South Carolina's Pre-abortion Ultrasounds

The South Carolina legislature is proposing mandatory ultrasounds for women considering pregnancy termination. The proposal, brought by non-physicians, raises multiple medical, financial, and ethical concerns. For many reasons, pre-abortion ultrasounds would create more problems than they would solve. Obvious crucial questions include: Who would perform each ultrasound - an ultrasound technician or a physician? What type of ultrasound would be performed - screening, anatomic, Advanced Life Support in Obstetrics (ALSO)-level, or other? Who would read the ultrasounds? Primary care physicians, radiologists, or perinatologists? Each has different skills. Who would convey results to patients? A physician, an ultrasound technician, or other medical staff? Would results include a written report? Would patients be offered counseling after the ultrasounds? Who would be liable for incorrect information? Politicians have called pre-abortion ultrasounds "accurate" and "non-judgmental". Ultrasounds, however, are imperfect tests. Information obtainable depends on gestational age, operator skill, and interpreter training. Anatomic surveys, for instance, can only be done only after about 17 weeks of gestation. Even gender determination is not 100% accurate. Ultrasounds must be interpreted in the context of other tests. Routine prenatal testing includes maternal screening for blood type, HIV, STDs, rubella immunity, and diabetes. Fetal studies including genetic testing, and viability and anatomic ultrasounds. Mothers can only make informed decisions about their pregnancies with all test results, and the proposed one hour to make a decision regarding abortion after an ultrasound is absurd. Suppose a pre-abortion ultrasound detects a major developmental abnormality, such as anencephaly or a neural tube defect? Suppose a mother tests positive for HIV before a pre-abortion ultrasound; or after? Pre-abortion ultrasounds raise ethical concerns for multiple reasons. Epidemiologically, reasons for seeking pregnancy termination may equate to risk factors for pregnancy complications. Low socioeconomic status, for instance, correlates with multiple pregnancy terminations. It is also a risk factor for stillbirth, gestational diabetes, low birthweight, and other complications. Pre-abortion ultrasounds stand to select for complicated pregnancies. Aside from technical issues, ultrasounds are expensive to perform and interpret. Each pre-abortion ultrasound could necessitate additional diagnostic and therapeutic interventions. Add increased costs for higher-risk pregnancies, and pre-abortion ultrasounds would further stress obstetrical systems already strained by high liability. Pre-abortion ultrasounds would mandate the provision at great cost of incomplete information to women possibly at risk for complicated pregnancies. One alternative may be to offer optional pre-abortion ultrasounds. This may save short-term costs, yet is still fraught with the same pitfalls. Every test brings a responsibility to act on the results. Clearly, medical, financial, and ethical issues far outweigh the benefits of mandatory pre-abortion ultrasounds. Though not a resident of South Carolina, I am a physician who has cared for many pregnant women. I am an American citizen and a medical professional, and must protest when politics inappropriately interfere with medical practice and policy. I am surprised that South Carolina republicans support a program extending government control into private life, and I am appalled at the deleterious consequences. As South Carolina attempts to mandate unneeded, costly, and possibly harmful medical testing for part of its population, thousands go without any health care at all. As a citizen and physician, I expect our politicians to help resolve these greater priorities of our health care system, locally and nationwide.