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    Womb with a view: How to prepare for tomorrow’s ob/gyn images


    Do our patients really need all that technological power? Most likely not. Most patients who have 3D/4D ultrasounds are having the scans as “keepsake” mementos because they are excited about the opportunity to see a facial reconstruction of their fetus. A glimpse of their baby smiling or sucking his thumb while in utero is a moment parents don’t forget. However, the US Food and Drug Administration (FDA) has recently been vocal about avoiding such elective scans.

    In an FDA statement released in 2014, Shahram Vaezy, PhD, an FDA biomedical engineer, is quoted as saying, “ultrasound can heat tissues slightly, and in some cases, it can also produce very small bubbles (cavitation) in some tissues.” The concern is that the long-term effects of tissue heating and cavitation are unknown. Therefore, the FDA recommends that ultrasound scans be done only when there is a medical need, based on a prescription, and performed by appropriately trained operators.5

    This FDA opinion is focused on protecting the population as a whole—preventing patients from being taken advantage of financially, being reassured of normality from a non-diagnostic “study,” and keeping them from putting their unborn children at theoretical risk.

    The Wall Street Journal reported that in 2014 the most common fetal-ultrasound procedures were performed an average of 5.2 times per pregnancy in the United States, up 92% from 2004; some women report getting scans at every doctor visit during pregnancy.6 The article goes on to say that the rising usage rates may in part reflect a belief among obstetricians that routine scans can help stave off “surprises.” Such “defensive” medical practices may be related the fact that obstetricians pay among the highest malpractice premiums of any medical specialty.

    Indeed, the same WSJ article also noted, “experts in the field say it isn’t uncommon for lawsuits against obstetricians to allege that more ultrasounds should have been performed.”6

    So if ultrasounds can legitimately aid in prenatal diagnosis, more precisely diagnose gynecological disorders and perhaps prevent litigation, are all ob/gyn residents comfortable using ultrasound to its full potential upon completing training? A recent evaluation of the quality of ultrasound education in Canadian ob/gyn residency programs found that most residents reported inadequate exposure to gynecologic ultrasound and claimed that there was little standardization in training.7

     One proposed solution is to introduce an accreditation training process to standard ob/gyn training. When facilitated feedback from a board-certified ob/gyn sonography expert is included, the quality of sonographic examinations performed by ob/gyn residents reportedly improves markedly.8


    Brian A. Levine, MD, MS, FACOG
    Dr. Levine is Practice Director at the Colorado Center for Reproductive Medicine, New York, New York.


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