Concerns About Prenatal Care: Spinal Fusion and Maternal Health

Question
I am a frantic grandma to be (I already have 2 grands).  My daughter in law has had dreadful care duting her pregnancy.  She is due 4/03/05 with her first child.  She first was seen by a practice on Cape Cod where you are only seen by a variety of nurses for the first trimester+...that alarmed me immediately but her mother who lives there did not seem too concerned at the time.  She had terrible morning sickness and could keep nothing down for days and days...my son took her to a hospital there and they would give her meds to stop the sickness.  The first ultra sound went ok.  But no one would see her in the office...they said that was their practice. The did not put her on folic acid for weeks and weeks.  Then they cancelled the 2nd ultrasound.  At this point her mom had had it and found another ob/gyn.  That was early Nov.  The second ultrasound was 11/10.  She had her next appointment yesterday and the doctor announced that she was scheduling another ultrasound to get a better look at the spinal fusion!  This is not scheduled until 12/17!  I am beyond amazed that ultra sound tech did not flag this back in No. or that someone who received this picture at the doctor's office did not bring it to her immediate attention.  The ultrasond picture doe look very odd and I thought so the second I say it!  It looks like the head and the spine are not fused below the neck!  I want to insist that my son take his wife to the emergency room and have her admitted for an emergency ultrasound so they can make decisions now if necessary.  I am horrified...any input would be greatly apprecited.  Am I correct to insist on this?  

Answer
Your daughter is now 23 weeks 2 days gestational age. Usually the first sonogram should be done at around 20 weeks gestation. I do not know whether the baby has a fused spine or not, because it is very difficult to see it at this time. She should have had a quad screen (alphafetoprotein) to see if there were any neural tube defects. This should have been done at 16 weeks gestation. I would suggest that you get a copy of the ultrasound report (not the actual picture since you really can't tell anyting with a still photo). I doubt that there is spinal fusion of the baby, but there may be some abnormality in the spine of the baby.  There is no reason to go to an emergency room because nothing can be done, in any case, except repeat the sonogram next week. Even if an abnormality is found, the baby cannot be delivered until lung maturity or, at least, after 29 weeks gestation. Be patient and wait for the results of the sonogram and then demand to know what is going on and  what alternatives you have. Once you have all the information, you can determine what course to take.