Student Competency for Midtrimester Obstetrics Scan upon Completion of the Master’s Degree in Medical Sonography (original) (raw)
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Aim: To assess reproducibility of estimating gestational age (GA) of foetus using femur length (FL), biparietal diameter (BPD) and abdominal circumference (AC) within experienced and inexperienced sonographers and between the two. Patients and methods: Two sets of GA estimates each were obtained for FL, BPD and AC by the two observers in 20 normal singleton foetuses. The first estimates for the three biometric parameters were made by the experienced sonographer. Subsequently, the inexperienced sonographer, blind to the estimates of the first observer obtained his own estimates for the same biometric parameters. After a time interval of ten minutes the process was repeated for the second set of GA estimates. All the gestational age estimates were made following standard protocol. Statistical analysis was performed by Pearson's and intraclass correlations, coefficient of variation and BlandeAltman plots. Statistical inferences were drawn at p < 0.05. Results: The Pearson's and intraclass correlations of between GA estimates within and between both observers from measurement of FL, BPD and AC were very high and statistically significant (p < 0.05). Coefficient of variation for duplicate measurements for GA estimates within observers and between observers were quite negligible. Between observers, the first and second GA estimates from FL measurements showed the least variation. Estimates from BPD and AC measurements showed greater degree of variation between the observers. Conclusion: Reproducibility of GA estimation using FL, BPD and AC within experienced and inexperienced sonographers and between the two was excellent. Therefore, a fresh Nigerian radiography graduate with adequate exposure in obstetric ultrasound can correctly determine the gestational age of foetus in routine obstetric ultrasound without supervision.
Australasian Journal of Ultrasound in Medicine, 2013
Introduction: The aim of this study is to provide a quantitative scoring system to assess sonographer performance by reviewing images from the fetal morphology examination. Methods: Ten ultrasound images from patients at 18-22 weeks gestation were assessed and scored for quality according to predefined criteria. One hundred normal cases were randomly selected and 10 images from each case were analysed by four experienced reviewers. The preliminary training incorporated the first 25 cases and involved a training period for reviewers; the remaining 75 cases were allocated to post training. The scores acquired by each reviewer were statistically analysed using Pearson's and intra-class correlations to determine the reproducibility of the results. Results: The preliminary training results were calculated separately and compared to the post training study. The preliminary intra-class correlation coefficient was 0.12. In the post training study the intraclass correlation coefficient was doubled at 0.24. The greatest correlation was observed between reviewers 1 and 4 with a coefficient of 0.71. Reviewers 3 and 4 demonstrated the lowest correlation coefficient of 0.30. Discussion: A significant increase in the intra-class correlation coefficient indicated that training reviewers achieves more reproducible results. Suggested improvements to the study include recording fetal position, maternal BMI and assessing individual reviewer variability. An instruction manual defining each criterion might also yield better results. Conclusion: The quantitative method used in this study assessed ultrasound images by placing a numerical value on image quality. Analysis of the preliminary training period demonstrates improved reproducibility of the results. Further investigation into the criteria is necessary to refine the quantitative method.
Accuracy of emergency physicians using ultrasound to determine gestational age in pregnant women
The American Journal of Emergency Medicine, 2010
Introduction: Rapid and accurate determination of gestational age may be vital to the appropriate care of the critically ill pregnant patient. Before the use of emergency ultrasound, physical examination of fundal height (FH) in the nonverbal patient was considered the quickest method to estimate gestational age. We conducted a prospective, observational study of the performance of bedside sonography to determine gestational age. Methods: We enrolled a convenience sample of women in their second or third trimester of pregnancy. Emergency physicians (EPs) made ultrasound measurements of fetal biparietal diameter (BPD) and femur length, followed by a measurement of FH. These measurements were compared with true gestational age (TGA), sonography by an ultrasound technician, and measurement of FH performed by an obstetrician. Main outcome measures were the average time needed to complete measurements; correlation coefficients between EP measurements and those made by an ultrasound technician, an obstetrician, and TGA, and overall accuracy to determine fetal age greater than 24 weeks. Results: The average time to complete ultrasound measurements was less than 1 minute. When physician-performed measurements were compared with TGA, the correlation coefficients were 0.947 (0.926-0.968) for BPD, 0.957 (0.941-0.973) for femur length, and 0.712 (0.615-0.809) for FH. When determining fetal viability, EP's overall accuracy was 96% using ultrasound and 80% using FH. Conclusions: With brief training, EPs can quickly and accurately determine gestational age using ultrasound, and these estimates may be more accurate than those obtained through physical examination. Emergency physicians should consider using ultrasound in emergent evaluation of pregnant patients who are unable to provide history.
The European Research Journal, 2020
Objectives: We consider the difference between estimated fetal weight and birth weight through the measurement according to the seniority of the residents in obstetrics and gynecology. In this study, we aimed to determine the fallibility of the residents according to their seniority years. Methods: This research was planned as a prospective and approved by the Ethics Committee Ultrasonographic measurements were performed with ultrasound device and the estimated fetal weight was calculated with Hadlock 4 (BPD, HC, AC, FL) formula. Measurements were performed by the residents in the first, second, third and fourth year of training and repeated by the same specialist for each patient. Only those who gave birth within 48 hours of the ultrasonographic measurements were included in the study. Results: A total of 392 pregnant women were included in the study. Ninety-eight pregnant women were examined by 1st year resident, 100 pregnant by 2nd year resident, 93 pregnant by 3rd year resident and 101 pregnant by 4th resident. Largest difference between the estimated fetal weight and birth weight was performed by the fourth year resident with 125.06 ± 247.40 grams. Conclusions: The estimated fetal weight by ultrasonography has an important place in obstetric practice and it may vary according to the years of seniority of the resident. For this reason, ultrasonography should be used effectively and accurately during the training of the residents in the centers of education in obstetrics and gynecology and it is essential that the residents learn the ultrasound examination properly and completely.
Journal of Obstetrics and Gynaecology, 2020
Our study aims to present the preliminary findings of an ongoing prospective cohort study that assesses the trainees' ability to perform foetal biometry during the third trimester of pregnancy. Sixtythree women with third-trimester singleton pregnancies were included. A biometry scan was performed byboth residents and a foetal medicine specialist in the Third department of Obstetrics and Gynaecology of Attikon University Hospital. For each case, the ultrasonographic measurements of the two operator groups were compared. The mean difference of the resident group compared to the specialist group was: for the biparietal diameter þ1.3 mm (CI 95%, range À10.6 to þ13,3, ±1.96 SD), for the occipitofrontal diameter À2.6 mm (CI 95%, range À31.5 to þ26.2), for the anterior-posterior abdominal diameter À2.6 mm (CI 95%, range À17.9 to þ12.8), for the transverse abdominal diameter À0.7 mm (CI 95%, range À17.1 to þ15.7) and for the femur length À1.1 mm (CI 95%, range À11.7 to þ9.6). We observed that, among all biometric parameters, the most accurate-based on the specialist group were the head circumference measurements. The highest discrepancy was noted for the abdominal assessment. Given that foetal biometry is of utmost importance in obstetrical clinical evaluation and management, a study that highlights the weaknesses of residents in this field could open new horizons in optimising the learning procedure. IMPACT STATEMENT What is already known on this subject? After review of the literature, we found only a few studies on inter-and intra-observer discrepancy in foetal biometry measurements among specialists. What the results of this study add? To our knowledge, our study is the first to evaluate residents' capacity of performing a biometry scan, by comparing their measurements to those of MFM specialists. What the implications are of these findings to clinical practice and/or further research? The need for constant evaluation of residents is indisputable. Our study could help to improve their ultrasound skills by giving emphasis on residents' weaknesses. With further research on this subject, a standard system of evaluation could be formed and determine the duration and type of training required for each resident.
Gestational Age Estimation Based on Fetal Pelvimetry on Fetal Ultrasound in Iraqi Women
Journal of Global Radiology, 2016
Ultrasound is an integral part of obstetric practice, and assessment of gestational age (GA) is a central element of obstetric ultrasonography. Sonographic estimation of GA is derived from calculations based on fetal measurements. Numerous equations for GA calculation from fetal biometry have been adopted in routine practice. This study reports a new method of estimating GA in the second and third trimester using interischial distance (IID), the distance between the two ischial primary ossification centers, on fetal ultrasound. Four hundred women with uncomplicated normal singleton pregnancies from 16 weeks to term were examined. Standard fetal obstetric ultrasound was done measuring biparietal diameter (BPD) and femur length (FL) for each fetus. The IID, in millimeters, was correlated with the GA in weeks based upon the BPD and FL individually, and the BPD and FL together. Statistical analysis showed strong correlation between the IID and GA calculated from the FL with correlation coefficient (r =0.989, P<0.001). Strong linear correlation was also found between the IID and GA based upon BPD and BPD+FL. Further statistical analysis using regression equations also showed that the IID was slightly wider in female fetuses, but this difference was not statistically significant. Resulting from this analysis, we have arrived at an easy-to-use equation: GA Weeks = (IID mm + 8) ±1 week. We feel this method can be especially applicable in the developing world, where midwives may not have access to software for fetal biometry in their basic handheld ultrasound machines. Even more sophisticated machines may not come with loaded software for obstetrics analysis. There are several limitations to this study, discussed below. We recommend further studies correlating the IID with other biometric parameters.
Accuracy of Ultrasound to Determine Gestational Age in Third Trimester
Rapid and accurate determination of gestational age (GA) may be vital to the appropriate care of the critically ill pregnant patient and improve obstetric care through allowing the optimal timing of necessary INTERVENTIONS and the avoidance of unnecessary ones. Ultrasound scans are considered to be the most cost-effective, accurate and safe methods for measurement of various fetal parts in pregnant women. The aim of this research is to explore the accuracy of ultrasound in determining gestational age of fetus in third trimesters. Data collected for all pregnant women referred to the Maternity & Children’s Hospital in Jeddah. Only women with single live fetus were included in this study. Women who participated in the study were selected on following criteria: Regular menstrual cycles, known date of last menstrual period and previous live normal neonates in multipara. All scans were performed by a single ultrasonologist on one ultrasound machine. From collected data, it was found that out of 53 (100%) patients, 44 (84.62%) pregnant woman have different gestational age from US and last menstrual period (LMP). From this study we can conclude that the main method to follow fetus growth in third trimester not biparietal diameter (BPD) measurement only. The BPD in third trimester is not reliable and be useless when the patient pass 30 weeks and the BPD has to be side with other measurements when we take it in later trimesters to emphasize the normal growth of fetus and avoid wrong measurement of ultrasound.
Natural Science, Vol.5, No.8A2, 32-35 (2013) doi:10.4236/ns.2013.58A2005
Background: Some researchers have suggested that when Naegle’s rule (NR) and Dubowitz score (DS) are combined, it could out-perform obstetric ultrasound scan (USS). Others still believe that obstetric USS alone is still effective relative to the combination of NR rule and DS in assessing the gestational age (GA) of babies. Objectives: To determine and compare the GA of babies using obstetric USS, NR and DS; and to provide relevant public health information on obstetric USS in the 21st century. Methods: Subjects were selected using systematic ran- dom sampling and the GA of babies was deter- mined using obstetric USS, NR, and DS. Statis- tical package for social science (SPSS) statisti- cal software version 16, Illinois, Chicago USA was used for all data analysis. Results: Eighty- five mother-baby pairs were studied. Forty-four babies (52%) were males and 41 (48%) females. Sixty four (75%) were term with a mean (SD) BW of 3.02 (0.59) at 95%CI (2.89 - 3.14) kg. The over- all mean GA of the babies was 38.49 (2.89) at 95%CI (38.14 - 38.85) weeks. The mean GA using obstetric USS, NR and DS were 38.52 (1.98) at 95%CI (38.14 - 38.99), 38.09 (4.13) at 95%CI (37.20 - 38.99) and 38.82 (2.02) at 95%CI (38.39 - 39.26), but comparison of these means was not significant (p = 0.256). Combined mean GA by NR and DS was 38.46 (3.26) at 95%CI (37.96 - 38.95). Comparing this mean with mean GA ob- tained by obstetric USS was also not significant (p = 0.885). Conclusion: The GA assessments by Obstetric USS, NR and DS were all reliable, and Obstetric USS performed effectively relative to combined NR and DS. Keywords: Gestational Age; Babies; Obstetric Ultrasound Scan; Naegle’s Rule; Dubowitz Score; Maiduguri; Nigeria
Frontiers in Global Women's Health, 2022
IntroductionEstablishing an accurate gestational age is essential for the optimum management of pregnancy, delivery and neonatal care, with improved estimates of gestational age considered a public health priority by the World Health Organization (WHO). Although ultrasound is considered the most precise method to achieve this, it is unavailable to many women in low- and middle- income countries (LMICs), where the lack of trained practitioners is considered a major barrier. This systematic review explores what initiatives have previously been undertaken to train staff to date pregnancies using ultrasound, which were successful and what barriers and facilitators influenced training.MethodsThe systematic review was conducted according to PRISMA guidelines and the protocol registered (PROSPERO CRD42019154619). Searches were last performed in July 2021. Studies were screened independently by two assessors, with data extracted by one and verified by the other. Both reviewers graded the me...