Against – 3D ultrasound in first and second trimester pregnancy – hype or helpful?

DEBATE " It is impossible to read through an imaging journal nowadays and turn a blind eye to the plethora of articles dealing with different aspects of three and four-dimensional ultrasound in our specialty " 1. This statement was made in 2007 and is concordant with my current literature review. Superficially, the message obtained from the mere volume of material could be that 3D ultrasound has a significant place in O&G imaging. The reality is that in the first and second trimesters of pregnancy 3D ultrasound is merely hype. This debate will not address gynaecological 3D imaging. The concept that 3D ultrasound should be helpful is logical. Information obtained in volumes rather than slices and presentation in lifelike images, could easily improve accuracy in spatial calculations, diagnosis and communication. However, it is now twenty years since the first publication of a system for the three-dimensional reconstruction of a fetus 2. Twenty years and we are still debating its usefulness. Surely that in itself supports, that in the main, we are dealing with hype. Initially the slow applicability in first and second trimester pregnancy could be excused due to technical hurdles. These included cumbersome transducer manipulation to acquire data and time-consuming off-line computer processing to produce meaningful displays. But, over the last five years, many advances in technology have been directly relevant to obstetric 3D use. " First, an increasingly fast acquisition speed, enabling quick sequences of fast moving organs such as the heart to be captured. Second, the increasing number of display modalities, making understanding and analysis of normal anatomy and pathology easier for clinicians " 1. It follows that this would account for the recent explosion in volume and diversity of publications relating to 3D ultrasound in pregnancy. It is true, the obstetric community awaits a solution to the at least one major issue that besieges 2D imaging: operator dependence, suboptimal detection of abnormalities at screening and lack of evidence for improvement in perinatal outcomes. But, the irony of 3D imaging in first and second trimester pregnancy is that the main outcome from all this sophisticated research and development so far, is the ability to produce an instant surface rendered image of a fetal face at a routine 18 to 20 week scan or later – hype not helpful. Limitations Like any imaging technique, 3D in the first and second trimester of pregnancy has common problems that need to …