Sowohl das Ultraschall-Screening in der Betreuung von Schwangeren nach den Mutterschaftsrichtlinien [1] als auch das DEGUM-Mehrstufenkonzept in der pränatalen Diagnostik [2] sind in Deutschland etabliert. Eine vom Gemeinsamen Bundesausschuss (GBA) in Auftrag gegebene Untersuchung des Ultraschall-Screening-Programms hinsichtlich der Entdeckungsraten fetaler Anomalien konnte zeigen, dass es positive Korrelationen zwischen der Qualifikation der Untersucher und der Qualität der Geräte einerseits und den Detektionsraten andererseits gibt [3].
Mit der Neufassung der Mutterschafts-Richtlinien [2] wurden am 1. April 1995 drei Ultraschalluntersuchungen in die Mutterschaftsvorsorge aufgenommen und die damit verbundenen Screening-Leistungen (Mindestanforderungen) definiert. Mit diesem sog. 10 -20 -30 Schwangerschaftswochen-Screening sollte die Basis geschaffen werden, Auffälligkeiten früher und gezielter zu erkennen, um ggf. noch weitere diagnostische Maßnahmen in die Wege leiten zu können. Durch Konzentration von auffälligen Befunden in entsprechend ausgerichteten Pränatalzentren (3-Stufen-Konzept) [2] konnte innerhalb der letzten Jahre eine praxisrelevante Verbesserung der pränatalen Diagnostik erzielt werden [1]. Der Erfolg dieses Mehrstufenkonzeptes in der pränatalen Diagnostik ist gekennzeichnet durch eine fundierte Basissonographie, vorwiegend durch niedergelassene Frauenärzte und deren Zusammenarbeit mit qualifizierten Ultraschallspezialisten in pränataldiagnostisch ausgerichteten Zentren/Praxen.
A precondition for the early detection of fetal abnormalities is the high quality of prenatal basic ultrasound (screening examination). The objective of ultrasound screening is the recognition of abnormal fetal growth and fetal anatomical anomalies. The prenatal detection of fetal abnormalities enables detailed prenatal counselling of parents, improved care at birth and potentially a reduction in morbidity and mortality. In the guidelines for maternity care in Germany (“Mutterschaftsrichtlinien”), the performance of basic ultrasound in pregnancy is not clearly defined. The required image documentation includes a few biometric measurements only. Therefore, adherence to a standard technique and the possibility of audit are limited, thus not necessarily resulting in high screening quality. In this update of the DEGUM quality requirements for level I screening ultrasound examination between 18 + 0 and 21 + 6 weeks of gestation, the required parameters, standard planes and required documentation are described in detail. The greater experience of gynecologists in the field of sonographic screening examinations and the use of a modern ultrasound technique allow improvement of the screening quality. This will improve the standard of basic ultrasound screening. Due to the enhanced standard of the DEGUM I examination, more pregnant women may benefit from a detailed ultrasound examination and specialized therapy in DEGUM level II and III centers. The required fetal structures are described in detail. This update of the requirements for level I DEGUM basic ultrasound examination between 18 + 0 and 21 + 6 weeks of gestation goes far beyond the guidelines for maternity care in Germany (the “Mutterschaftsrichtlinien”) thereby elevating standards.
Gynecological sonography is the central and most frequently used technical examination method used by gynecologists. Its focus is on the clarification of masses of the uterus and the adnexa, fertility diagnosis, clarification of bleeding disorders and chronic and acute pelvic problems, pelvic floor and incontinence diagnosis as well as the differential diagnosis of disturbed early pregnancy. The indication for diagnostic and therapeutic interventions, preoperative planning and postoperative controls are largely based on the findings of gynecological sonography. These examinations are particularly dependent on the experience of the examiner.Based on the proven multi-stage concept of obstetric diagnostics, gynecological sonography should primarily be performed by an experienced and specialized examiner in patients for whom the initial gynecological examinations have not yet led to a sufficient assessment of the findings. So that the expert status required for this has an objective basis, the Gynecology and Obstetrics Section of DEGUM in cooperation with ÖGUM and SGUM implemented the option of acquiring DEGUM Level II for gynecological sonography. The effectiveness of the care in the multi-level concept depends on the quality of the ultrasound examination at level I. Quality requirements for the basic examination and the differentiation between the basic and further examination have therefore already been defined by DEGUM/ÖGUM. The present work is intended to set out quality requirements for gynecological sonography of DEGUM level II and for the correspondingly certified gynecologists.Common pathologies from gynecological sonography and requirements for imaging and documentation are described.
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