The evolving role of ultrasound in obstetrics/gynecology practice

Abstract

The value of ultrasound examinations depends heavily on the preparation of the personnel carrying out the examination and the technical capabilities of the equipment they use. Only well-organized regional or national programs are able to provide high level, cost-effective care based on certification of quality. Such certification must include the training of professionals, the definition of competence levels, accreditation of laboratories and the establishment of professional protocols. Together, these factors can guarantee the standard of care and provide legal protection for practitioners. It is worth carrying out routine screening in each pregnancy because the majority of abnormalities occur in pregnancies with low risk. Abnormalities detected on screening cases and the examination of high risk groups should be referred to higher level centers. Here, appropriate technical background and qualified personnel are present to provide cost-effective care. At the same time, necessary invasive interventions can also be performed. A minimum of three screening tests should be performed during pregnancy. The first should be performed at the fetal age of 10-14 weeks to detect abnormalities and pathological conditions in early pregnancy. The second one has to be performed between the fetal ages of 18 and 22 weeks to assess detailed fetal anatomy and rate of development. The third should be performed between the fetal age of 30 and 34 weeks to assess fetal anatomy, rate of development, placentation and circulation. It is worth considering a fourth screening at approximately 36-38 weeks to assess the intrauterine condition of the fetus and determine the appropriate method of delivery. Finally, besides improving the standard of living, education, and hygienic conditions in developing countries, developed countries also have to help improve the standard of pregnancy care. Within this context, the dissemination of diagnostic ultrasound must be given special emphasis.

Prenatal Sonographic Detection of Birth Defects in 18 Hospitals From South America

“…Sensitivity is influenced considerably by several factors, such as the population selected, public health policies, gestational age at screening, total number of sonographic scans, distribution of malformations among different health insurance schemes, exclusion of fetal malformations, accuracy of neonatal examinations, training of practitioners in charge of the examinations, technological equipment used, and period of ascertainment. 3,29,30 The distribution of malformations in this population probably differed from those observed in developed countries. The lack of health policies for the prenatal diagnosis of anomalies as well as pregnancy termination could have influenced the whole spectrum of anomalies and increased the number of fetuses with more than 1 anomaly.…”

Customer's self-audit to improve the technical quality of maternity care in Tabriz: a community trial

“…According to our study findings only 15% of pregnant women in both groups received ultrasound examination at the recommended level, showing that our proposed intervention and education did not change pregnant women's attitudes and behaviours with regard to ultrasound examination (25). A minimum of 3 screening tests should be performed during pregnancy (26). Unlike developed countries, the quality of pregnancy care is below standard and a shortage of some services in developing countries is a major weakness in antenatal care.…”

“…Unlike developed countries, the quality of pregnancy care is below standard and a shortage of some services in developing countries is a major weakness in antenatal care. However, a proportion of our participants recorded overuse as well as underuse of ultrasound examination and in some countries, including ours, these services tend to be over-used due to a misunderstanding about the safety of ultrasound scans in pregnancy (5,(25)(26)(27). Therefore, care providers especially specialists and private sector providers must inform pregnant women about the side-effects of over-use of ultrasound and advise them to follow the recommended standard.…”

Goal-directed junior ultrasound training in quantitative measurement of crown-rump length and fetal nuchal translucency: evaluation of a specific training program in a specialized center for prenatal diagnosis

“…Goal-directed junior ultrasound training in quantitative measurement of crown-rump length and fetal nuchal translucency: evaluation of a specific training program in a specialized center for prenatal diagnosis Dear Editors, Most practitioners have been made aware of the need for training and strict quality control programs in order to make screening programs as efficient as possible [1]. In fact, careful and precise measurement of fetal crown-rump length (CRL) and nuchal translucency (NT) is essential in providing an accurate risk calculation for women choosing to be screened for aneuploidy and in dating pregnancy.…”