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The Provision of Limited Obstetrical Ultrasound in the Second and Third Trimesters of Pregnancy

January 2004
By: Thomas Glessner

The National Institute of Family and Life Advocates (NIFLA) promotes limited obstetrical ultrasound examinations at pregnancy help medical clinics. In promoting ultrasound we have found that there is a great deal of confusion regarding the nature of the ultrasound exam given at a pregnancy center and the scope of this exam. Some centers are reluctant to have sonographers provide ultrasound services beyond the first trimester of pregnancy, believing that such examinations increase the risk of legal liability. That may be true; however, NIFLA believes that the benefits outweigh the risks.

The vast majority of ultrasound examinations at pregnancy help medical clinics are performed during the first trimester of pregnancy. However, according to the Alan Guttmacher Institute, approximately 12% of abortions (156,000 per year) occur after the first trimester. Since a significant number of abortions occur in the second and third trimesters, ultrasound examinations should not be limited to the first trimester.

The decision to provide ultrasound examinations in the second and third trimesters falls to the medical director of the pregnancy help medical clinic. This assessment should be based solely upon the training and competency of the nurse/sonographer to perform ultrasound examinations at these stages of pregnancy. The medical director of each center is the person uniquely qualified to make such a determination.

According to the Alan Guttmacher Institute approximately 12% of abortions (156,000 per year) occur after the first trimester. 

A consistent pro-life worldview requires that we do everything possible to save all unborn lives subject to the possibility of abortion—including those babies who are gestationally in the second and third trimesters. Proper training, risk management, policies and procedures, the performance of a limited ultrasound exam, and the recruitment of qualified medical personnel all serve as proper checks against the risks of legal liability. However, unreasonable fears of legal liability should not deter us from providing a window to the womb for mothers considering second and third trimester abortions.

Current medical literature indicates that fetal abnormalities can be found through ultrasound in all three trimesters of pregnancy. "Ongoing improvements in ultrasound technology allow us to see more details of the embryo or fetus at earlier gestational ages than ever before. This is resulting in a rethinking of when the first anatomical survey should be performed" (Monteagudo A, Timor-Tritsch IE, "First trimester anatomy scan: pushing the limits. What can we see now?" Current Opinion in Obstetrics and Gynecology, 2003 Apr; 15(2): 131-141). "As sonographic spatial resolution continues to improve, first trimester sonography increasingly will offer early pregnancy screening for chromosomal abnormalities and fetal structural abnormalities" (Lazarus E., "What's new in the first trimester ultrasound," The Radiologic Clinics of North America, 2003 Jul; 41(4): 663-679).

It is clear that as technology advances the future medical standard of care for ultrasound will require screening for fetal abnormalities in the first trimester. Hence, current concerns of liability for failure to identify such abnormalities cannot be limited to just examinations performed in the second and third trimesters. If such concerns prevent the provision of ultrasound services in later stages of pregnancy, then eventually such concerns will justify the prohibition of ultrasound in the first trimester of pregnancy. Accordingly, legal concerns surrounding liability issues for ultrasound examinations should be based upon the category of ultrasound examination performed not upon the gestational age of the pregnancy.

A limited ultrasound exam, as opposed to a Level I or Level II exam, under the direction and supervision of a qualified physician provides the legal protection to answer such concerns. A limited exam can be performed in all trimesters of pregnancy. Such exam is limited in scope to find only specific information regarding this pregnancy, i.e., fetal heartbeat and gestational age. A pregnancy help medical clinic can confidently provide limited ultrasound exams in all three trimesters of pregnancy when: 1) a proper consent form is used to inform the patient of the nature of the limited exam; 2) the performance of the exam is under the supervision of a physician qualified to oversee the exam; and 3) the nurse/ sonographer providing the exam is properly trained and is approved by the medical director. A pregnancy help medical clinic will significantly lower the risks of legal liability by adhering to these policies.

NIFLA takes seriously the concerns of increased exposure to legal liability through the identification by ultrasound of fetal abnormalities in any stage of pregnancy. However, our core values are rooted in the firm belief that all unborn children are made in the image of God whether or not they suffer from physical handicaps. Since every life is sacred to God, pregnancy help medical clinics should courageously face any increased risks of liability related to the performance of ultrasound at any stage of pregnancy. When fetal abnormalities are identified, we believe that women and unborn children are always better served in a life-affirming medical setting, where the core value of the sanctity of life is not compromised.

Thomas A. Glessner, J.D., is president of the National Institute of Family and Life Advocates (NIFLA).

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