[The development of obstetric ultrasound in Switzerland]

Ultrasound has conquered obstetrics during the last 40 years. Today it is an integral part of antenatal care. Its broad use as a screening method has pushed critics who found open doors at health authorities facing short resources. In Switzerland in early 1996, routine ultrasound as a health technology was temporarily excluded from reimbursement by the health insurances. Under the pressure of the public, the health authorities had to reintroduce reimbursement within a few months. However, reimbursement was linked with several conditions: the ultrasound examination has to be performed by physicians with adequate training and experience; routine ultrasound needs a strict informed consent, and its benefit has to be evidenced. This decision has had a positive impact on quality. After 7 years, Switzerland has a good training program; guidelines for prenatal ultrasound already exist in their second edition, and spot checks of performance showed that quality in Switzerland meets international standards. Ultrasound mainly has a positive cost-effectiveness ratio due to the detection of fetal malformations with consecutive termination of pregnancy. Since termination of pregnancy is ethically questionable, the discussion with respect to reimbursement will most probably go on. In this light, a comprehensive informed consent of the pregnant women is essential.