Re: ULTRASOUND digest 2814
From: Joan P Baker (jbakerbaker@comcast.net)
Sun Jul 20 17:30:11 2008
Sound Ergonomics is now offering a "pannus sling" for obese patients and a
breast sling for cardiac patients with D cup breasts or larger. You can find
these under products on our website. It is not my intent to advertize on
this site but Dr Worrall's issues prompted me to do so.
-----Original Message-----
From: ultrasound@obgyn.net [mailto:ultrasound@obgyn.net]
Sent: Saturday, July 19, 2008 5:38 AM
To: Multiple recipients of list ULTRASOUND
Subject: ULTRASOUND digest 2814
ULTRASOUND Digest 2814
Topics covered in this issue include:
1) Re: Birthweight Prediction in Obese Gravidas
by evsono@pipeline.com (art fougner, md)
2) Re: Birthweight Prediction in Obese Gravidas
by evsono@pipeline.com (art fougner, md)
3) Re: Birthweight Prediction in Obese Gravidas
by DoctorJoe@aol.com
----------------------------------------------------------------------
Date: Fri, 18 Jul 2008 17:03:22 -0500 (CDT)
----------------------------------------------------------------------
From: evsono@pipeline.com (art fougner, md)
--
----------------------------------------------------------------------
To: ULTRASOUND@OBGYN.net
Subject: Re: Birthweight Prediction in Obese Gravidas
Message-ID: <200807182203.m6IM3MN29358@mail.obgyn.net>
"You can observe a lot by watching."
Yogi Berra
At Wed, 16 Jul 2008, James Smeltzer wrote:
>
>This gives an idea of what is possible. It is true that this sample has a
high ascertainment bias:
>
>CONCLUSIONS: In experienced hands, sonography has 97% sensitivity in
detecting anomalous fetuses when compared with perinatal autopsy results.
Although the sensitivity of sonography in detecting major fetal
abnormalities is 75%, the sensitivity for minor abnormalities is poor, even
when using a complete anatomic sonographic survey. Although it has
limitations, this type of survey is invaluable for both patients and
physicians in diagnosing fetal abnormalities.
>
>Value of a complete sonographic survey in detecting fetal abnormalities:
correlation with perinatal autopsy.
>
>Yeo L, Guzman ER, Shen-Schwarz S, Walters C, Vintzileos AM.
>
>J Ultrasound Med. 2002 May;21(5):501-10.
>
>--
>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
>
>>>> "DuBose, Terry" <DuboseTerryJ@uams.edu> 7/14/2008 1:13 PM >>>
>"> Terry - this looks like a good research project for one of your
students."
>
>Excellent suggestion... I will add it to the possible topics for papers in
>the Current Issues in Sonography course.
>
>Thanks,
>
>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/
>
>---------------------------------------------------------------
>
>---------------------------------------------------------------
>P Please consider the environment before printing this e-mail
>---------------------------------------------------------------
>---------------------------------------------------------------
>
>---------------------------------------------------------------
>---------------------------------------------------------------
>
>-----Original Message-----
>From: ultrasound@obgyn.net [mailto:ultrasound@obgyn.net] On Behalf Of
>jworrall@alaska.net
>Sent: Saturday, July 12, 2008 12:25 PM
>To: Multiple recipients of list ULTRASOUND
>Subject: Re: Birthweight Prediction in Obese Gravidas
>
>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
>
>> pregnancy may be better than standard prediction methods for obese
>
>> women, researchers said.
>
>> One such method using ultrasound measurement at 34 to 36 weeks predicted
>
>> birth weight within 20% accuracy in more than 90% of cases, reported
>
>> Loralei Thornburg, M.D., of the University of Rochester Strong Memorial
>
>> Hospital here, and colleagues in the July issue of Ultrasound in
>
>> Obstetrics and Gynecology.
>
>> In their retrospective study, this gestation-adjusted prediction (GAP)
>
>> method had lower sensitivity among morbidly obese women for the
>
>> clinically important prediction of macrosomia, but could exclude
>
>> macrosomia with more than 90% accuracy regardless of maternal body mass
>
>> index.
>
>> http://www.medpagetoday.com/OBGYN/Pregnancy/tb/10090
>
>> Terry - this looks like a good research project for one of your
>
>> students.
>
>> Art
>
>> --
>
>> art fougner, md
>
>> "May The Wings of Liberty Never Lose a Feather." - Jack Burton
>
>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.
>
>________________________________________________
>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
------------------------------
Date: Fri, 18 Jul 2008 17:05:05 -0500 (CDT)
------------------------------
From: evsono@pipeline.com (art fougner, md)
------------------------------
To: ULTRASOUND@OBGYN.net
Subject: Re: Birthweight Prediction in Obese Gravidas
Message-ID: <200807182205.m6IM55e00508@mail.obgyn.net>
Most difficult imaging patient I saw was a woman who, after 3 Cesareans,
had undergone an abdominoplasty aka tummy tuck.
Art
At Wed, 16 Jul 2008, James Smeltzer wrote:
>
>.. also dropping the head ot the table, trendelenberg and/or raising the
hips helps a lot, especially if the patient is not strong enough to hold her
own pannicucus. Be sure she can breathe, as a few are not that strong
either.
>Jim
>
>>>> "James Smeltzer" <James.Smeltzer@wellstar.org> 7/16/2008 12:54 PM >>>
>How about placing the patient more to the side, and moving the panniculus
north for the exam, scanning through the naval and vagina with the vaginal
probe (an idea of mine I must share with Guzman & al, who actually studied
it systematically vide infra), or asking the patient to hold her own
panniculus so you can insonate above the pubus. I routinely use all of
these. I also find that the technical quality of the equipment and
especially the post-processing) has kept up with the deteriorating image
quality attributed to increasing levels of confusion between the transducer
and the target. I am not specifically interested in lawsuits, as I have not
been tagged yet, but this is a legitimate question. As I recall, the
STANDARD OF CARE WE SHOULD BE HELD TO (and we ALL need to stick together on
this) IS TO LOOK, AND NOT NECESSARILY TO SEE.
>
>The code word my sonographers and I use on this is "best", as in I did my
..., or this was the ... possible under the conditions present. If it was a
matter of position and other factors - some non-obese patients are harder to
scan - that are deemed to be likely to improve with time, we work patients
in for repeat attempts, gratis. If a problem is suspected, they get to pay
for a targeted study.
>
>On the other hand, training and attention to detail and persistent
attention to outcomes and quality are VERY important. The harder you try the
better you get. With our current practice we identify the large majority of
babies with subsequently identified chromosomal anomalies, including Down
syndrome with NO identifiable structural anomalies. We have been humbled in
this regard twice, so it is wrong to promise that a "genetic" sonogram is as
good for detection of chromosomal anomalies as an amniocentesis. We do say
that it is safer for a normal baby. We perform extremely few amniocenteses,
and about 20% to a third are positive.
>
>Jim
>
>>>> "DuBose, Terry" <DuboseTerryJ@uams.edu> 7/14/2008 1:13 PM >>>
>"> Terry - this looks like a good research project for one of your
students."
>
>Excellent suggestion... I will add it to the possible topics for papers in
>the Current Issues in Sonography course.
>
>Thanks,
>
>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/
>
>---------------------------------------------------------------
>
>---------------------------------------------------------------
>P Please consider the environment before printing this e-mail
>---------------------------------------------------------------
>---------------------------------------------------------------
>
>---------------------------------------------------------------
>--
>---------------------------------------------------------------
>
>---------------------------------------------------------------
>-----Original Message-----
>From: ultrasound@obgyn.net [mailto:ultrasound@obgyn.net] On Behalf Of
>jworrall@alaska.net
>Sent: Saturday, July 12, 2008 12:25 PM
>To: Multiple recipients of list ULTRASOUND
>Subject: Re: Birthweight Prediction in Obese Gravidas
>
>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
>
>> pregnancy may be better than standard prediction methods for obese
>
>> women, researchers said.
>
>> One such method using ultrasound measurement at 34 to 36 weeks predicted
>
>> birth weight within 20% accuracy in more than 90% of cases, reported
>
>> Loralei Thornburg, M.D., of the University of Rochester Strong Memorial
>
>> Hospital here, and colleagues in the July issue of Ultrasound in
>
>> Obstetrics and Gynecology.
>
>> In their retrospective study, this gestation-adjusted prediction (GAP)
>
>> method had lower sensitivity among morbidly obese women for the
>
>> clinically important prediction of macrosomia, but could exclude
>
>> macrosomia with more than 90% accuracy regardless of maternal body mass
>
>> index.
>
>> http://www.medpagetoday.com/OBGYN/Pregnancy/tb/10090
>
>> Terry - this looks like a good research project for one of your
>
>> students.
>
>> Art
>
>> --
>
>> art fougner, md
>
>> "May The Wings of Liberty Never Lose a Feather." - Jack Burton
>
>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.
>
>________________________________________________
>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.
>
>________________________________________________
>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
------------------------------
Date: Fri, 18 Jul 2008 18:49:48 EDT
------------------------------
From: DoctorJoe@aol.com
------------------------------
To: ultrasound@obgyn.net
Subject: Re: Birthweight Prediction in Obese Gravidas
Message-ID: <bdd.31ad3ec2.35b2780c@aol.com>
MIME-Version: 1.0
Content-Type: multipart/alternative;
boundary="part1_bdd.31ad3ec2.35b2780c_boundary"
In a message dated 7/18/08 5:04:21 PM, evsono@pipeline.com writes:
> "You can observe a lot by watching."
>
Well, I've LONG felt that U/S was basically a "physical exam" of the fetus.
I don't see why that's such a mystery. You look -- you see.
Of course, the devil's advocate position is, remember that U/S is not
"vision." It's computer interpretation of reflections of sound waves through
a
complex biological organism. (That's way kewel in and of itself!)
But I always liked U/S much better than I liked looking at little kids with
runny noses and dirty diapers and maybe crackly lungs. Smelling U/S jelly is
a
lot nicer than ... well, you know.
Joe P.
------------------------------
End of ULTRASOUND Digest 2814
------------------------------
*****************************
------------------------------
