If there is no probable connection between the error and the outcome
then there is no harm.
--
James S. Smeltzer, MD, FACOG, SMFM
Consultant, Maternal Fetal Medicine
Wellstar Physicians' Group
Northwest Women's Care
787 Campbell Hill St
Marietta GA 30060
James.Smeltzer@wellstar.org
VM 678-290-3035
Off 770-528-0260
Page 404-318-3451
>>> <FManningOB@aol.com> 5/21/2008 9:31 PM >>>
Davie
How goes it amigo??
Frank M
In a message dated 5/21/2008 5:20:04 P.M. Eastern Daylight Time,
djberck@yahoo.com writes:
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 allow a vaginal
delivery, in
which case this is simply a case of an unavoidable shoulder dystocia.
David J. Berck, MD, MPH
--- On Wed, 5/21/08, DuBose, Terry <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 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/sonography/_
(http://www.uams.edu/chrp/sonography/)
_http://www.obgyn.net/us/panel/panel.htm_
(http://www.obgyn.net/us/panel/panel.htm)
_http://www.io.com/~dubose/_ (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" <DoctorJoe@aol.com>
To: M
ultiple recipients of list ULTRASOUND
<ultrasound@mail.obgyn.net>
Sent: Tuesday, May 20, 2008 4:39:17 PM
Subject: Re: EFW 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.
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