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Peering at the Future

Malka Forster

Can it save lives — or cause unnecessary anguish? Both, it seems. Here are two sides of the heated debate on the 20-week prenatal scan

Wednesday, June 06, 2012

ultrasoundNot everyone is so enthusiastic about the scan (known as skirat ma’archot in Israel), which is an in-depth, risk-free ultrasound administered to women in their 20th week of pregnancy. Indeed, it has caused some of the thorniest halachic dilemmas for poskim — and is the subject of significant controversy.


While some argue that the occasional erroneous scan can be a source of deep — and needless — anguish and worry, revealing a plethora of “problems” in various organs, others opine that for the small percentages of cases where a treatable problem is detected, the screening saves lives.


Dr. Hava-Yael Schreiber, for one, is a fierce medical proponent of doing the scan.


“There are many prenatal tests I don’t recommend,” says the renowned Jerusalem ob-gyn and senior staff doctor at Bikur Cholim Hospital. “As a frum woman, I won’t send patients for tests that we can do nothing about — for example, the blood test that checks for Down syndrome. But when it comes to the 20-week scan, there is so much that can be done.”


Once a defect is discovered, there are four possible ways the knowledge can help, explains Dr. Michael Nadjari, director of the ultrasound unit in the ob-gyn department at Hadassah Ein Kerem Medical Center. It can help determine the need for in utero treatment for certain defects; help determine the type of birth that will take place (i.e. natural vs. Cesarean); c) help choose which hospital to go to for the birth; and d) help plan a treatment protocol for immediately after birth.


While the list of detectable — and treatable — problems is immense, including kidney disorders, spina bifida, anemia, neck tumors, urinary tract blockage, or a malfunctioning placenta, the most critical and common defect helped by the scan’s early detection, says Dr. Schreiber, is cardiological in nature.


“Seven out of 1,000 babies are born with a heart defect,” she states, citing the Williams Manual of Obstetrics, the profession’s prevailing reference guide, as a source. “Of these, some can be treated in utero via heart medication administered to the mother. The others can be planned for accordingly.”


Once, Dr. Schreiber relates, a patient who had not done the 20-week scan went into labor. Almost immediately, fetal distress was detected, an emergency C-section was carried out — and the baby was born in cardiac arrest, in a hospital miserably unequipped to deal with pediatric cardiology cases. Blue-faced and oxygen-deprived, the newborn baby with a defective heart was shipped off, motherless, in a Friday-night ambulance to another facility.


“The baby made it,” says Dr. Schreiber happily. “It was a miracle. But I ask mothers: Why would you take that chance? With heart defects, every minute is a universe — the baby is losing precious oxygen to the brain. And even if the newborn survives, the oxygen deficiency can have lifelong effects like retardation.”


Anecdotes aside, her stance is overwhelmingly supported by the current research. Ultrasound specialist Dr. Nadjari cites three studies offhand, all published in widely respected journals, all concluding that prenatal detection, diagnosis, and early management of various heart defects greatly reduces neonatal mortality.


Gita, a Jerusalem mother of seven, hardly needs research to corroborate this claim; she saw it firsthand with her son.


“Yaakov is my fifth child,” she says. “I had never done a skirat ma’archot with my other children. We were told by a rav that it wasn’t advisable. But with this pregnancy, I had a nagging premonition. I hadn’t been pregnant for eight years and I was getting older. I was eager to do the scan.”


Gita’s husband asked their rav again. This time, they were told that if undergoing the scan would bring her menuchas hanefesh, she could do it. She did — and the verdict was frightening.


“The baby appears to be missing the left heart chamber,” the technician announced, following an interminable hour of checking and rechecking. What’s more, the thymus — a major hormonal gland essential for immune function — was nowhere to be seen. “He won’t make it to term. If he does, he’ll be born with half a heart, and need to live in a germ-free bubble,” declared the doctors.


“What would you do if this was your wife?” a desperate Gita cried out to one specialist, after yet another dismal consultation.


“I’d go to the States,” the doctor responded emphatically. With extensive help from medical organizations and renowned askan, Reb Benny Fischer, Gita and her husband eventually made the journey abroad, leaving their children for almost three months. Her baby was born naturally, on time, with Cornell Hospital’s entire cardiological team ready to receive him. When he was less than three days old, he underwent a six-hour open-heart surgery at the hands of a leading specialist. The baby had a heart the size of a walnut, soft as butter, and his aorta had to be created completely from scratch out of surrounding tissue.


“I think it went well,” the surgeon softly informed Gita and her husband, when the life-threatening procedure was over. “As a policy, I almost never speak with patients’ parents directly. But for a couple who traveled 6,000 miles to save their son’s life, I want to share the good news personally.”


Two weeks postsurgery — after several critical instances when his heart needed to be shocked back into function — Gita’s baby boy went home. Today, he is an active, rambunctious 11-year-old.


“I asked the doctors, ‘What would have happened if I hadn’t done the skirah?’ ” Gita tearfully recounts. “They replied, ‘He would probably have died a crib death at two weeks. And you would have never even known why.’ ”



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