ad. 1. Prenatal, genetic, 3D, 4D, 4D HDlive examinations. Which of these should I undergo during pregnancy?

A lot of patients are confused when they browse examinations offers of the ultrasound centres, health centres and hospitals. New terms, like prenatal, genetic, 3D, 4D, 4D HDlive might be unclear, and as a result, cause difficulty in choosing an appropriate centre and necessary examinations.

To begin with, let us emphasize that these terms are often just pure marketing in order to draw more patients to a given centre. Pretty pictures, placed on websites, have a similar aim. Unfortunately, it is not always backed by the experience in detecting anomalies. Experience does not depend on the terms or the medical equipment, but it depends on the skills, predisposition, and knowledge of a specialist in the field of detecting congenital defects and genetic syndromes in fetuses. In fact, there are very few experienced specialists in Poland, which shows a lot of ultrasound examinations on the market in a bad light.

A questionable ultrasound image will be sent to a specialist having diagnostic experience either way, in order to properly diagnose or exclude a problem. An average OB/GYN physician, who does not have everyday contact with anomalies in ultrasound, encounters only several anomalies throughout his career, which makes it difficult for him to know what to look for and how to classify a given anomaly. A scan performed by a proper specialist reduces the entire process, always connected with the necessity to dedicate additional time to visit a specialist with an experience in this field.

The term “prenatal” appeared along with the Prenatal Program, created by the National Health Fund, ensuring ultrasound examinations in the first and second trimester for selected patients. In reality, the term “prenatal” means all the examinations performed prior to birth.
The term “genetic” originated in the USA, although it is rarely used with the same meaning, as it requires analysts with experience in detecting the Down syndrome in the second trimester. A vast majority of specialists have no contact with such cases, and for this reason, this term, in our personal opinion, is highly overused in the offers (a detailed description can be found in the answer to the question: “What is genetic ultrasound examination?”).
3D and 4D, as well as 4D HDlive, are often understood by patients as more accurate examinations, but they are useful only when an anomaly has been confirmed, to specify a diagnosis, but not to exclude a congenital defect in a correctly developing fetus. 3D technique had spread commonly because of the interesting effects of a reconstructed image, which we use only as an addition during the examination, provided that a baby is properly positioned and a patient is rather slim. We do not charge for such so-called commercial 3D/4D scans because we take the position that it would be unfair giving no diagnostic benefits to a patient. In the respect of that, we do not offer 3D/4D examinations. The 3D reconstruction technique is constantly developing. There are new methods, such as HDlive mode which we tested in 2011 and 2012, but they are still only additions, having nothing in common with the diagnostic purposes of ultrasound. The requirement of proper circumstances for an examination remains unchanged, which means that we can “play” with the reconstruction only in limited cases. Of course, an image on websites or brochures will always draw attention as it is simply interesting.

The term “4D HDlive has nothing in common with HD television. It is a kind of reconstruction of the surface of a fetal body giving interesting effects, resulting from the possibility to control virtual lighting. It has no use in the field of diagnostics. It gives good artistic impressions in an early pregnancy. Similar to other 3D reconstruction techniques, 4D requires proper examination conditions, which makes it available only for some patients and is only an addition to an examination. This kind of additions to an ultrasound examination in the form of images of faces, limbs or gender should not cover the real purpose which is an examination of anatomy and activity of a fetus. That is why, each self-respecting sonologist would not draw your attention to the images but to the assessment of the health of a baby.

To sum up, irrespective of the terms, three well-performed examinations should be conducted during pregnancy: first one, at about 12 weeks; second one between 18 and 20 weeks and the third one between 28 and 32 weeks, carried out by a specialist who knows what to look for that is the one who deals with fetal anomalies. We recommend checking the qualifications of the specialists as well as their experience in the field of detecting defects. It may save your time and the number of ultrasound scans. The medical equipment has a secondary meaning, as a detailed examination can be performed on nearly all devices currently available on the market. Please remember that even the best apparatus will not help a less experienced specialist in making a diagnosis.