How Things Were Before Ultrasound
Mary Cronk said in response to being asked on the Midwifery egroup how things were before the development of ultrasound:
I am trying to remember. I think that we did not realise just how common and "normal" was early fetal loss. Taking menstrual history when booking women we were often told of long cycles and then a "very heavy period" which was most probably an early fetal loss/missed abortion. Women would sometimes wonder with us if it had been.
The received wisdom was to wait until two or three periods had been missed before seeing one's doctor or midwife and we diagnosed a probable pregnancy on the history, and feeling a palpable uterus per abdomen. Nausea and vomiting was another probable sign. And very excessive N&V could alert one to either a multiple pregnancy or a molar pregnancy and a pregnancy test was excessively positive.
There were several pregnancy tests available which relied on identifying the presence of human gonadotrophin in the urine. Urine from the woman was injected into various immature animals: mice for the Ascheim-Zondek test, rabbits for the Friedman test and frogs from South Africa for the Hogben test. If the animals then ovulated the woman was probably pregnant. Mice and rabbits were killed but the frogs could be used again and again. Not many pregnancy tests were done!
Textbooks described what else could deceive us: cysts, fibroids and psuedo-cyesis. The next probable sign was quickening ie the woman feeling movements and the hearing of a uterine souffle was a very probable sign. But a definite diagnosis was not possible until the fetal heart was heard at 26 weeks+. Doctors and private obstetricians did X-rays to establish a diagnosis with the dire results that we are all aware of. The midwifery textbooks separated signs and symptoms of pregnancy into probable and diagnostic signs. Most women and most midwives were pretty sure if a woman was pregnant or not, but I have been caught out twice that I can remember. Once was a big ovarian cyst and the second was a psuedo-cyesis. Pregnancy tests were not totally reliable and very elaborate and expensive.
US has totally changed this scene of patient waiting. The tremendous advantage for many women and midwives was the threatened spontaneous abortion scenario when a woman at about 13 /14 weeks amenorrheoa starts bleeding. Is this a viable pregnancy or not? We didn't know until she passed an embryo that miscarriage was inevitable and many women spent time they could ill afford in bed, sometimes in hospital, unsure if they had a viable pregnancy or not and in the futile belief that bedrest might save a pregnancy which might well have become non viable a week ago.
Ultrasound gives a woman who is bleeding an option of seeing if this pregnancy has gone or if it is viable and this for many women is such a benefit and the uncertainty of lying in bed not knowing has been eliminated by US.
It also assists us in the diagnosis of a tubular pregnancy where before US all we could do was wait and see. I am unsure if the woman was less anxious in the very early stages - probably she was, but US has helped to reduce the misery of the "threatened spontaneous abortion".
There was a sort of fatalism about and maybe the necessity of "wait and see" had advantages in that the feverish and obsessive need to know just was not there because there WAS no way of knowing. Sadly many women paid large sums of money for X-rays and it became a fashionable thing to do. One's X-rays could be shown at one's dinner party when the ladies retired.
I had a missed abortion in the late 60s and when I became pregnant again there was no option but to wait and see, and I remember the joy of feeling the first movements.
In sisterhood, Mary