Rays of Death and Visions of Life: Ultrasound Narratives, Risk Evaluations, and Prenatal Imaging.

Diagnostic ultrasound visualization was initially developed and introduced as a more benign alternative to X-rays and is today established as a harmless routine procedure and tool for risk management, but as this article shows, it took several decades to overcome the popular notion that ultrasound itself was a high-risk technology, a potentially deadly weapon. Swedish newspaper material provides a window into internationally circulated narratives portraying ultrasound as both a frightening and promising phenomenon. These ideas also constituted an important context for risk assessment during the early adoption and development of obstetrical ultrasound imaging, as shown by the case of Lund, Sweden, where the still-experimental technology was first imported from Scotland in the early 1960s. The article repositions ultrasound in the history of risk and risk management in modern societies and also sheds new light on the history of ultrasound visualization by situating it in a broader context of media culture.

The history of imaging in obstetrics.

During the past century, imaging of the pregnant patient has been performed with radiography, scintigraphy, computed tomography, magnetic resonance imaging, and ultrasonography (US). US imaging has emerged as the primary imaging modality, because it provides real-time images at relatively low cost without the use of ionizing radiation. This review begins with a discussion of the history and current status of imaging modalities other than US for the pregnant patient. The discussion then turns to an in-depth description of how US technology advanced to become such a valuable diagnostic tool in the obstetric patient. Finally, the broad range of diagnostic uses of US in these patients is presented, including its uses for distinguishing an intrauterine pregnancy from a failed or ectopic pregnancy in the first trimester; assigning gestational age and assessing fetal weight; evaluating the fetus for anomalies and aneuploidy; examining the uterus, cervix, placenta, and amniotic fluid; and guiding obstetric interventional procedures.

From monster to twin reversed arterial perfusion: a history of acardiac twins.

A human being born without heart and head, i.e., the acardius/acranius malformation, has been described since antiquity. Superstition and fear made it a mystical disorder, a sign of God's wrath. The inquisition ruled that acranic infants should not be baptized and located the soul in the brain. Acardia was not associated with twin gestation until the reports of Mery in 1720 and Winslow in 1740. In 1850, Meckel identified the pathogenetic mechanism as reversed perfusion due to large arterio-arterial and veno-venous anastomoses; he believed the heart would fail to develop or arrest during development, and the acardiac fetus would be maintained by arterial perfusion from the pump twin. In 1859, Claudius articulated that after normal initial development, the heart degenerates when reversed flow in the aorta leads to thrombosis. Today, it is assumed that both mechanisms may exist. With the advent of prenatal ultrasound diagnosis and radiofrequency ablation of the acardiac twin's circulation, it became possible to save the pump twin.

Una ontología híbrida de género: cromosomas, fotografías y ecografías en la circulación de la imaginería fetal en España, 1950-1970 / A hybrid ontology of gender chromosomes, photographs, and ultrasound scans in the circulation of fetal imagery in Spain, 1950-1970

Este texto presenta una propuesta de cronología de imágenes fetales en España, que incluye el proceso de producción y circulación de representaciones de cromosomas humanos —el cariotipo como retrato—, de las fotografías hechas y publicadas por el fotógrafo sueco Lennart Nilsson y de las figuras obtenidas por ecografía. Este conjunto de representaciones construyó la cultura visual del feto como una ontología híbrida que tomó la forma de sujeto histórico de género. Esa manufactura medicalizó y tecnificó el embarazo, privilegió al embrión y al feto y restó protagonismo al cuerpo de las mujeres. El trabajo se suma a la historiografía sobre la centralidad del feto, que se analiza aquí como producto de la interacción entre tres tecnologías: la citológica, la fotográfica y la ecográfica. (AU)

This article presents a proposal for a chronology of fetal images in Spain that includes the process of production and circulation of human chromosomes (fetal karyotype as a portrait), of the photographs of fetuses by Lennart Nilsson, and of the images provided by ultrasound scanning. This set of representations made the visual culture of the fetus a gendered historical subject that medicalized and technified pregnancy, privileging the fetus instead of the woman’s pregnant body as the subject of pregnancy. In this process, the fetus gained autonomy as a hybrid ontology. This article contributes to a fetal historiography that analyzes the fetus as manufactured by the interaction of three technologies: cytology, photography, and ultrasound scanning. (AU)

Fetal views: histories and habits of looking at the fetus in Germany.

This article examines historical and ideological trajectories that have made looking at the fetus via ultrasound a normal part of being pregnant for many women around the world. How did looking into so unlit a bodily space as the uterus become so natural? So everyday? So habit-forming? The answers lie in the convergence over time of technological hardware with knowledge practices that moved from medical to public domains. Germany serves as a site for an interrogation of how learned ways of thinking about anatomy, the development of technologies that "look," a privileging of the visual in medical domains, and seeing as metaphor for truth about health reinforced and normalized prenatal ultrasound use.

Development of prenatal screening--A historical overview.

The first prenatal screening test to be introduced was based on a single maternal serum marker of neural tube defects. Since then various prenatal screening concepts have been developed, the most successful being Down syndrome risk estimation using multiple serum and ultrasound markers. Today a completely new approach to aneuploidy screening is available based on maternal plasma cell-free DNA testing. This has the potential to markedly improve screening performance but routine testing is currently too expensive in a public health setting. However, it can be cost-effective when used in combination with existing multi-maker tests. Some are beginning to broaden prenatal screening to include pregnancy complications such as pre-eclampsia that can be prevented using soluble low-dose aspirin treatment started before 16 weeks of gestation. Prenatal screening for cardiac abnormalities, fragile X syndrome and recessive genetic disorders is underutilized and public health planners should considered a more widespread application of available methods.