Re: Nuchal Cord
From: Charlotte Henningsen (charlotte.henningsen@fhchs.edu)
Sun Feb 22 07:27:05 2004
At Sat, 21 Feb 2004, Philippe Jeanty wrote:
>
>My sonographers are my eyes... no wonder I treat them with utmost respect !
>
Thanks to all of you for providing such insight on imaging nuchal cord.
And thanks to Dr. Jeanty for his comments re:songraphers.
Charlotte
>-----Original Message-----
>From: ultrasound@obgyn.net [mailto:ultrasound@obgyn.net] On Behalf Of Sue
>Davies
>Sent: Friday, February 20, 2004 9:23 PM
>To: Multiple recipients of list ULTRASOUND
>Subject: Re: Nuchal Cord
>
>Thanks from me too Dr Jeanty, there are many practices in Australia where
>sonographers are treated as medical professionals with sound judgement and
>the ability to talk to patients sensibly and it is nice to hear that your is
>one of those too.
>
>Cheers
>
> Sue Davies
>Program Director
>PO Box 434
>Mermaid Beach, Q, 4218
>tel: (07) 5526-6655
>http://www.aiu.edu.au
>
>-----Original Message-----
>From: ultrasound@obgyn.net [mailto:ultrasound@obgyn.net] On Behalf Of
>DuBose, Terry
>Sent: Saturday, 21 February 2004 6:36 AM
>To: Multiple recipients of list ULTRASOUND
>Subject: Re: Nuchal Cord
>
>Dr. Jeanty. Thank you.
>
>Terry J. DuBose, M.S., RDMS, FSDMS, FAIUM
>
>Assistant Professor & Director
>Diagnostic Medical Sonography Program
>University of Arkansas for Medical Sciences, CHRP
>4301 West Markham St. Mail Slot #563
>Little Rock, Arkansas, 72205 USA
>501-686-6510
>DuBoseTerryJ@UAMS.edu
>http://www.io.com/~dubose/
>http://www.uams.edu/chrp/dms/default.asp
>http://www.obgyn.net/us/panel/panel.htm
>---------------------------------------------------------------
>
>---------------------------------------------------------------
>---------------------------------------------------------------
>---------------------------------------------------------------
>-----Original Message-----
>---------------------------------------------------------------
>From: ultrasound@obgyn.net [mailto:ultrasound@obgyn.net] On Behalf Of
>---------------------------------------------------------------
>Philippe Jeanty
>---------------------------------------------------------------
>Sent: Friday, February 20, 2004 10:03 AM
>To: Multiple recipients of list ULTRASOUND
>Subject: Re: Nuchal Cord
>
>Not wanting to pour oil on the fire, but I let my sonographers tell the
>patient about nuchal cord. There are several reasons for that:
>1) my sonographers are very qualified people with excellent clinical
>judgment
>2) when they start taking extra pictures of something, a great proportion of
>patients notice the "change" in the conduct of the examination (they
>concentrate more on something, they stop talking for a few seconds...)
>3) they have heard me tell the patient thousands of time what it meant and
>are not likely to say something stupid
>4) the patient having heard the story once is better prepared to ask me
>questions
>
>Further I thing it is a basic matter of human respect 1) for the patient to
>be informed and 2) for the sonographer to be regarded as a medical
>professional and not some moron button pusher
>
>Philippe Jeanty, MD PhD
>
>-----Original Message-----
>From: ultrasound@obgyn.net [mailto:ultrasound@obgyn.net] On Behalf Of Sue
>Davies
>Sent: Thursday, February 19, 2004 4:28 PM
>To: Multiple recipients of list ULTRASOUND
>Subject: Re: Nuchal Cord
>
>If I could buy into this one - surely a sonographer is duty bound to examine
>the fetus in all its aspects and document the findings. We routinely include
>cord examination in third trimester scans, it is the obstetrician's duty to
>discuss the results with the patient and make decisions on management, if a
>sonographer finds a nuchal cord wrapped securely (3 or 4 times
>circumferentially) and does not report this, they would be liable for
>censure if anything went wrong. Maybe the best outcome for your current
>difficulty would come from the referring physicians having a discussion with
>the sonographer in question and make them aware of their cocerns
>
>Cheers
>
> Sue Davies
>Program Director
>PO Box 434
>Mermaid Beach, Q, 4218
>tel: (07) 5526-6655
>http://www.aiu.edu.au
>
>-----Original Message-----
>From: ultrasound@obgyn.net [mailto:ultrasound@obgyn.net] On Behalf Of
>Charlotte Henningsen
>Sent: Friday, 20 February 2004 8:01 AM
>To: Multiple recipients of list ULTRASOUND
>Subject: Re: Nuchal Cord
>
>At Thu, 19 Feb 2004, Philippe Jeanty, MD, PhD wrote:
>>
>>The answer is actually very simple: the information was obtained FROM
>>the patient, FOR the patient and thus the patient has the right to be
>>made aware.
>>The skill is on how to provide explanations so that the patient does
>>not freak out and forces her MD into unnecessary further examinations.
>>(futile since they would not alter the management). Those who review
>>legal case should stand firm on this (an I do).
>>
>I agree that if we see a nuchal cord that it is our duty to document it, so
>it is reported to the managing physician and the patient can be apprised.
>And certainly if there is accompanying decreased movement or bradycardic
>episodes. But do you routinely look for a nuchal cord? That is not part of
>standard protocol, and is what this particular sonographer is doing.
>Charlotte
>>-----Original Message-----
>>From: ultrasound@obgyn.net [mailto:ultrasound@obgyn.net] On Behalf Of
>>Charlotte Henningsen, MS, RT, RDMS, RVT, FSDMS
>>Sent: Thursday, February 19, 2004 1:39 AM
>>To: Multiple recipients of list ULTRASOUND
>>Subject: Nuchal Cord
>>
>>I have heard many times obstetricians and perinatalogist state that
>>sonographers should not be looking for cord around the neck because it
>
>>only creates angst for the patient with a situation that may be
>>dynamic, very common, and probably insignificant. But I have not been
>>able to find this in the literature. We have a sonographer who is
>>documenting nuchal cord and it is leading to a lot of unnecessary
>>follow up, not to mention worry. Can anyone point to articles that
>>addresses when and if nuchal cord should be documented?
>>
>>Thank you,
>>Charlotte
>>
>>--
>>Charlotte Henningsen, MS, RT, RDMS, RVT, FSDMS Chair and Professor -
>>Sonography Department Florida Hospital College
>>407-303-5733
>>
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