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Re: fetal Heart rate....Basic/Advance OB ultrasound report From: DuBose, Terry (DuboseTerryJ@uams.edu) Tue Aug 7 15:45:34 2001 Messages sorted by: [ date ][ thread ][ subject ][ author ] Next message: DuBose, Terry: "Ultrasound Accreditation & Education in the USA" Previous message: Marveen Craig: "Re: 1956 - Argonne Nat. Lab" Dr. Fazeel, that is a very old [mid]wife's tale. In fact that was the question that came up that led to my first notice of the heart rate curve. In 1982 I had started working with personal computers... first was a Sinclair Z80A with 2k of ram, and saving files to audio tape... not very dependable. By 1984 I had a DOS machine, wrote the first version of BASIC BABY (written in Basic programming language, thus the name) and we started accumulating data. We (Austin Radiological Association, Austin Texas) were actually trying to develop more accurate estimates for fetal weight and age. We gave 1000 women self-addressed post cards asking about birthing information, weight, length, birth date, APGAR, days before discharge, and gender of the fetus. Once we started getting information back, someone mentioned this tale that her aunt had told her. She asked "Can you see if it is true that the heart rate predicts the sex of the baby?" It was fairly easy to plot out the data, and run an ANOVA on the heart rates for males and females. The following image is the actual plot from the 1994-1987 data: http://www.obgyn.net/english/pubs/features/dubose/Image13.gif The pink circles are female, and the blue squares are males... confirmed at birth, with heart rates measured during pregnancy via M-mode. You can see there is no difference in males or females. While we found no difference in male and female heart rates, it was that plot that first showed the feed-back damping curve of the developing human heart. It was then that I realized that a linear regression on the EHR could be used to estimate embryonic age (before the curve peaked). It was about 10 years later (1994) that we realized the significance of the low EHRs and that there was not a single threshold but is also age dependent. I, and others, have worked up numerous higher order polynomials to describe the heart rate curve. See: DuBose TJ, FETAL SONOGRAPHY, W. B. Saunders Co. 1996, Chapter 12, Heart Rate. It has now been over 15 years that I have studied the embryofetal heart rate. I can assure you there is absolutely no statistical difference in female or male heart rates at any time in gestation. It is more age dependent before about 15-18 weeks, and depends upon other factors in the last half of pregnancy such as fetal activity and maternal sugar intake. Please have your colleague read the following: http://www.obgyn.net/english/pubs/features/dubose/ehr-age.htm and http://www.obgyn.net/us/cotm/0001/ehr2000.htm I would like to know how many genders she predicted correctly out of what size population... Thanks for your interest. Peace, Terry J. DuBose, M.S., RDMS, APS Assistant Professor & Director, Diagnostic Medical Sonography Program CHRP, University of Arkansas for Medical Sciences Little Rock, Arkansas, USA 501-686-6510 http://www.io.com/~dubose/ http://www.uams.edu/CHRP/dmshome.htm http://www.obgyn.net/us/panel/panel.htm -----Original Message----- From: Dr Fazeel uz Zaman [mailto:fazeel@atd.hazara.net.pk] Sent: Tuesday, August 07, 2001 3:03 PM To: Multiple recipients of list ULTRASOUND Subject: Re: fetal Heart rate....Basic/Advance OB ultrasound report Dear Terry, You have a great interest in fetal heart rates.........did you also observe this?.... In a local ultrasound conference in Pakistan, a doctor presented a paper that female fetuses tend to have faster heart rates (probably she coated 146/min and above) than male fetuses.....and she accurately predicted fetal heart when not seen the gender yet.....as in early pregnancy or even in late pregnancy. Dr.Fazeel Terry J DuBose wrote: > I agree with this list of observations and measurements for obstetrical > sonography, it is very complete. If there are any suspicious findings > then we look further, of course. > > In addition, I like the heart rate documented with M-mode, and before 9.2 > LMP weeks I compare the EHR and CRL ages (see: > http://www.obgyn.net/us/cotm/0001/ehr2000.htm; Jan 2000). > > I do a 3D BPD Correction if there is any molding or head shape question. > For the abdomen, I like a coronal image of the abdomen showing the > relationship of the heart, stomach, and bladder. This coronal oblique > view also facilitates observations of the relationships and textures of > the liver, bowel, lung, and diaphragm, among other things that Nayana > lists below. > > One observation that very few make is measuring the liver when the > abdominal circumference appears large compared to the head circumference. > The reason is that the liver and spleen often are enlarged, and the head > small with fetal infections, and I find that a HC/AC too low for the age > is a fair screen visceral enlargement (this needs more research). > > Of course your question was about what goes into the report. Because I > am a sonographer (ARDMS) and not a licensed physician, I do not always > decide what goes into the final medical report... but the above and what > Nayana of India lists below are what I routinely attempt to provide in > every case. > > Also agree with Nayana that "I personally feel that every obs scan > warrants detailed examination...." The subsequent exams are very > important for evaluating whether fetal growth in time is normal or not, > and thus well being. Serial exams offer another look for subtle > findings, and as the fetus gets larger these are easier to see. > > I do not like "limited exams" and the current tendency to believe that a > "limited exam" implies that it only requires "limited ultrasound specific > education and experience". Of course, in the USA medicine is now > controlled by HMOs and the insurance corporations who do not want to pay > for more than one sonographic examination for each pregnancy. And in many > settings, the schedule is so rushed that it is difficult to do all that > can and should be done even in the one they allow. For profit health > care seems to have become "You money or your life." Don't get me > started.... > > Peace, Terry J DuBose > Little Rock, Arkansas, USA Next message: DuBose, Terry: "Ultrasound Accreditation & Education in the USA" Previous message: Marveen Craig: "Re: 1956 - Argonne Nat. Lab"

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