Doppler Ultrasound in Detecting Fetal Anomalies

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Terry DuBose, M.S.:  “We’re at the 44^th Annual Conference of the AIUM in San Francisco in April of 2000, and we have Yaron Zalel from Israel here. He has done quite a bit of work in gynecology, particularly in Doppler and fetal analysis or fetal anomaly diagnosis.  Why don’t you tell us where you’re from and what you do?”

Dr. Zalel:  “Thanks, Terry.  I work at the Sheba Medical Center that’s in Tel-Hashomer Hospital in the center of Israel.  Our main topics are prenatal diagnosis and gynecologic ultrasound, especially Doppler ultrasound.  In prenatal diagnosis we are dividing the exam into three main exams.  The first is done at 12 weeks with nuchal translucency; it’s brought to us by Professor Nicholides from England.  The second is an early scan for fetal anomalies done at 14-16 weeks of pregnancy, and the third scan for fetal anomalies is done at about 22-24 weeks of pregnancy.”

Terry DuBose, M.S.:  “So you do more than one exam per pregnancy routinely.”

Dr. Zalel:  “Right, we know that in the states there is only one scan that is done between 18-20 weeks of pregnancy.”

Terry DuBose, M.S.:  “Only one that gets paid for by insurance.”

Dr. Zalel:  “Yes, but if we’re talking logically and from the medical point of view, we think it’s much better to do the nuchal translucency.  Then you exclude or include those willing to continue the pregnancy or those where we have to do some things according to this exam especially the early scan for fetal anomalies done at 15 weeks of pregnancy.  As Professor Timor-Tritsch said yesterday - you can prepare the pregnancy according to these results because if you see the woman for the first time at 21 weeks of pregnancy, it might be too late to do things.  And if you see her at 15 weeks of pregnancy, I would say everything is okay and you have to do an amniocentesis to exclude chromosomal abnormalities or saying this is a fetus with anomalies that are incompatible with life so you can abort at 15 weeks instead of 24 weeks.”

Terry DuBose, M.S.:  “It is better that way, yes.  You also get a better idea of fetal growth and progression of size so if you pick up on the growth problems… whereas with one sonographic examination you have no idea what’s going on.”

Dr. Zalel:  “Right, especially when you’re dealing with a more difficult pregnancy.  A more difficult pregnancy is sometimes the first time that the woman is seen at 15 weeks of pregnancy.  If you see her at 7-8 weeks, with a more difficult pregnancy, you can know the whole chronicity, the amnionicity, and prepare according to this.”

Terry DuBose, M.S.:  “Yes, I agree it’s much more logical.  The problem we have here is the insurance companies and the government don’t want to pay for more than one sonographic examination, that is the problem."

Dr. Zalel:  “Yes, I know it’s a problem too as far as the government is concerned but most of the early scans are done privately. That’s why there are some people in Israel that are very experienced in it, because we are doing it.  I’ve been doing it for the last ten years, and a colleague that started it fifteen years ago is the most experienced in the world in early transvaginal scans and we are getting more and more experience in it.”

Terry DuBose, M.S.:  “That’s good, and I appreciate your visiting with us.  I think it’s good work and I hope America will follow suit, it’s time.  Thank you very much.”

Dr. Zalel:  “Thanks a lot.”