Re: EFW accuracy
From: Sue Davies (sue@aiu.edu.au)
Thu May 22 18:05:16 2008
Surely the measurement is only one part of an ultrasound study! It should be considered in conjunction with a careful survey of B-Mode appearances, as well as comparison with individual familial background.
Sue
-----Original Message-----
From: ultrasound@obgyn.net [mailto:ultrasound@obgyn.net] On Behalf Of art fougner, md
Sent: Friday, 23 May 2008 8:55 AM
To: Multiple recipients of list ULTRASOUND
Subject: Re: EFW accuracy
On the other hand, no amount of measuring takes into account individual
variations in tissue density. Is a large AC large because of a triple
fat layer or a large liver? The ultraound measurement doesn't
differentiate between subcutaneous tissue and muscle. Yes, the
statistics look good until you run into a statistical outlier - the
relatively short squat fetus with a relatively smaller head than
abdomen. When you want to find out how much you weigh, you stand on a
scale. You don't measure your waistline. The word "estimate" is
nothing but a fancy word for guess.
Of course, that's just my opinion. I could be wrong.
Art
At Thu, 22 May 2008, James Smeltzer wrote:
>
>Hi! In our experience multiple careful measurements are better than
>one. It IS operator dependent. This is an easy-to-measure quality index
>for your practice. David brings out an important point, namely that
>there needs to be a connection. A terribly measured AC made me flunk
>the only practice I flunked as a AIUM reviewer. They had missed an IUGR
>baby and then submitted the case.
>
>If there is no probable connection between the error and the outcome
>then there is no harm.
>
>Jim Smeltzer
>
>--
>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 â€â€¦ 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.
>
>AOL Food.
>(_http://food.aol.com/dinner-tonight?NCID=aolfod00030000000001_
>(http://food.aol.com/dinner-tonight?NCID=aolfod00030000000001) )
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art fougner, md
"May The Wings of Liberty Never Lose a Feather." - Jack Burton
