ULTRASOUND Messages for May, 2008: Re: EFW accuracy

Re: EFW accuracy
From: Dave Berck (djberck@yahoo.com)
Wed May 21 16:16:33 2008

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<table cellspacing='0' cellpadding='0' border='0' ><tr><td style='font: inherit;'>I agree. This applies to other areas of u/s also. 1st tri screening works presumably because standards are adhered to.  But in this case, had the birthweight been known exactly, most OBs would still allow a vaginal delivery, in which case this is simply a case of an unavoidable shoulder dystocia. David J. Berck, MD, MPH --- On Wed, 5/21/08, DuBose, Terry <DuboseTerryJ@uams.edu> wrote: <BLOCKQUOTE style="PADDING-LEFT: 5px; MARGIN-LEFT: 5px; BORDER-LEFT: rgb(16,16,255) 2px solid">From: DuBose, Terry <DuboseTerryJ@uams.edu> Subject: Re: EFW accuracy To: "Multiple recipients of list ULTRASOUND" <ultrasound@mail.obgyn.net> Date: Wednesday, May 21, 2008, 10:42 AM <DIV id=yiv1175798356> <STYLE>  </STYLE>
<DIV class=Section1> I suspect the reason sonographic measurements are considered so questionable is that there are so many people using sonography who do not have rigorous training and do not practice precise methods.   Many seem to think precise measurement methods are not necessary because â€œultrasoundâ€ is not considered accurate, a sort of self-fulfilling problem.   In a lawsuit in which I was an expert witness, a case very similar the one under current discussion, the sonographer has attended an unaccredited, short course of study, was not credentialed by the ARDMS, and was on-call by herself.   It was obvious she had measured the abdominal circumference at the ribs and spine in back, completely excluding the skin, baby fat, and muscles in back.   The vaginal delivery also ended up with dystocia and neurological damage in the neonate.   It is my opinion that sonography, in the hands of a skilled sonographer, is much more accurate than it is given credit for being.   But many simply do not take the time and/or do not have the understanding and skill to use it effectively.   I would like to see how the measurements in the case under current discussion were actually made.    We also need to be moving to volumetric measurements, the fetus does not live in â€œ Flat Land â€â€¦ and the head molds considerably, especially in the vertical axis due to the sutures and fontanels.   <DIV> Terry J. DuBose, M.S., RDMS, FSDMS, FAIUM Associate 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 or 501-686-5948 DuBoseTerryJ@UAMS.edu <A href="http://www.uams.edu/chrp/sonography/" target=_blank rel=nofollow>http://www.uams.edu/chrp/sonography/</A> <A href="http://www.obgyn.net/us/panel/panel.htm" target=_blank rel=nofollow>http://www.obgyn.net/us/panel/panel.htm</A> <A href="http://www.io.com/~dubose/" target=_blank rel=nofollow>http://www.io.com/~dubose/</A> ----------------></DIV> =_blank rel=nofollow>http://www.io.com/~dubose/</A> ----------------<DIV> =_blank rel=nofollow>http://www.io.com/~dubose/</A> ----------------<DIV class=MsoNormal style="MARGIN-LEFT: 0.5in; TEXT-ALIGN: center" alignÎnter> <HR tabIndex=-1 alignÎnter width="100%" SIZE=2> </DIV> From: ultrasound@obgyn.net [mailto:ultrasound@obgyn.net] On Behalf Of Dave Berck Sent: Tuesday, May 20, 2008 4:46 PM To: Multiple recipients of list ULTRASOUND Subject: Re: EFW accuracy</DIV>   <DIV> true <DIV>  </DIV> David J. Berck, MD, MPH <DIV>   <DIV> oman" size=3>----- Original Message ---- From: "DoctorJoe@aol.com" <DoctorJoe@aol.com> To: Multiple recipients of list ULTRASOUND <ultrasound@mail.obgyn.net> Sent: Tuesday, May 20, 2008 4:39:17 PM Subject: Re: EFW accuracy In a message dated 5/20/08 1:57:45 PM, djberck@yahoo.com writes: 
comparison was made between U/S EFW, Leopold's , and Maternal estimates of EFW. The maternal estimates were the most accurate. Only mother's who had already had one pregnancy already (I believe). Joe P. ) </DIV></DIV></DIV></DIV> <PRE>Confidentiality Notice: This e-mail message, including any attachments, is for the sole use of the intended recipient(s) and may contain confidential and privileged information. Any unauthorized review, use, disclosure or distribution is prohibited. If you are not the intended recipient, please contact the sender by reply e-mail and destroy all copies of the original message. </PRE> </DIV></BLOCKQUOTE></td></tr></table>

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