Re: EFW accuracy
From: Terry DuBose (terrydubose@sbcglobal.net)
Thu May 22 20:25:37 2008
Of course you are correct to some degree. I agree the abdominal circumference measurement alone does not distinguish the infected fetus with an enlarged liver and spleen from a fat fetus of a diabetic mother.
However, if we will consider all of the organ volumes, I believe we can get much better estimates, that will be better than just guessing. When we were collecting our data for the Basic Baby II database, we were measuring and estimating ages from 12 different parameters, not just Hadlock's four.
I am convinced that we do not get better estimates because we do not gather enough data in precise ways. As I said before, if we believe that sonographic assessment of fetal size and age is no better than a guess, we will tend to be sloppy in our methods, and will minimize the number of measurements we use, and the results become "garbage in, garbage out."
IMHO. Terry
"art fougner, md" <evsono@pipeline.com> wrote:
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
>
>>>> 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 wrote:
>
>From: DuBose, Terry
>Subject: Re: EFW accuracy
>To: "Multiple recipients of list ULTRASOUND"
>
>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"
>To: M
>ultiple recipients of list ULTRASOUND
>
>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) )
>
>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.
>
>(http://food.aol.com/tyler-florence?video=4&?NCID=aolfod00030000000002)
>
>________________________________________________
>This email and any files transmitted with it may contain
>________________________________________________
>________________________________________________
>confidential and /or proprietary information in the possession
>of WellStar Health System, Inc. ("WellStar") and is intended
>only for the individual or entity to whom addressed. This email
>may contain information that is held to be privileged, confidential
>and exempt from disclosure under applicable law. If the reader
>of this message is not the intended recipient, you are hereby
>notified that any unauthorized access, dissemination, distribution
>or copying of any information from this email is strictly prohibited,
>and may subject you to criminal and/or civil liability. If you have
>received this email in error, please notify the sender by reply email
>and then delete this email and its attachments from your computer.
>- Thank you.
>
--
art fougner, md
"May The Wings of Liberty Never Lose a Feather." - Jack Burton
