Obstetrics Ultrasound.

[KLPM]

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Just a quick question for those who know significantly more than I do.

In my evidence-based medicine class 🙂p) we're discussing MS-AFP and ultrasound in screening foetal anomalies. Someone was saying that ultrasound had much greater sensitivity than MS-AFP when it comes to detecting anomalies. However, I was just curious about operator-dependency of ultrasound. I would imagine that the accuracy of ultrasound screen would be highly dependent on the skill of the operator and whether they were lucky enough to catch the foetus in a good position of see the anomalies.

Am I on the right track or am I way off?

 

[shark2000]

Just a quick question for those who know significantly more than I do.

In my evidence-based medicine class 🙂p) we're discussing MS-AFP and ultrasound in screening foetal anomalies. Someone was saying that ultrasound had much greater sensitivity than MS-AFP when it comes to detecting anomalies. However, I was just curious about operator-dependency of ultrasound. I would imagine that the accuracy of ultrasound screen would be highly dependent on the skill of the operator and whether they were lucky enough to catch the foetus in a good position of see the anomalies.

Am I on the right track or am I way off?

US is more sensitive.

OB ultrasound is standardized to some extent. It means some standard views should be seen in order to clear that organ.

For example, for spinal anomalies, you should see the entire spine in sagital and axial plane. Otherwise, you can not clear it. Or for Abdominal wall defect, you have to see the cord insertion.

OB US has some check lists, consisting of standard views of different organ system. You have to go through and should clear all organs. In many instances you can not clear some organs, because of the position of the baby, so you defer it to the next time.

Though it is operator dependent, it is systematic. It is not like jumping randomly from one organ to the other. IMO, the most reason for missing something by a well trained individual is not the skill of technician or radiologist. It is missed because either it is a busy day and you have to go through tens of exams or you are distracted by a lot of telephones. Since most of the exams are normal, it is easy to miss something between multiple normal exams.

These days because of malpractice issues, most people do not do it. Only people who feel comfortable (i.e. fellowship trained) do it. Most of it is done by OBs trained in Feto-materal medicine (3 year fellowship).

 

[colbgw02]

These days because of malpractice issues, most people do not do it. Only people who feel comfortable (i.e. fellowship trained) do it. Most of it is done by OBs trained in Feto-materal medicine (3 year fellowship).

The bolded part isn't true. It's a common misconception that most OB studies are read by MFMs, but - nationwide - more are read by radiologists. The misconception arises because most radiologists train at large, tertiary care centers, where perinatologists do read almost all of them. That also explains its relatively litigious nature, because radiology residents don't receive adequate training during residency, since all of the patients are in the OB department. However, the numbers make sense when you think about the number of people getting these studies as compared to the number of radiologists/MFMs in practice. If MFMs were reading most of these, then that's all they would do.

 

[KLPM]

Slightly different question. How often does one resort to trans-vaginal US as opposed to trans-abdominal US for obstetrics patients? Ever? Never? What about our ever growing/fattening population?

 

[colbgw02]

Slightly different question. How often does one resort to trans-vaginal US as opposed to trans-abdominal US for obstetrics patients? Ever? Never? What about our ever growing/fattening population?

In the 1st trimester, I'd say you should pretty much always be doing endovaginal imaging.

Later in pregnancy, it's typically used as a problem-solving tool, like if there were a question of cervical competence or an adnexal mass. Once the fetus is large enough, EV imaging is of minimal utility in evaluating the gestation, irrespective of the mother's biscuit toxicosis.

 

[KLPM]

biscuit toxicosis

I am going to be using this one.

 

[shark2000]

The bolded part isn't true. It's a common misconception that most OB studies are read by MFMs, but - nationwide - more are read by radiologists. The misconception arises because most radiologists train at large, tertiary care centers, where perinatologists do read almost all of them. That also explains its relatively litigious nature, because radiology residents don't receive adequate training during residency, since all of the patients are in the OB department. However, the numbers make sense when you think about the number of people getting these studies as compared to the number of radiologists/MFMs in practice. If MFMs were reading most of these, then that's all they would do.

I always thought it is done 70 percent by MFM and 30 percent by radiology. but I don't have any proof for that.
When I was a resident, It was a shared service between radiology and MFM. Now in pp, we do some OB. But I don't know what is the proportion in our region.

Our none MFM referrers either OB or Family doctors or midlevels prefer it to be done by radiology, since there is no risk of losing the patient.

I agree that if you want to do it, there is enough business.