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


    Others have proposed simulation-based training, wherein residents train on a virtual-reality transvaginal simulator until they attain an expert performance level and progress to training using a pelvic mannequin.9 In a randomized study of new ob/gyn residents with no prior ultrasound experience, researchers found that a rigorous simulation-based ultrasound training program led to a substantial improvement in clinical performance (as graded by the Objective Structured Assessment of Ultrasound Skills [OSAUS] scale) that was sustained for months during clinical training.9

    In fact, a poster presented at this year’s annual meeting of the American College of Obstetricians and Gynecologists demonstrated that when medical students were tasked with teaching inexperienced rural healthcare workers to use the Rural Obstetrical Ultrasound Triage Exam—a diagnostic algorithm using portable ultrasound in rural areas to triage patients for future risk of maternal or fetal complications—there was a significant improvement in the quality of the healthcare workers’ practical sonographic skills.10

    Technological advances are increasing at an exponential rate, and as the tools improve, so do their clinical and research applications. Pregnancies can be identified earlier, complications can be detected sooner and more accurately, and some data are so robust that we don’t have the tools to know how to interpret them.

    For example, a recently published study found that rates of mouth movement and facial self-touch differ significantly between the fetuses of smokers and those of nonsmokers.11 These authors openly admit that interpretation and extrapolation of these data are difficult and that further research is needed to help understand why and how this all comes together.

    From a technological standpoint, ultrasound is the wave of the future.


    1. Donald I, MacVicar J, Brown TG. Investigation of abdominal masses by pulsed ultrasound. Lancet. 1958;1:1188–1195.

    2. Donald I. Clinical applications of ultrasonic techniques in obstetrical and gynaecological diagnosis. Br J Obstet Gynaecol. 1962;69:1036.

    3. Donald I, Abdulla U. Placentography by sonar. J Obstet Gynaecol Br Commonw. 1968;75:993–1006.

    4. Voluson E10 OB/GYN Ultrasound with World's First Curved Matrix Electronic 4D Probe. http://www.medgadget.com/2014/09/voluson-e10-obgyn-ultrasound-with-world.... Accessed August 21, 2015.

    5. The US Food and Drug Administration. Avoid Fetal "Keepsake" Images, Heartbeat Monitors http://www.fda.gov/ForConsumers/ConsumerUpdates/ucm095508.htm. Accessed August 21, 2015.

    6. The Wall Street Journal. Pregnant women get more ultrasounds, without clear medical need. http://www.wsj.com/articles/pregnant-women-get-more-ultrasounds-without-clear-medical-need-1437141219. Accessed August 21, 2015.

    7. Green J, Kahan M, Wong S. Obstetric and gynecologic resident ultrasound education project: Is the current level of gynecologic ultrasound training in Canada meeting the needs of residents and faculty? J Ultrasound Med. 2015 Aug 7. pii: 15.14.10067. [Epub ahead of print]

    8. Popowski T, Huchon C, Fathallah K, Falissard B, Dumont A, Fauconnier A. Impact of accreditation training for residents on sonographic quality in gynecologic emergencies. J Ultrasound Med. 2015;34(5):829-835.

    9. Tolsgaard MG, Ringsted C, Dreisler E, et al. Sustained effect of simulation-based ultrasound training on clinical performance: a randomized trial. Ultrasound Obstet Gynecol. 2015. doi: 10.1002/uog.14780. [Epub ahead of print]

    10. Sanchez O, Baker J, Vaughan J, et al. The Rural Obstetrical Ultrasound Triage Exam (ROUTE): Teaching Health Care Workers in International Settings [392].

    11. Reissland N, Francis B, Kumarendran K, Mason J. Ultrasound observations of subtle movements: a pilot study comparing foetuses of smoking and nonsmoking mothers. Acta Paediatr. 2015;104(6):596-603. 

    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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