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Sun H, Wu A, Lu M, Cao S. Liability, risks, and recommendations for ultrasound use in the diagnosis of obstetrics diseases. Heliyon 2023; 9:e21829. [PMID: 38045126 PMCID: PMC10692788 DOI: 10.1016/j.heliyon.2023.e21829] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2023] [Revised: 10/27/2023] [Accepted: 10/30/2023] [Indexed: 12/05/2023] Open
Abstract
This literature review will summarize the liability issues, risks, and ultrasound recommendations for diagnosing obstetrics diseases. One liability issue is related to misdiagnosis or failure to detect abnormalities during an ultrasound examination. Ultrasound images can be subjective interpretations, and errors may occur due to factors such as operator skill, equipment limitations, or fetal positioning. Another liability concern is related to the potential adverse effects of ultrasound exposure on both the mother and fetus. While extensive research has shown that diagnostic ultrasound is generally safe when used appropriately, there are still uncertainties regarding long-term effects. Some studies suggest a possible association between prolonged or excessive exposure to ultrasound waves and adverse outcomes such as low birth weight, developmental delays, or hearing impairment. Additionally, obtaining informed consent from patients is crucial in mitigating liability risks. Patients should be informed about the purpose of the ultrasound examination, its benefits, limitations, potential risks (even if minimal), and any alternative diagnostic options available. This ensures that patients know the procedure and can make informed decisions about their healthcare. Proper documentation helps establish a clear record of the care provided and can serve as evidence in any legal disputes.
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Affiliation(s)
- Haiting Sun
- Department of Ultrasound, The Affiliated Xiangshan Hospital of Wenzhou Medical University, Ningbo, 315700, Zhejiang Province, PR China
| | - An Wu
- Department of Ultrasound, The Affiliated Xiangshan Hospital of Wenzhou Medical University, Ningbo, 315700, Zhejiang Province, PR China
| | - Minli Lu
- Department of Ultrasound, The Affiliated Xiangshan Hospital of Wenzhou Medical University, Ningbo, 315700, Zhejiang Province, PR China
| | - Shan Cao
- Department of Obstetrics, The Affiliated Second People's Hospital of Yuhang District, Hangzhou City, Hangzhou, 311100, Zhejiang Province, PR China
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2
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Christensen D, Pazol K, Overwyk KJ, England LJ, Alexander AA, Croen LA, Dowling NF, Schieve LA, Tian LH, Tinker SC, Windham GC, Callaghan WM, Shapira SK. Prenatal ultrasound use and risk of autism spectrum disorder: Findings from the case-control Study to Explore Early Development. Paediatr Perinat Epidemiol 2023; 37:527-535. [PMID: 37483151 PMCID: PMC10527947 DOI: 10.1111/ppe.12998] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/21/2022] [Revised: 07/04/2023] [Accepted: 07/07/2023] [Indexed: 07/25/2023]
Abstract
BACKGROUND Studies evaluating the association between prenatal ultrasounds and autism spectrum disorder (ASD) have largely produced negative results. Concern remains due to the rising identification of children with ASD and ultrasound use. OBJECTIVE To evaluate the association between prenatal ultrasound use and ASD. METHODS We used data from the Study to Explore Early Development, a multisite case-control study of preschool-aged children with ASD implemented during 2007-2012. We recruited cases from children receiving developmental disability services and randomly selected population controls from birth records. ASD case status was based on in-person standardised assessments. We stratified analyses by pre-existing maternal medical conditions and pregnancy complications associated with increased ultrasound use (ultrasound indications) and used logistic regression to model case status by increasing ultrasound counts. For pregnancies with medical record data on ultrasound timing, we conducted supplementary tests to model associations by trimester of exposure. RESULTS Among 1524 singleton pregnancies, ultrasound indications were more common for ASD cases than controls; respectively, for each group, no indications were reported for 45.1% and 54.2% of pregnancies, while ≥2 indications were reported for 26.1% and 18.4% of pregnancies. The percentage of pregnancies with multiple ultrasounds varied by case status and the presence of ultrasound indications. However, stratified regression models showed no association between increasing ultrasound counts and case status, either for pregnancies without (aOR 1.01, 95% CI 0.92, 1.11) or with ultrasound indications (aOR 1.01, 95% CI 0.95, 1.08). Trimester-specific analyses using medical record data showed no association in any individual trimester. CONCLUSIONS We found no evidence that prenatal ultrasound use increases ASD risk. Study strengths included gold-standard assessments for ASD case classification, comparison of cases with controls, and a stratified sample to account for conditions associated both with increased prenatal ultrasound use and ASD.
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Affiliation(s)
- Deborah Christensen
- National Center on Birth Defects and Developmental Disabilities, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Karen Pazol
- National Center on Birth Defects and Developmental Disabilities, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Katherine J. Overwyk
- National Center on Birth Defects and Developmental Disabilities, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Lucinda J. England
- National institute for Occupational Safety and Health, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Aimee A. Alexander
- National Center on Birth Defects and Developmental Disabilities, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Lisa A. Croen
- Kaiser Permanente Division of Research, Oakland, California, USA
| | - Nicole F. Dowling
- National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Laura A. Schieve
- National Center on Birth Defects and Developmental Disabilities, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Lin H. Tian
- National Center on Birth Defects and Developmental Disabilities, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Sarah C. Tinker
- National Center on Birth Defects and Developmental Disabilities, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Gayle C. Windham
- California Department of Public Health, Division of Environmental and Occupational Disease Control, Richmond, California, USA
| | - William M. Callaghan
- National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Stuart K. Shapira
- National Center on Birth Defects and Developmental Disabilities, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
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Dudwiesus H, Merz E. How safe is it to use ultrasound in prenatal medicine? Facts and contradictions - Part 2 - Laboratory experiments regarding non-thermal effects and epidemiological studies. ULTRASCHALL IN DER MEDIZIN (STUTTGART, GERMANY : 1980) 2021; 42:460-502. [PMID: 33836546 DOI: 10.1055/a-1394-6194] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
The first part of this CME article (issue 5/20) provided a detailed examination of the biophysical effects of ultrasound waves, the exposure values, and in particular the thermal effect. In vivo and in vitro measurements have shown that the temperature increase in tissue associated with B-mode ultrasound is far too low to pose a potential risk. Even experiments with exposure values in the range of pulsed Doppler have shown that temperature increases of over 1.5 °C can only occur in areas in direct contact with the probe, thus making a limited exposure time particularly in the case of transvaginal application advisable. The second part of this CME article describes various laboratory and animal experiments for evaluating non-thermal effects and also presents the most important epidemiological studies in the last 30 years in the form of an overview and review. In addition to direct insonation of isolated cells to examine possible mutagenic effects, the blood of patients exposed in vivo to ultrasound was also analyzed in multiple experiments. Reproducible chromosome aberrations could not be found in any of the studies. In contrast, many experiments on pregnant rodents showed some significant complications, such as abortion, deformities, and behavioral disorders. As in the case of thermal effects, the results of these experiments indicate the presence of an intensity- or pressure-dependent effect threshold. Numerous epidemiological studies examining possible short-term and long-term consequences after intrauterine ultrasound exposure are available with the most important studies being discussed in the following. In contrast to information presented incorrectly in the secondary literature and in the lay press, health problems could not be seen in the children observed in the postpartum period in any of these studies.
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Affiliation(s)
| | - Eberhard Merz
- Centre for Ultrasound and Prenatal Medicine Frankfurt/Main, Germany
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Thakur APS, Sharma V, Ramasamy V, Choudhary A, Patel P, Singh S, Parol S. Management of ureteric stone in pregnancy: a review. AFRICAN JOURNAL OF UROLOGY 2020. [DOI: 10.1186/s12301-020-00070-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
Abstract
Background
Urolithiasis in pregnancy is a major health concern and is one of the most common causes for non-obstetrical abdominal pain and subsequent hospital admission during pregnancy. The incidence of urinary calculi during pregnancy varies in the range of 1/200 to 1/2000. Acute ureteric colic in pregnancy is associated with significant potential risks to both mother and fetus. Significant anatomic and functional changes occur in pregnancy which not only lead to stone formation but also create diagnostic dilemma. The diagnosis of ureteric calculi can be incorrect in about 28% of pregnant patients.
Main body
Management of ureteric stone during pregnancy is remaining to be a challenge for the treating urologist. Because of the inability to use good imaging options for the diagnosis confirmation and more invasive approach for the treatment, management continues to be difficult. The main threats are preterm labor with delivery and premature rupture of membranes. Other pregnancy complications are obstructive uropathy, gestational diabetes mellitus, recurrent abortions and pre-eclampsia. Management of diagnosed ureteric stone is unique in the pregnant population and requires multi-disciplinary care. It should be individualized for each patient and moves preferably from conservative to invasive approaches sequentially. With continued advancements in endourological techniques, few definitive treatment options are also available for such patients.
Conclusion
There are several lacunae related with the diagnostic imaging, medical expulsive therapy, reliability of ureteral stent/percutaneous nephrostomy insertions and safety of ureteroscopy during pregnancy. Herein, we review the management of ureteric stone during pregnancy, the various diagnostic modalities and treatment options with their advantages and disadvantages. We also proposed our management algorithm to deal with such clinical scenario in this particular population.
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Rodgers CC. Continuous electronic fetal monitoring during prolonged labor may be a risk factor for having a child diagnosed with autism spectrum disorder. Med Hypotheses 2020; 145:110339. [PMID: 33126162 DOI: 10.1016/j.mehy.2020.110339] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2020] [Revised: 09/23/2020] [Accepted: 10/05/2020] [Indexed: 11/16/2022]
Abstract
In just 50 years the prevalence of autism spectrum disorder has vaulted from extremely rare to common in every community. During this time, a large body of scientific literature has been amassed regarding what environmental, genetic, maternal, or obstetric factors may be at work. The hypothesis presented here identifies two developments in today's childbirth experience that, in combination, may provide the key: 1) a significant increase in the mean duration of labor and 2) the adoption of continuous electronic fetal monitoring utilizing Doppler ultrasound as the standard of care even in low-risk pregnancies. Together, these two factors have created an unprecedented fetal environment that has the potential to affect neuronal migration and cause non-inherited genetic disruptions. This paper will briefly describe the nature and history of contributing factors, why there may be a link between evolving maternal characteristics, obstetric trends and the increase in autism, as well as the means by which the hypothesis can be tested.
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Forster D, Schwarz JH, Brosinski K, Kalinke U, Sutter G, Volz A. Obstetric Ultrasonography to Detect Fetal Abnormalities in a Mouse Model for Zika Virus Infection. Viruses 2020; 12:v12010072. [PMID: 31936159 PMCID: PMC7019633 DOI: 10.3390/v12010072] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2019] [Revised: 12/22/2019] [Accepted: 01/02/2020] [Indexed: 01/06/2023] Open
Abstract
In 2015 Zika virus (ZIKV) emerged for the first time in South America. The following ZIKV epidemic resulted in the appearance of a clinical phenotype with microcephaly and other severe malformations in newborns. So far, mechanisms of ZIKV induced damage to the fetus are not completely understood. Previous data suggest that ZIKV may bypass the placenta to reach the fetus. Thus, animal models for ZIKV infection are important to facilitate studies about ZIKV infection during pregnancy. Here, we used ultrasound based imaging (USI) to characterize ZIKV induced pathogenesis in the pregnant Type I interferon receptor-deficient (IFNAR-/-) mouse model. Based on USI we suggest the placenta to be a primary target organ of ZIKV infection enabling ZIKV spreading to the fetus. Moreover, in addition to direct infection of the fetus, the placental ZIKV infection may cause an indirect damage to the fetus through reduced uteroplacental perfusion leading to intrauterine growth retardation (IUGR) and fetal complications as early as embryonic day (ED) 12.5. Our data confirmed the capability of USI to characterize ZIKV induced modifications in mouse fetuses. Data from further studies using USI to monitor ZIKV infections will contribute to a better understanding of ZIKV infection in pregnant IFNAR-/- mice.
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Affiliation(s)
- Dominik Forster
- Institute for Infectious Diseases and Zoonoses, Ludwig-Maximilians-Universität Munich, 80539 Munich, Germany; (D.F.); (J.H.S.); (K.B.); (G.S.)
| | - Jan Hendrik Schwarz
- Institute for Infectious Diseases and Zoonoses, Ludwig-Maximilians-Universität Munich, 80539 Munich, Germany; (D.F.); (J.H.S.); (K.B.); (G.S.)
| | - Katrin Brosinski
- Institute for Infectious Diseases and Zoonoses, Ludwig-Maximilians-Universität Munich, 80539 Munich, Germany; (D.F.); (J.H.S.); (K.B.); (G.S.)
| | - Ulrich Kalinke
- Institute for Experimental Infection Research, TWINCORE, Centre for Experimental and Clinical Infection Research, a joint venture between the Helmholtz Centre for Infection Research Braunschweig and the Hannover Medical School, 30625 Hannover, Germany
| | - Gerd Sutter
- Institute for Infectious Diseases and Zoonoses, Ludwig-Maximilians-Universität Munich, 80539 Munich, Germany; (D.F.); (J.H.S.); (K.B.); (G.S.)
- German Center for Infection Research (DZIF), partner site Munich, 80539 Munich, Germany
| | - Asisa Volz
- Institute for Infectious Diseases and Zoonoses, Ludwig-Maximilians-Universität Munich, 80539 Munich, Germany; (D.F.); (J.H.S.); (K.B.); (G.S.)
- German Center for Infection Research (DZIF), partner site Munich, 80539 Munich, Germany
- Correspondence: ; Tel.: +49-89-2180-2612
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Bagley JE, Nematzadeh F, Spitz JL, Baldwin J. Written Feedback on Thermal Index During the First-Trimester Nuchal Translucency Examination Does Not Improve Compliance With the “as Low as Reasonably Achievable” Principle. JOURNAL OF DIAGNOSTIC MEDICAL SONOGRAPHY 2019. [DOI: 10.1177/8756479319871252] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Objective: The null hypothesis was that there would be no change in as low as reasonably achievable (ALARA) behavior based on feedback from comments on the nuchal translucency quality review (NTQR) image submissions. Methods: A review of the Perinatal Quality Foundation Database found 206 practitioners who failed their first credential attempt and received ALARA comments as feedback. The second submissions of the same subjects were reviewed to determine if compliance with ALARA improved following written feedback. Results: Seventeen percent of all second submissions addressed ALARA. Sixty-one percent of second submissions passed, however only 18.4 % of those addressed ALARA. Among those who submitted thermal index at bone values on both first and second submissions, the mean values on the second submission were 0.20 lower compared to the first submission ( P = .0288). Second submission mean thermal index at bone values were 0.68 lower among those submissions with ALARA concerns addressed compared to those not addressing these concerns ( P < .001). Conclusions: Written feedback without consequences on the ALARA principle did not improve compliance.
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Affiliation(s)
- Jennifer E. Bagley
- Department of Medical Imaging and Radiation Sciences, University of Oklahoma Health Sciences Center, Schusterman Center, Tulsa, OK, USA
| | - Freshta Nematzadeh
- Department of Medical Imaging and Radiation Sciences, University of Oklahoma Health Sciences Center, Schusterman Center, Tulsa, OK, USA
| | | | - Jonathan Baldwin
- Department of Medical Imaging and Radiation Sciences, University of Oklahoma Health Sciences Center, Schusterman Center, Tulsa, OK, USA
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Bölte S, Girdler S, Marschik PB. The contribution of environmental exposure to the etiology of autism spectrum disorder. Cell Mol Life Sci 2019; 76:1275-1297. [PMID: 30570672 PMCID: PMC6420889 DOI: 10.1007/s00018-018-2988-4] [Citation(s) in RCA: 253] [Impact Index Per Article: 50.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2018] [Revised: 11/14/2018] [Accepted: 12/04/2018] [Indexed: 01/04/2023]
Abstract
Autism spectrum disorder (ASD) is a neurodevelopmental condition of heterogeneous etiology. While it is widely recognized that genetic and environmental factors and their interactions contribute to autism phenotypes, their precise causal mechanisms remain poorly understood. This article reviews our current understanding of environmental risk factors of ASD and their presumed adverse physiological mechanisms. It comprehensively maps the significance of parental age, teratogenic compounds, perinatal risks, medication, smoking and alcohol use, nutrition, vaccination, toxic exposures, as well as the role of extreme psychosocial factors. Further, we consider the role of potential protective factors such as folate and fatty acid intake. Evidence indicates an increased offspring vulnerability to ASD through advanced maternal and paternal age, valproate intake, toxic chemical exposure, maternal diabetes, enhanced steroidogenic activity, immune activation, and possibly altered zinc-copper cycles and treatment with selective serotonin reuptake inhibitors. Epidemiological studies demonstrate no evidence for vaccination posing an autism risk. It is concluded that future research needs to consider categorical autism, broader autism phenotypes, as well as autistic traits, and examine more homogenous autism variants by subgroup stratification. Our understanding of autism etiology could be advanced by research aimed at disentangling the causal and non-causal environmental effects, both founding and moderating, and gene-environment interplay using twin studies, longitudinal and experimental designs. The specificity of many environmental risks for ASD remains unknown and control of multiple confounders has been limited. Further understanding of the critical windows of neurodevelopmental vulnerability and investigating the fit of multiple hit and cumulative risk models are likely promising approaches in enhancing the understanding of role of environmental factors in the etiology of ASD.
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Affiliation(s)
- Sven Bölte
- Department of Women's and Children's Health, Karolinska Institutet & Child and Adolescent Psychiatry, Stockholm Health Care Services, Center of Neurodevelopmental Disorders (KIND), Centre for Psychiatry Research, Stockholm County Council, Stockholm, Sweden.
- Curtin Autism Research Group, School of Occupational Therapy, Social Work and Speech Pathology, Curtin University, Perth, WA, Australia.
| | - Sonya Girdler
- Curtin Autism Research Group, School of Occupational Therapy, Social Work and Speech Pathology, Curtin University, Perth, WA, Australia
| | - Peter B Marschik
- Department of Women's and Children's Health, Karolinska Institutet & Child and Adolescent Psychiatry, Stockholm Health Care Services, Center of Neurodevelopmental Disorders (KIND), Centre for Psychiatry Research, Stockholm County Council, Stockholm, Sweden
- Department of Child and Adolescent Psychiatry and Psychotherapy, University Medical Center Göttingen, Göttingen, Germany
- iDN-interdisciplinary Developmental Neuroscience, Department of Phoniatrics, Medical University of Graz, Graz, Austria
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Rosman NP, Vassar R, Doros G, DeRosa J, Froman A, DiMauro A, Santiago S, Abbott J. Association of Prenatal Ultrasonography and Autism Spectrum Disorder. JAMA Pediatr 2018; 172:336-344. [PMID: 29435580 PMCID: PMC5875374 DOI: 10.1001/jamapediatrics.2017.5634] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/27/2017] [Accepted: 12/07/2017] [Indexed: 12/28/2022]
Abstract
Importance The prevalence of autism spectrum disorder (ASD) has been increasing rapidly, with current estimates of 1 in 68 children affected. Simultaneously, use of prenatal ultrasonography has increased substantially, with limited investigation into its safety and effects on brain development. Animal studies have demonstrated that prenatal ultrasonography can adversely affect neuronal migration. Objective To quantify prenatal ultrasound exposure by the frequency, timing, duration, and strength of ultrasonographic scans in children with later ASD, developmental delay, and typical development. Design, Setting, and Participants This case-control study included 107 patients with ASD, 104 control individuals with developmental delay, and 209 controls with typical development. Participants were identified from medical records based on prenatal care and delivery at Boston Medical Center, a diverse, academic, safety-net medical center, from July 1, 2006, through December 31, 2014, with a gestational age at birth of at least 37 weeks. Data were analyzed from May 1, 2015, through November 30, 2017. Exposures Ultrasonographic exposure was quantified by the number and timing of scans, duration of exposure, mean strength (depth, frame rate, mechanical index, and thermal index), and time of Doppler and 3- and 4-dimensional imaging. Main Outcomes and Measures Among participants with ASD and controls with developmental delay and typical development, ultrasound exposure was quantified and compared per trimester and for the entire pregnancy, with adjustment for infant sex, gestational age at birth, and maternal age. Results A total of 420 participants were included in the study (328 boys [78.1%] and 92 girls [21.9%]; mean age as of January 1, 2016, 6.6 years; 95% CI, 6.5-6.8 years). The ASD group received a mean of 5.9 scans (95% CI, 5.2-6.6), which was not significantly different from the 6.1 scans (95% CI, 5.4-6.8) in the developmental delay group or the 6.3 scans (95% CI, 5.8-6.8) in the typical development group. Compared with the typical development group, the ASD group had shorter duration of ultrasound exposure during the first (290.4 seconds [95% CI, 212.8-368.0 seconds] vs 406.4 seconds [95% CI, 349.5-463.3 seconds]) and second (1687.6 seconds [95% CI, 1493.8-1881.4 seconds] vs 2011.0 seconds [95% CI, 1868.9-2153.1 seconds]) trimesters but no difference in the number of scans. The ASD group had greater mean depth of ultrasonographic penetration than the developmental delay group in the first trimester (12.5 cm [95% CI, 12.0-13.0 cm] vs 11.6 cm [95% CI, 11.1-12.1 cm]). The ASD group had greater mean depth than the typical development group during the first (12.5 cm [95% CI, 12.0-13.0 cm] vs 11.6 cm [95% CI, 11.3-12.0 cm]) and the second (12.9 cm [95% CI, 12.6-13.3 cm] vs 12.5 cm [95% CI, 12.2-12.7 cm]) trimesters. Conclusions and Relevance This study found significantly greater mean depth of ultrasonographic penetration in the ASD group compared with the developmental delay group in the first trimester and compared with the typical development group in the first and second trimesters. Further research is needed to determine whether other variables of ultrasound exposure also have adverse effects on the developing fetus.
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Affiliation(s)
- N. Paul Rosman
- Department of Pediatrics, Boston University School of Medicine, Boston Medical Center, Boston, Massachusetts
- Department of Neurology, Boston University School of Medicine, Boston Medical Center, Boston, Massachusetts
- Division of Pediatric Neurology, Boston University School of Medicine, Boston Medical Center, Boston, Massachusetts
- Departments of Pediatrics and Neurology, Division of Pediatric Neurology, Boston Medical Center, Boston, Massachusetts
| | - Rachel Vassar
- medical student at Boston University School of Medicine, Boston, Massachusetts
- Department of Pediatrics, Benioff Children’s Hospital, University of California, San Francisco
| | - Gheorghe Doros
- Department of Biostatistics, Boston University School of Public Health, Boston, Massachusetts
| | - James DeRosa
- graduate student at Boston University School of Public Health, Boston, Massachusetts
| | - Allison Froman
- graduate student at Boston University School of Public Health, Boston, Massachusetts
| | - Audrey DiMauro
- medical student at Boston University School of Medicine, Boston, Massachusetts
- Department of Pediatrics, Floating Hospital for Children, Tufts Medical Center, Boston, Massachusetts
| | - Sherry Santiago
- Division of Pediatric Neurology, Boston University School of Medicine, Boston Medical Center, Boston, Massachusetts
- Division of Pediatric Neurology, Puerto Rico Children’s Hospital, Bayamón, Puerto Rico
| | - Jodi Abbott
- Division of Maternal and Fetal Medicine, Department of Obstetrics and Gynecology, Boston University School of Medicine, Boston, Massachusetts
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10
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Quality and Safety of Obstetric Practices Using New Modalities— Ultrasound, MR, and CT. Clin Obstet Gynecol 2017; 60:546-561. [DOI: 10.1097/grf.0000000000000300] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
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11
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Ultrasound in Assisted Reproductive Technologies and the First Trimester: Is There a Risk? Clin Obstet Gynecol 2017; 60:121-132. [DOI: 10.1097/grf.0000000000000256] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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12
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Webb SJ, Garrison MM, Bernier R, McClintic AM, King BH, Mourad PD. Severity of ASD symptoms and their correlation with the presence of copy number variations and exposure to first trimester ultrasound. Autism Res 2016; 10:472-484. [PMID: 27582229 DOI: 10.1002/aur.1690] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2015] [Revised: 04/07/2016] [Accepted: 07/21/2016] [Indexed: 01/13/2023]
Abstract
Current research suggests that incidence and heterogeneity of autism spectrum disorder (ASD) symptoms may arise through a variety of exogenous and/or endogenous factors. While subject to routine clinical practice and generally considered safe, there exists speculation, though no human data, that diagnostic ultrasound may also contribute to ASD severity, supported by experimental evidence that exposure to ultrasound early in gestation could perturb brain development and alter behavior. Here we explored a modified triple hit hypothesis [Williams & Casanova, ] to assay for a possible relationship between the severity of ASD symptoms and (1) ultrasound exposure (2) during the first trimester of pregnancy in fetuses with a (3) genetic predisposition to ASD. We did so using retrospective analysis of data from the SSC (Simon's Simplex Collection) autism genetic repository funded by the Simons Foundation Autism Research Initiative. We found that male children with ASD, copy number variations (CNVs), and exposure to first trimester ultrasound had significantly decreased non-verbal IQ and increased repetitive behaviors relative to male children with ASD, with CNVs, and no ultrasound. These data suggest that heterogeneity in ASD symptoms may result, at least in part, from exposure to diagnostic ultrasound during early prenatal development of children with specific genetic vulnerabilities. These results also add weight to on-going concerns expressed by the FDA about non-medical use of diagnostic ultrasound during pregnancy. Autism Res 2017, 10: 472-484. © 2016 International Society for Autism Research, Wiley Periodicals, Inc.
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Affiliation(s)
- Sara Jane Webb
- Center on Child Health, Behavior and Development, Seattle Children's Research Institute, Seattle, Washington.,Departments of Psychiatry & Behavioral Science, Neurological Surgery, Seattle, Washington
| | - Michelle M Garrison
- Center on Child Health, Behavior and Development, Seattle Children's Research Institute, Seattle, Washington.,Departments of Psychiatry & Behavioral Science, Neurological Surgery, Seattle, Washington
| | - Raphael Bernier
- Departments of Psychiatry & Behavioral Science, Neurological Surgery, Seattle, Washington
| | - Abbi M McClintic
- Departments of Psychiatry & Behavioral Science, Neurological Surgery, Seattle, Washington
| | - Bryan H King
- Center on Child Health, Behavior and Development, Seattle Children's Research Institute, Seattle, Washington
| | - Pierre D Mourad
- Departments of Psychiatry & Behavioral Science, Neurological Surgery, Seattle, Washington.,Division of Engineering and Mathematics, University of Washington, Seattle, Washington
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Helmy S, Bader Y, Koch M, Tiringer D, Kollmann C. Measurement of Thermal Effects of Doppler Ultrasound: An In Vitro Study. PLoS One 2015; 10:e0135717. [PMID: 26302465 PMCID: PMC4547707 DOI: 10.1371/journal.pone.0135717] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2015] [Accepted: 07/24/2015] [Indexed: 11/24/2022] Open
Abstract
Objective Ultrasound is considered a safe imaging modality and is routinely applied during early pregnancy. However, reservations are expressed concerning the application of Doppler ultrasound in early pregnancy due to energy emission of the ultrasound probe and its conversion to heat. The objective of this study was to evaluate the thermal effects of emitted Doppler ultrasound of different ultrasound machines and probes by means of temperature increase of in-vitro test-media. Methods We investigated the energy-output of 5 vaginal and abdominal probes of 3 ultrasound machines (GE Healthcare, Siemens, Aloka). Two in-vitro test objects were developed at the Center for Medical Physics and Biomedical Engineering, Medical University Vienna (water bath and hydrogel bath). Temperature increase during Doppler ultrasound emission was measured via thermal sensors, which were placed inside the test objects or on the probes’ surface. Each probe was emitting for 5 minutes into the absorbing test object with 3 different TI/MI settings in Spectral Doppler mode. Results During water bath test, temperature increase varied between 0.1 and 1.0°C, depending on probe, setting and focus, and was found highest for spectral Doppler mode alone. Maximum temperature increase was found during the surface heating test, where values up to 2.4°C could be measured within 5 minutes of emission. Conclusions Activation of Doppler ultrasound in the waterbath model causes a significant increase of temperature within one minute. Thermally induced effects on the embryo cannot be excluded when using Doppler ultrasound in early pregnancy.
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Affiliation(s)
- Samir Helmy
- Department of Obstetrics and Gynecology, Medical University Vienna, Vienna, Austria
- * E-mail:
| | - Yvonne Bader
- Department of Gynecology, Obstetrics and Reproductive Medicine, University Clinic of Saarland, Homburg, Germany
| | - Marianne Koch
- Department of Obstetrics and Gynecology, Medical University Vienna, Vienna, Austria
- Karl Landsteiner Society, Austria
| | - Denise Tiringer
- Department of Obstetrics and Gynecology, Medical University Vienna, Vienna, Austria
| | - Christian Kollmann
- Center for Medical Physics and Biomedical Engineering, Medical University Vienna, Vienna, Austria
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Casanova MF. Autism as a sequence: from heterochronic germinal cell divisions to abnormalities of cell migration and cortical dysplasias. Med Hypotheses 2014; 83:32-8. [PMID: 24780284 PMCID: PMC4070182 DOI: 10.1016/j.mehy.2014.04.014] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2014] [Revised: 03/11/2014] [Accepted: 04/06/2014] [Indexed: 02/07/2023]
Abstract
The considerable heterogeneity in the number and severity of symptoms observed in autism spectrum disorders (ASD) has been regarded as an obstacle to any future research. Some authors believe that clinical heterogeneity results from the complex interplay of the many genetic and environmental factors that themselves define a condition as multifactorial. However, it is important to note that neuropathological findings in both idiopathic and syndromic autism suggests a single pathophysiological mechanism acting during brain development: the heterochronic division of germinal cells and subsequent migrational abnormalities of daughter cells to their target fields. Multiple exogenous (e.g., viruses, drugs) and endogenous (e.g., genetic mutations) factors are known to disrupt the division of germinal cells and provide for an autism phenotype. The variety of endogenous and exogenous factors, their timing of action during brain development, and the genetic susceptibility of affected individuals (a Triple Hit hypothesis) may all account for the clinical heterogeneity of ASD.
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Affiliation(s)
- Manuel F Casanova
- Department of Psychiatry, University of Louisville, 500 South Preston Street, Building A, Room 217, Louisville, KY 40202, United States.
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