Report: Too many ultrasound and CTG examinations for pregnant women

Pregnancies and births in Germany are often overshadowed by the danger of possible risks and complications, which means that healthy pregnant women with a normal pregnancy are often subjected to unnecessary examinations. These findings emerge from an analysis of billing data from the Barmer health insurance company.

According to Barmer, the data of around 251,000 pregnant women with live births in the years 2019 to 2022 were analyzed. The study looked at women who were insured with Barmer for at least one full year before giving birth.

The results indicate that only around 15 percent of the pregnant women examined had no particular need for monitoring during pregnancy. Only pregnant women who did not have a single risk factor were included in the "no increased need for monitoring" category. The analysis of the routine data also revealed that around 84% of all pregnant women had at least one risk factor in 2022.

Only 34% of women without risks received the scheduled up to three ultrasound examinations. According to Barmer, 4.7 percent of healthy pregnant women received "between ten and 14 examinations".

The most common reason for a higher number of ultrasounds is the recommendation made to gynecologists in 2021 to carry out "closer follow-up checks (approx. every 3-5 days)" if the due date is exceeded from week 40 of pregnancy.

Overall, it was found that the number of examinations hardly differs between pregnant women with and without a special need for monitoring. Barmer therefore sees an overuse and calls for the maternity guidelines and maternity pass to be revised to provide better care for risk groups, such as women with diabetes or who have already had premature births. This should also prevent healthy pregnant women from being frightened and unsettled by an unnecessary risk label. According to Barmer, the associations of statutory health insurance physicians should monitor the existing guidelines for CTG and ultrasound examinations during pregnancy.

Too many examinations harbor risks

"Too many ultrasound examinations may pose a risk to the child and too much diagnostics may trigger a cascade of interventions that are ultimately unnecessary, but at worst harmful," says Barmer CEO Prof. Christoph Straub. Although ultrasound examinations are safe, they can lead to uncertainty among pregnant women, as the German Society for Ultrasound in Medicine also points out.

However, the European Committee for Ultrasonic Radiation Safety (PDF), among others, also advises against 3D ultrasound, which has been banned for "non-medical purposes" since 2017, for safety reasons. The Radiation Protection Ordinance also states that a foetus must not be "exposed" to unnecessary radiation. Other institutions such as the American Institute of Ultrasound in Medicine also advocate caution when it comes to ultrasound during pregnancy, despite differing study results.

(mack)