfully converted two years ago, after operating as a pregnancy center since 1989. They converted, she says, "to be less vulnerable from attacks by abortion advocates.

"Typically when they sue," Krifik says, "their accusation is that a center is operating as a bogus clinic. So we thought, 'We'll be a real clinic.'"

They've been offering ultrasound for about a year and a half. "Most women are really excited to see their baby," Krifik says, "but we have some who still go ahead and have the abortion." She knows of a clinic in Baton Rouge, Louisiana, that she says has a 100-percent turnaround of abortion-minded women after hearing their baby's fetal heartbeat with the Doppler.

"Maybe in California people's hearts are hardened," she muses. "Their lifestyle is more sinful."

Dr. Joan Roy is the Ramona Pregnancy Care Clinic's medical director and practicing physician. She gives clients physicals to confirm their pregnancies, then can schedule them for an ultrasound when the sonographer comes in with his equipment each week.

"With ultrasound," Roy says, "we're thinking if we can show them the heart, fingers, toes, that will make them realize they can't (abort). Once they see the reality, some are just livid at us because they still want an abortion and we've made them feel guilty."

She recalls one girl who had decided that if she was, as she suspected, in her first trimester, she would abort. The girl demanded an ultrasound to verify gestational age and give herself "peace of mind."

"The baby's daddy came with the girl," Roy says. "The sonographer told him, 'I'll give you a starter picture of your baby.' But she still had the abortion. What more could we have done?"