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Re: Nuchal CordFrom: laure (lfolgar@vianwe.com)Sat Feb 21 03:25:42 2004
Hi, I am a obgyn physician from Spain. The figure of sonographers don´t exist here, but more or less is the same whe you make an eco for another physician. I allways say to my patients all I´ve seen, with my personal opinion of its meaning and prognosis. In case of other physician´s patients, I never tell her nothing about management, just what I´ve seen, because I don´t know what is the intention of others. In a nuchal cord, I just invite my patients to make a cardiotocographer register at the begining of labor, instead of wait till clear labor condition. As the saying goes; by the mouth, dies the fish. Most of the litigations begin with two diferents opinions. L. Folgar County Area Specialist obgyn physician Melilla Spain -----Mensaje original----- De: ultrasound@obgyn.net [mailto:ultrasound@obgyn.net]En nombre de Sue Davies Enviado el: Sábado, 21 de Febrero de 2004 04:30 a.m. Para: Multiple recipients of list ULTRASOUND Asunto: RE: Nuchal Cord Sorry Terry, I read my emails back to front!! I believe that sonographers who are well trained make these sorts of descisions all the time. The central issue here is TEAM WORK - if physicians and sonographers work as a team then there is rarely any difficulty. We, like Dr. Jeanty's team, know what our colleagues expect and how they usually deal with many situations and behave accordingly. For the case in point, if I saw a cord draped over the babies shoulder, I would make no comment - since that is the policy our team has decided upon. If the cord is wrapped tightly or more than twice - then we comment. Once again, I believe that the physician who started this discussion should talk to the sonographer or radiology department involved and resort to some team work. 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 12:08 AM To: Multiple recipients of list ULTRASOUND Subject: Re: Nuchal Cord Sue, what you say is true. However, it still does not answer the question of what a sonographer should do when they observe a nuchal cord, which is just across the fetal shoulder and not wrapped tightly around the neck or 2-3 loops around the neck. As I understood the original question, the physician did not think it was important and did not want the sonographer to draw attention to the nuchal cord (comment or record images) because the physician then felt obligated to comment in the report. I have worked with physicians who also did not want incidental findings recorded because they then felt obligated to comment. So the question remains, should the sonographer ignore conditions which they believe are insignificant or not, or should they give all information to the physician and let her/him make the decision? 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 Sue Davies Sent: Thursday, February 19, 2004 8:07 PM To: Multiple recipients of list ULTRASOUND Subject: Re: Nuchal Cord I agree Terry, that is why referring physicians should discuss such things with both the radiologists and the sonographers in their area so that all are aware of what is considered best for their particular needs. 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: Friday, 20 February 2004 10:44 AM To: Multiple recipients of list ULTRASOUND Subject: Re: Nuchal Cord As I understood the original question, it was not the sonographer telling the patient about the cord, but the physician did not want to know if the cord was just draped over the fetal shoulder, with a film showing this, because the physician then felt obligated to comment in the report about in case there was a poor outcome. So should the sonographer take a picture of a nuchal cord that does not encircle the neck two or more times? Or ignore it... that is the question, as I understand it. Sonographers are expected to take diagnostic images, but not considered a diagnostician, even though their credential is "Registered Diagnostic Medical Sonographer". They are between a rock and a hard place with many physicians. Peace, Terry J. DuBose, M.S. RDMS Little Rock, Arkansas ------------------------------------ I absolutely agree......why is a sonographer telling the patient about ------------------------------------ the cord? Perhaps a policy should be put in place that the sonographer -- ------------------------------------ tells the doc about the cord, then leaves it up to the doc to tell the pt.
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