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Re: ULTRASOUND digest 2786From: evsono@pipeline.comWed May 21 20:31:15 2008
If you want to find out how much you weigh, you get on a scale. You don't measure your waistline. Estimate is just a fancy word for guess. Of course, that's just my opinion. I could be wrong. -----Original Message----- From: ultrasound@obgyn.net Subj: ULTRASOUND digest 2786 Date: Wed May 21, 2008 9:21 pm Size: 25K To: Multiple recipients of list ULTRASOUND <ultrasound@mail.obgyn.net> 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 “ultrasound” 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 “Flat Land” and the head molds considerably, especially in the vertical axis due to the= = sutures and fontanels. 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 http://www.uams.edu/chrp/sono= graphy/ http://www.obgyn.net/us/pa= nel/panel.htm http://www.io.com/~dubose/ --------------------------------------------------------------- --------------------------------------------------------------- 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 true David J. Berck, MD, MPH
> ----- Original Message ---- 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.
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. ------_=_NextPart_001_01C8BB50.85285723-- ------------------------------ Date: Wed, 21 May 2008 14:16:17 -0700 (PDT) From: Dave Berck To: ultrasound@obgyn.net Subject: RE: EFW accuracy Message-ID: MIME-Version: 1.0 Content-Type: text/html; charset=utf-8 Content-Transfer-Encoding: quoted-printable 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 all= ow a vaginal delivery, in which case this is simply a case of an unavoidabl= e shoulder dystocia.
------_=_NextPart_001_01C8BB50.85285723-- ------------------------------ Date: Wed, 21 May 2008 14:16:17 -0700 (PDT) From: Dave Berck To: ultrasound@obgyn.net Subject: RE: EFW accuracy Message-ID: MIME-Version: 1.0 Content-Type: text/html; charset=utf-8 Content-Transfer-Encoding: quoted-printable 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 all= ow a vaginal delivery, in which case this is simply a case of an unavoidabl= e shoulder dystocia. David J. Berck, MD, MPH ------_=_NextPart_001_01C8BB50.85285723-- ------------------------------ Date: Wed, 21 May 2008 14:16:17 -0700 (PDT) From: Dave Berck To: ultrasound@obgyn.net Subject: RE: EFW accuracy Message-ID: MIME-Version: 1.0 Content-Type: text/html; charset=utf-8 Content-Transfer-Encoding: quoted-printable 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 all= ow a vaginal delivery, in which case this is simply a case of an unavoidabl= e shoulder dystocia. --- On Wed, 5/21/08, DuBose, T= erry <DuboseTerryJ@uams.edu> wrote: 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 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 no= t practice precise methods. Many seem to think precise measurem= ent methods are not necessary because “ultrasound†is not c= onsidered accurate, a sort of self-fulfilling problem. In a lawsuit in whic= h I was an expert witness, a case very similar the one under current discus= sion, 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 bac= k. The vaginal delivery also ended up with dystocia and neurolo= gical damage in the neonate. It is my opinion tha= t 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 effective= ly. I would like to see = how the measurements in the case under current discussion were actually mad= e. We also need to be moving to volumetric measurements, = the fetus does not live in “ Flat Land â€â€¦ and the h= ead molds considerably, especially in the vertical axis due to the sutures = and fontanels. Terry J. DuBose, = M.S., RDMS, FSDMS, FAIUM Associate Professor & Director Diagn= ostic Medical Sonography Program University of Arkansas for Medical Scie= nces, CHRP 4301 West Markham St. Mail Slot #563 Little Rock , Arkansa= s , 72205 USA 501-686-6510 or 501-686-5948 DuBoseTerryJ@UAMS.edu http://www.uams.edu/chrp/sonography/ http://www.obgyn.ne= t/us/panel/panel.htm http://www.io.com/~dubose/ ----------------= ----------------------------------------------- ----------------= ----------------------------------------------- From: ultrasound@obgyn.net [mailto:ultrasound@= obgyn.net] On Behalf Of Dav= e Berck ----------------= ----------------------------------------------- Sent: Tuesday, M= ay 20, 2008 4:46 PM To: = Multiple recipients of list ULTRASOUND Subject: Re: EFW accuracy true = David J. Berck, MD, MPH
> ----- Original Message ----From: "DoctorJoe@aol.com" <DoctorJoe@aol.com> 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 ac= curate. Only mother's who had already had on= e pregnancy already (I believe). Joe P.
Confidentiality Notice: This e-mail message, including any attachme= nts, is for the sole use of the intended recipient(s) and may contain confi= dential and privileged information. Any unauthorized review, use, disclosu= re or distribution is prohibited. If you are not the intended recipient, p= lease contact the sender by reply e-mail and destroy all copies of the orig= inal message. ------------------------------ End of ULTRASOUND Digest 2786 *****************************
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