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Re: ULTRASOUND digest 2786From: Terry DuBose (terrydubose@sbcglobal.net)Wed May 21 21:26:58 2008
Art, you are correct, weight is given by a scale, that is difficult with a fetus. An estimate does have more variance than a measurement by scale; but a good sonographic instrument, in skilled hands can reduce the variance. A sonographic estimate by a skilled operator is more than a guess. IMHO. And as people understand volumetric fetal measurements, the variance will be reduced more. Peace, Terry evsono@pipeline.com wrote: 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 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 liv! e in "Fla t 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/sonography/ http://www.obgyn.net/us/panel/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 ---- From: "DoctorJoe@aol.com" To: Multiple recipients of list ULTRASOUND Sent: Tuesday, May 20, 2008 4:39:17 PM Subjec! t: Re: EF t 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/sonography/ http://www.obgyn.net/us/panel/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 ---- From: "DoctorJoe@aol.com" To: Multiple recipients of list ULTRASOUND Sent: Tuesday, May 20, 2008 4:39:17 PM Subjec! W 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. ************** Wondering what's for Dinner Tonight=3F Get new twists on family favorites at AOL Food. (http://food.aol.com/dinner-tonight=3FNCID=3Daolfod00030000000001)=20 Confidentiality Notice: This e-mail message, including any attachments, is = =66or the sole use of the intended recipient(s) and may contain confidentia= l= 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 Content-Type: text/html; charset=us-ascii Content-Transfer-Encoding: quoted-printable !
>t 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/sonography/ http://www.obgyn.net/us/panel/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 ---- From: "DoctorJoe@aol.com" To: Multiple recipients of list ULTRASOUND Sent: Tuesday, May 20, 2008 4:39:17 PM Subjec! 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 wrote: From: DuBose, Terry = 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" 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 *****************************
Many seem to think precise measurement methods are not necessary because "ultra!<BR>sound" is<BR>not considered accurate, a sort of self-fulfilling problem.=20 =20 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.=20 =20 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.=20 =20 I would like to see how the measurements in the case under current = discussion were actually This is a multipart message in MIME format. ------=_NextPart_000_0083_01C8BC11.A9C0F440 Content-Type: text/plain; charset="us-ascii" Content-Transfer-Encoding: 7bit Hi Guys I don't often contribute to this forum but here goes, I'll weigh into this one! Many years ago (1979) we did a prospective study on EFW, with very tight guidelines and criteria (too long to go into here). The results showed that, in our hands (well trained, careful sonographers with a strict attention to detail), the EFW by ultrasound was within +/- 50gms. I would imagine that, were the study to be repeated, we would be even better nowadays with modern sensitive equipment at our fingertips. I'm with you Terry - don't knock something unless you are prepared to do it properly, ultrasound fetal measurement is not a slapdash procedure, it should be undertaken with much care and attention. Those who are properly trained will do the best job. Cheers Sue From: ultrasound@obgyn.net [mailto:ultrasound@obgyn.net] On Behalf Of Terry DuBose Sent: Thursday, 22 May 2008 12:29 PM To: Multiple recipients of list ULTRASOUND Subject: Re: ULTRASOUND digest 2786 Art, you are correct, weight is given by a scale, that is difficult with a fetus. An estimate does have more variance than a measurement by scale; but a good sonographic instrument, in skilled hands can reduce the variance. A sonographic estimate by a skilled operator is more than a guess. IMHO. And as people understand volumetric fetal measurements, the variance will be reduced more. Peace, Terry evsono@pipeline.com wrote: 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 Digest 2786 Topics covered in this issue include: 1) RE: EFW accuracy by "DuBose, Terry" 2) RE: EFW accuracy by Dave Berck ---------------------------------------------------------------------- Date: Wed, 21 May 2008 09:39:47 -0500 From: "DuBose, Terry" To: ---------------------------------------------------------------------- Date: ultrasound@obgyn.net, "Multiple recipients of list ULTRASOUND" Subject: RE: ---------------------------------------------------------------------- Date: EFW accuracy Message-ID: Content-class: urn:content-classes:message MIME-Version: 1.0 Content-Type: multipart/alternative; boundary="----_=_NextPart_001_01C8BB50.85285723" This is a multi-part message in MIME format. ------_=_NextPart_001_01C8BB50.85285723 Content-Type: text/plain; charset=us-ascii Content-Transfer-Encoding: quoted-printable 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 "ultra! sound" 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 liv! e in "Fla t 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/sonography/ http://www.obgyn.net/us/panel/panel.htm http://www.io.com/~dubose/ --------------------------------------------------------------- [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 ---- From: "DoctorJoe@aol.com" To: Multiple recipients of list ULTRASOUND Sent: Tuesday, May 20, 2008 4:39:17 PM Subjec! t: Re: EF W 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. ************** Wondering what's for Dinner Tonight=3F Get new twists on family favorites at AOL Food. (http://food.aol.com/dinner-tonight?NCID=aolfod00030000000001) 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 Content-Type: text/html; charset=us-ascii Content-Transfer-Encoding: quoted-printable ! 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. David J. Berck, MD, MPH --- On Wed, 5/21/08, DuBose, T= erry wrote: From: DuBose, Terry = 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" 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 ***************************** ------------------------------ End of ULTRASOUND Digest 2786 ------------------------------ End of ULTRASOUND Digest 2786 ------=_NextPart_000_0083_01C8BC11.A9C0F440 Content-Type: text/html; charset="us-ascii" Content-Transfer-Encoding: quoted-printable <html xmlns:v="urn:schemas-microsoft-com:vml" xmlns:o="urn:schemas-microsoft-com:office:office" xmlns:w="urn:schemas-microsoft-com:office:word" xmlns:m="http://schemas.microsoft.com/office/2004/12/omml" xmlns="http://www.w3.org/TR/REC-html40"> <head> <meta http-equiv=Content-Type content="text/html; charset=us-ascii"> <meta name=Generator content="Microsoft Word 12 (filtered medium)"> <style> <!-- /* Font Definitions */ @font-face {font-family:Calibri; panose-1:2 15 5 2 2 2 4 3 2 4;} @font-face {font-family:Tahoma; panose-1:2 11 6 4 3 5 4 4 2 4;} /* Style Definitions */ p.MsoNormal, li.MsoNormal, div.MsoNormal {margin:0cm; margin-bottom:.0001pt; font-size:12.0pt; font-family:"Times New Roman","serif";} a:link, span.MsoHyperlink {mso-style-priority:99; color:blue; text-decoration:underline;} a:visited, span.MsoHyperlinkFollowed {mso-style-priority:99; color:purple; text-decoration:underline;} span.EmailStyle17 {mso-style-type:personal-reply; font-family:"Calibri","sans-serif"; color:#1F497D;} .MsoChpDefault {mso-style-type:export-only;} @page Section1 {size:612.0pt 792.0pt; margin:72.0pt 72.0pt 72.0pt 72.0pt;} div.Section1 {page:Section1;} --> </style> <!--[if gte mso 9]><xml> <o:shapedefaults v:ext="edit" spidmax="1026" /> </xml><![endif]--><!--[if gte mso 9]><xml> <o:shapelayout v:ext="edit"> <o:idmap v:ext="edit" data="1" /> </o:shapelayout></xml><![endif]--> </head> <body lang=EN-AU link=blue vlink=purple> <div class=Section1> <p class=MsoNormal><span style='font-size:11.0pt;font-family:"Calibri","sans-serif"; color:#1F497D'>Hi Guys<o:p></o:p></span></p> <p class=MsoNormal><span style='font-size:11.0pt;font-family:"Calibri","sans-serif"; color:#1F497D'>I don’t often contribute to this forum but here goes, I’ll weigh into this one! Many years ago (1979) we did a prospective study on EFW, with very tight guidelines and criteria (too long to go into here). The results showed that, in our hands (well trained, careful sonographers with a strict attention to detail), the EFW by ultrasound was within +/- 50gms. I would imagine that, were the study to be repeated, we would be even better nowadays with modern sensitive equipment at our fingertips.<o:p></o:p></span></p> <p class=MsoNormal><span style='font-size:11.0pt;font-family:"Calibri","sans-serif"; color:#1F497D'><o:p> </o:p></span></p> <p class=MsoNormal><span style='font-size:11.0pt;font-family:"Calibri","sans-serif"; color:#1F497D'>I’m with you Terry – don’t knock something unless you are prepared to do it properly, ultrasound fetal measurement is not a slapdash procedure, it should be undertaken with much care and attention. Those who are properly trained will do the best job.<o:p></o:p></span></p> <p class=MsoNormal><span style='font-size:11.0pt;font-family:"Calibri","sans-serif"; color:#1F497D'>Cheers<o:p></o:p></span></p> <p class=MsoNormal><span style='font-size:11.0pt;font-family:"Calibri","sans-serif"; color:#1F497D'>Sue<o:p></o:p></span></p> <p class=MsoNormal><span style='font-size:11.0pt;font-family:"Calibri","sans-serif"; color:#1F497D'><o:p> </o:p></span></p> <div style='border:none;border-top:solid #B5C4DF 1.0pt;padding:3.0pt 0cm 0cm 0cm'> <p class=MsoNormal><b><span lang=EN-US style='font-size:10.0pt;font-family: "Tahoma","sans-serif"'>From:</span></b><span lang=EN-US style='font-size:10.0pt; font-family:"Tahoma","sans-serif"'> ultrasound@obgyn.net [mailto:ultrasound@obgyn.net] <b>On Behalf Of </b>Terry DuBose<br> <b>Sent:</b> Thursday, 22 May 2008 12:29 PM<br> <b>To:</b> Multiple recipients of list ULTRASOUND<br> <b>Subject:</b> Re: ULTRASOUND digest 2786<o:p></o:p></span></p> </div> <p class=MsoNormal><o:p> </o:p></p> <div> <p class=MsoNormal>Art, you are correct, weight is given by a scale, that is difficult with a fetus. <o:p></o:p></p> </div> <div> <p class=MsoNormal> <o:p></o:p></p> </div> <div> <p class=MsoNormal>An estimate does have more variance than a measurement by scale; but a good sonographic instrument, in skilled hands can reduce the variance. A sonographic estimate by a skilled operator is more than a guess. IMHO. And as people understand volumetric fetal measurements, the variance will be reduced more. <o:p></o:p></p> </div> <div> <p class=MsoNormal> <o:p></o:p></p> </div> <div> <p class=MsoNormal>Peace, Terry <br> <br> <b><i>evsono@pipeline.com</i></b> wrote:<o:p></o:p></p> </div> <blockquote style='border:none;border-left:solid #1010FF 1.5pt;padding:0cm 0cm 0cm 4.0pt; margin-left:3.75pt;margin-top:5.0pt;margin-bottom:5.0pt'> <p class=MsoNormal style='margin-bottom:12.0pt'>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.<br> <br> Of course, that's just my opinion. I could be wrong.<br> <br> -----Original Message-----<br> <br> From: ultrasound@obgyn.net<br> Subj: ULTRASOUND digest 2786<br> Date: Wed May 21, 2008 9:21 pm<br> Size: 25K<br> To: Multiple recipients of list ULTRASOUND <br> <br> ULTRASOUND Digest 2786 Topics covered in this issue include: 1) RE: EFW accuracy by "DuBose, Terry" 2) RE: EFW accuracy by Dave Berck ---------------------------------------------------------------------- Date: ---------------------------------------------------------------------- Wed, 21 May 2008 09:39:47 -0500 From: "DuBose, Terry" To: ---------------------------------------------------------------------- ultrasound@obgyn.net, "Multiple recipients of list ULTRASOUND" Subject: Re: EFW accuracy Message-ID: Content-class: urn:content-classes:message MIME-Version: 1.0 Content-Type: multipart/alternative; boundary="----_=_NextPart_001_01C8BB50.85285723" This is a multi-part message in MIME format. ------_=_NextPart_001_01C8BB50.85285723 Content-Type: text/plain; charset=us-ascii Content-Transfer-Encoding: quoted-printable 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 "ultra!<br> sound" is<br> 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 liv!<br> e in "Fla<br> t 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/sonography/ http://www.obgyn.net/us/panel/panel.htm http://www.io.com/~dubose/ --------------------------------------------------------------- [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 ---- From: "DoctorJoe@aol.com" To: Multiple recipients of list ULTRASOUND Sent: Tuesday, May 20, 2008 4:39:17 PM Subjec!<br> t: Re: EF<br> W 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 |