This week a patient saw me for routine visit at 15 weeks pregnancy. I did an office ultrasound scan and sadly diagnosed her baby had anencephaly (absence of development a major portion of the brain, skull, and scalp). I had the findings confirmed by a specialist pregnancy ultrasound unit.
I, as most of my obstetrician colleagues, have never had any formal training in doing ultrasound scans. I frequently tell patients this. I tell them I am not an expert in doing scans.
I have found my office routine scan are not only popular with patients but also very accurate. Office ultrasound scans add to the accuracy of antenatal assessment of babies. I am very pleased with how often my baby birth weight predictions are very accurate and that many various pregnancy complications have been successfully diagnosed by me with my scanning. As well, it is important if a woman has a pregnancy concern, such as bleeding, she can see me immediately and with ultrasound scanning I can reassure her all is well with baby.
I am now using the 3rd ultrasound machine I have purchased. It is very good GE machine. It cost about $60,000 to purchase and about $1000 each quarter for maintenance. I absorb the cost. We don’t change the patients or bill Medicare for any ultrasound scans.
I strongly recommend a patient has a morphology scan done by a specialist pregnancy ultrasound unit at 20 weeks to check for baby having developmental abnormalities.
A recent patient decided not to go to the specialist pregnancy ultrasound unit to which I referred her for the morphology scan, but rather to a general radiology practice. This would most likely have been to save money on the scan cost. I advised her when I saw the result that as the general radiologists were not specialists in pregnancy scan there was the possibility that they may have not diagnosed a problem. The scan was reported as normal. The baby did have a congenital abnormality when born. It is possible there could have been signs of this at 20 weeks and it could have been suspected if she had gone to the specialist pregnancy ultrasound unit to which I referred her.
I am also now encouraging an early anatomy scan at about 14 weeks and growth and wellbeing scan at about 36 weeks pregnancy. While it can be argued these are not really necessary if there is no hint of any problems, I am finding patients find them reassuring and occasionally they may find something I missed. The early scan can check for cervical incompetence (a weak cervix which is shortening). Today I put a cervical stitch in the cervix of a woman at 23 weeks as an extra scan at 23 weeks showed the cervix very short, where it had been normal length at her 14-week scan and 20-week morphology scan.
If I have concern with an office scan finding I arrange for them to be checked at a specialist pregnancy ultrasound unit. I want as much accuracy as possible before making any management decisions.
As I said above, I have never had any formal training in doing ultrasound scans. I am self-taught. This is also true of most of my obstetrician colleagues. But I have subspecialist colleagues I refer to who do have formal training in doing pregnancy and gynaecology ultrasound scans. They are obstetricians who own or work for the specialist pregnancy ultrasound units. They have subspecialised in this discipline and so spend all their week doing ultrasound or reporting on ultrasound assessment. These doctors are COGU (Certification in Obstetric and Gynaecological Ultrasound) qualified. As well these doctors employ obstetric specialist ultra-sonographers to do ultrasound scans. The doctors view these images and report the findings.
But even with this extra training and considerable expertise and the most expensive and best ultrasound machines there are still incorrect diagnoses made by these COGU trained doctors. That has a lot to do with the limitations of ultrasound scans. Patients get upset with this. They often have the incorrect view that ultrasound scans are 100% accurate. I aways say to patients that ultrasound scans, no matter who does them, are only a guide and not 100% accurate.
If the COGU trained ultrasound doctor has a concern, then they and I will arrange for further imaging by an even more specialised doctor. This is most common when a cardiac defect is suspected. There are doctors who specialise in foetal cardiac ultrasound scanning. As well we may turn to other modalities of imaging such as MRI. Again, though there can been errors. With MRIs this is often due to the unborn baby moving during the MRI.
