Re: Nuchal Cord
From: Philippe Jeanty (jeanty@TheFetus.net)
Fri Feb 20 09:02:30 2004
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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