Pregnant women in Israel are being subjected to controversial tests, a recent study shows. In response, the Israel Society of Obstetrics and Gynecology intends to formulate new recommendations and regulations for its members.
A study conducted by ISOG's Maternal and Fetal Society found that 89 percent of gynecologists send women seeking to get pregnant, or in the early stages of pregnancy, for a Cytomegalovirus (CMV ) test. No Western country recommends subjecting all pregnant women to this test.
About 40 percent of embryos whose mothers carry an active CMV virus are infected, especially during the first third of the pregnancy. Moreover, 20 percent of babies infected with the virus could suffer developmental disorders, including hearing and sight problems. But only four percent of women contract the virus close to pregnancy.
"The ideal situation is a positive diagnosis of CMV virus in the past, indicating that the woman has natural immunity against reinfection, and a negative diagnosis for infection in the last few months," said Dr. Michal Kobo of the Maternal and Fetal Medicine Society.
But when an anomaly is detected, every gynecologist acts on the basis of his own experience, she added.
The study, which encompassed 180 gynecologists nationwide, found that 80 percent of them sent every pregnant woman for a CMV test, while 9 percent did so occasionally. In the central region, 95 percent of gynecologists referred women for the test, as did 93 percent in the coastal plain region. That compares to 78 percent in the Haifa area, 75 percent in the Sharon area, 74 percent in the south, 50 percent in Jerusalem and only 30 percent in the Galilee and Golan region.
"Many gynecologists advise women who do test positive for a new CMV infection to wait until taking the amniocentesis test, so as to find out whether the fetus has been infected with the virus," said Kobo. However, some of these women choose to abort the fetus at the beginning of the pregnancy.
On the other hand, women who have never contracted CMV have no immune-system defense against the virus. Yet there is no uniform rule as to the proper medical treatment in such cases, she said.
"Sometimes these women are sent for repeated tests during pregnancy, or for monitoring after revealing symptoms of illness, such as fever, but there is no fixed approach," Kobo explained.
The study found that in these cases, 34 percent of gynecologists send their patients for a second test during the pregnancy, 36 percent have them repeat the test several times and 30 percent do not repeat the test at all.
ISOG has therefore decided to formulate uniform regulations for Israel's gynecologists. Until then, however, the recommendation not to conduct CMV tests on all pregnant women remains intact.
Another controversial test commonly given to pregnant women is for the GBS bacteria, a Group B streptococcus infection. This bacteria could be transmitted to the baby during birth and cause an active disease.
While the U.S. Centers for Disease Control and Prevention recommends that all women take the test between the 35th and 37th week of pregnancy, ISOG has decided not to refer all women for this test.
"In Israel, the carrier rate is low, and fewer children contract the disease than in the United States," Kobo explained.
But the study found that each gynecologist does as he sees fit: About 40 percent send all their pregnant patients to conduct the test, 34 percent do so occasionally, 4 percent do so only if the woman asks for it, and the rest - 22 percent - do not advise it for various reasons.
"GBS tests for pregnant women cost the health system time and money," Kobo said. "If the test result is positive, the women are customarily given antibiotics during the pregnancy and sent for repeated tests, or else given antibiotics during the delivery."
ISOG intends to issue uniform regulations on this matter as well.
In recent years, it seems, many pregnant women have sought to have "perfect babies." About 80 percent of Israeli couples undergo tests to detect possible genetic diseases before pregnancy or in its early stages. A quarter of the women have amniotic fluid tests, despite the risk involved, and even though they are recommended only for 10 percent of women, mainly older ones. Every Israeli woman undergoes an average of seven ultrasound tests during each pregnancy, compared to the four the doctors recommend.
The number of malpractice suits against doctors has also increased in recent years, leading gynecologists to send women for numerous tests in a bid to prevent such suits, a Ben-Gurion University study found.
Since 1994, the number of malpractice suits has multiplied by 12, according to figures compiled by the Madanes Insurance Agency, which insures most of Israel's public medical institutions.
More suits are filed against gynecologists than against any other type of specialist. And 32 percent of such suits result in the plaintiffs being awarded compensation, compared with less than 10 percent of suits against other doctors.
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