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Re: Birthweight Prediction in Obese GravidasFrom: jworrall@alaska.netSat Jul 12 12:22:00 2008
And there certainly is no shortage of obese pregnant patients these days. I am finding obesity is becoming a major factor in reducing the accuracy of prenatal ultrasound and nuchal translucency measurement. Maybe, as the Philips ultrasound ads say, the answer is in better transducer crystals and better ultrasound machines. A serious study needs to be done, entitled "The impact of obesity on the practice of prenatal ultrasound". Or a metaanalysis of the studies already done: "Does obesity really impact the practice of prenatal ultrasound?" Also, does obesity play a role in the medical liability cases brought against sonographers and sonologists for alleged misdiagnosis or failure to diagnose in prenatal cases? Do we assume greater medical liability risk when we scan a very obese patient? And what is the impact of obesity on the incidence of injury to the sonographer? I have already told my referring physicians that I will not do second trimester or third trimester triplets - I am old and it just is physically too demanding. There are other places they can be scanned in our community. I wish I could pass a similar rule about not accepting patients above a certain BMI, but I do not think that would fly. But I find that trying to scan under a heavy pannus while holding up the pannus with my scanning hand and arm, is physically very difficult, and I actually have to stop the scan and rest my right arm every few minutes. I have one husband who was willing to hold up the pannus for me, difficult with all the gel on the abdomen. Here is how I try to deal with the problem: My ultrasound report routinely records the patient's weight, height, and BMI. I make a statement as to my evaluation of the quality of the imaging, ranging from "superb!" to "very poor". I may qualify this by saying that the imaging was good except for the fetal heart or the fetal brain or whatever part did not image well. Or I might say the imaging was poor except for the parts that did scan well. In doing the fetal biometry, if I have low confidence in a measurement (the AC when there is no fluid around the fetal abdomen, and you are pretty much guessing where to place the cursors) I will say that in my report. In other words, I try to give the person reading the report an idea of how much confidence to have in the report. In a lighter vein, I think we should charge for prenatal ultrasound by the pound, with the understanding that there are patients who scan so well, and it is such a pleasure scanning them , that we pay them for the privilege of scanning them. And we should have a rule that at major ultrasound conventions, the models that the manufacturers hire to demonstrate their machines must have a BMI of 40 or more. Then we could really tell what their machines could do. Allen -------------------------------------------------- From: "art fougner, md" <evsono@pipeline.com> -------------------------------------------------- Sent: Saturday, July 12, 2008 6:28 AM -------------------------------------------------- To: "Multiple recipients of list ULTRASOUND" <ultrasound@mail.obgyn.net> Subject: Birthweight Prediction in Obese Gravidas
> Birth weight projection based on ultrasound measurements earlier in
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