Obstetric Ultrasound: Balancing Recommendations with Expectations

2016 ◽  
Vol 10 (1) ◽  
pp. 14-22 ◽  
Author(s):  
Marguerite Lisa Bartholomew
Keyword(s):  
Pregnant Woman ◽  
Medical Imaging ◽  
Patient Autonomy ◽  
Obstet Gynecol ◽  
Ultrasound Examination ◽  
Definitive Diagnosis ◽  
Obstetric Ultrasound ◽  
Her Family ◽  
Practice Of Medicine ◽  
Compassionate Communication

ABSTRACT Obstetric ultrasound is unlike any other form of medical imaging. The expectations of the provider performing the ultrasound are dramatically different from those of the woman receiving the ultrasound. Ultrasound providers are often put into situations where the practice of medicine is superseded by expectations of a pregnant woman and her family who see themselves as consumers of ‘medictainment’ rather than patients. Women come to obstetric ultrasound with the primary expectation to hear the simple news that their baby is normal and most wish to know the fetal sex as a secondary piece of information. They would also like to have information ahead of time about what to expect from an ultrasound examination experience. Ultrasound physicians are charged with the task of identifying something wrong, providing a definitive diagnosis, and communicating it in a balanced and relatively unemotional manner, while at the same time being beneficent and respectful of patient autonomy. Patients may not want to find out that something is wrong, but when there is, they want direct, compassionate communication, and a plan of action. How to cite this article Bartholomew ML. Obstetric Ultrasound: Balancing Recommendations with Expectations. Donald School J Ultrasound Obstet Gynecol 2016;10(1):14-22.

scholarly journals A prenatal diagnosis case of partial duplication 21q21.1-q21.2 with normal phenotype maternally inherited

2021 ◽  
Vol 14 (1) ◽  
Author(s):  
Chunyan Jin ◽  
Zhiping Gu ◽  
Xiaohan Jiang ◽  
Pei Yu ◽  
Tianhui Xu
Keyword(s):  
Down Syndrome ◽  
Pregnant Woman ◽  
Prenatal Testing ◽  
Chromosome 21 ◽  
Chromosomal Microarray ◽  
Chromosomal Microarray Analysis ◽  
Serological Screening ◽  
Partial Duplication ◽  
Her Family ◽  
Clinical Consequences

Abstract Background Down syndrome is characterized by trisomy 21 or partial duplication of chromosome 21. Extensive studies have focused on the identification of the Down Syndrome Critical Region (DSCR). We aim to provide evidence that duplication of 21q21.1-q21.2 should not be included in the DSCR and it has no clinical consequences on the phenotype. Case presentation Because serological screening was not performed at the appropriate gestational age, noninvasive prenatal testing (NIPT) analysis was performed for a pregnant woman with normal prenatal examinations at 22 weeks of gestation. The NIPT results revealed a 5.8 Mb maternally inherited duplication of 21q21.1-q21.2. To assess whether the fetus also carried this duplication, ultrasound-guided amniocentesis was conducted, and the result of chromosomal microarray analysis (CMA) with amniotic fluid showed a 6.7 Mb duplication of 21q21.1-q21.2 (ranging from position 18,981,715 to 25,707,009). This partial duplication of 21q21.1-q21.2 in the fetus was maternally inherited. After genetic counseling, the pregnant woman and her family decided to continue the pregnancy. Conclusion Our case clearly indicates that 21q21.1-q21.2 duplication is not included in the DSCR and most likely has no clinical consequences on phenotype.

scholarly journals El paciente testigo de Jehová : la negativa al tratamiento médico en situación de gravedad y la circular 1/2012 de la Fiscalía General del Estado

2012 ◽  
Author(s):  
José Ramón Díez Rodríguez
Keyword(s):  
Pregnant Woman ◽  
Medical Treatment ◽  
Patient Autonomy ◽  
Blood Transfusions ◽  
Health Law ◽  
Medical Treatments ◽  
Jehovah’S Witness ◽  
Jehovah's Witness ◽  
Para Determinar ◽  
Witness Patient

El paciente testigo de Jehová y su rechazo a determinados tratamientos médicos, en concreto a las transfusiones de sangre, constituye uno de los problemas fundamentales con el que históricamente se ha tenido que enfrentar el derecho sanitario. La actual Ley 41/2002 de autonomía del paciente parece dejar claro el supuesto del paciente mayor de edad y la posibilidad de rechazar tratamientos médicos, pero mayores problemas plantean los supuestos del menor de edad, y especialmente la figura del menor maduro, y el supuesto de la mujer embarazada testigo de Jehová. Será necesario atender a la proporcionalidad de derechos en conflicto para determinar los criterios que en cada caso nos permitan inclinar la balanza a favor de una u otra posición.The Jehovah’s Witness patient and their rejection of certain medical treatments, namely blood transfusions, is one of the fundamental problems with which historically had to face the health law. The current Law 41/2002 of patient autonomy seems to clarify the adult patient’s adult and their possibility of refusing medical treatment, but major problems posed minor assumptions, especially the mature minor figure, and the course pregnant woman Jehovah’s Witness. It will be necessary to address the proportionality of conflicting rights, and determining criteria in each case allow us to tip the balance in favor of one position or another.

Ethics and Palliative Care (DRAFT)

2018 ◽  
Author(s):  
Robert C. Macauley
Keyword(s):  
Twentieth Century ◽  
Palliative Care ◽  
Patient Autonomy ◽  
Practice Of Medicine ◽  
Core Components ◽  
Positive Light ◽  
Distinct Field

While ethics and palliative care have always been core components of the practice of medicine, each was only recently recognized as a distinct field. Both emerged from the twentieth-century shift of emphasis from paternalism (more inclusively termed parentalism) to patient autonomy, as well as the technological explosion that prompted many novel questions. With evolving recognition that patient wishes were not always honored—and patient suffering insufficiently addressed—the two fields attempted to empower patients and ameliorate suffering. Given the overlap between the two fields, there may be areas of conflict which—when viewed in a more positive light—may actually be opportunities for collaboration.

THE ROUTINE OBSTETRIC ULTRASOUND EXAMINATION

1998 ◽  
Vol 25 (3) ◽  
pp. 451-463 ◽  
Author(s):  
Richard K. Wagner ◽  
Byron C. Calhoun
Keyword(s):  
Ultrasound Examination ◽  
Obstetric Ultrasound

scholarly journals HDliveFlow with HDlive Silhouette Mode in Antenatal Diagnosis of Bilobed Placenta

2016 ◽  
Vol 10 (4) ◽  
pp. 415-417 ◽  
Author(s):  
Megumi Ishibashi ◽  
Pei-Yin Yang
Keyword(s):  
Pregnant Woman ◽  
Umbilical Cord ◽  
Gestational Age ◽  
Obstet Gynecol ◽  
Antenatal Diagnosis ◽  
Anterior Part ◽  
In Utero ◽  
Two Dimensional ◽  
Old Japanese ◽  
Live Fetus

ABSTRACT We present a case of bilobed placenta diagnosed by HDliveFlow with the HDlive silhouette mode early in the 2nd trimester of pregnancy. A 29-year-old Japanese pregnant woman, gravida 4, para 1, was referred to our hospital based on the patient's wish at 23 weeks and 3 days of gestation. Two-dimensional (2D) sonography showed a single live fetus with biometry consistent with the gestational age. Moreover, two separated parts of the placenta were noted at the anterior and posterior uterine walls. HDliveFlow with the HDlive silhouette mode clearly depicted two lobes of the placenta (near equal size), and the main umbilical cord attached to the periphery of the anterior part of the placenta. One large connecting vessel between these two placental parts was also clearly identified. Bilobed placenta was strongly suggested. After birth, the gross specimen of the placenta confirmed the diagnosis. HDliveFlow with the HDlive silhouette mode may be an adjunctive tool to 2D sonography to diagnose abnormalities of the placenta in utero. How to cite this article Yang P-Y, Kanenishi K, Ishibashi M, Mori N, Hata T. HDliveFlow with HDlive Silhouette Mode in Antenatal Diagnosis of Bilobed Placenta. Donald School J Ultrasound Obstet Gynecol 2016;10(4):415-417.

scholarly journals Empirical Indicators of Psychobiological Needs of Pregnant Women: Integrative Review

10.3823/2283 ◽  
2017 ◽  
Vol 10 ◽  
Author(s):  
Flávio César Bezerra da Silva ◽  
Rosineide Santana de Brito ◽  
Jovanka Bittencourt Leite de Carvalho
Keyword(s):  
Pregnant Woman ◽  
Pregnant Women ◽  
Eating Habits ◽  
Well Being ◽  
Integrative Review ◽  
Natural Phenomenon ◽  
Depression And Anxiety ◽  
Inclusion Criteria ◽  
Her Family ◽  
Routine Monitoring

Introduction: Pregnancy is a natural phenomenon whose evolution requires routine monitoring in order to promote well-being and comfort to the woman and her family. Objective: To analyze the scientific literature on empirical indicators of the pregnant woman needs. Method: This is an integrative review considering publications between years 2005 and 2014. Databases consulted were Cochrane, CINAHL, Lilacs, Pubmed, Scopus and Journal of Midwifery. It was used as inclusion criteria articles published in full that dealt indicators related to the need of women during pregnancy. In 36 articles selected 64 indicators were identified consistent to the physiological needs of pregnant women. Results: The results show imbalances especially eating habits, physical activity, depression and anxiety. It was found low supply of treatments and tests relating to prenatal program. Conclusion: The reviewed publications indicate the existence of gaps in the psychobiological level of the pregnant woman. This situation is worrying when it is assumed that pregnant women not getting their needs met, they are predisposed to injuries to their health and of the conceptus and of the household as a social cell.

scholarly journals VP34.21: Machine learning of the basic obstetric ultrasound examination: validation of the standardised six‐step approach

2020 ◽  
Vol 56 (S1) ◽  
pp. 202-202
Author(s):  
A. Self ◽  
Q. Chen ◽  
S. Bhatnagar ◽  
J.A. Noble ◽  
A.T. Papageorghiou
Keyword(s):  
Machine Learning ◽  
Ultrasound Examination ◽  
Obstetric Ultrasound

Deep Vein Thrombosis during Pregnancy in Double Homozygous Carrier of Factor V Leiden and Prothrombin G20210A.

Blood ◽  
2005 ◽  
Vol 106 (11) ◽  
pp. 1633-1633
Author(s):  
Ida Martinelli ◽  
Tullia Battaglioli ◽  
Angelo L. Beretta ◽  
Marina Bianchi ◽  
Pier Mannuccio Mannucci
Keyword(s):  
Deep Vein Thrombosis ◽  
Venous Thrombosis ◽  
Ultrasound Examination ◽  
Factor V Leiden ◽  
Prothrombin G20210a ◽  
Factor V ◽  
Her Family ◽  
Vein Thrombosis ◽  
Gestational Week ◽  
Deep Vein

Abstract Background. Factor V Leiden and prothrombin G20210A are gain-of-function mutations leading to an increased risk of venous thrombosis. They are the most common causes of thrombophilia, being present in their heterozygous form in 15–20% for factor V Leiden and 6–15% for prothrombin G20210A of unselected patients with venous thrombosis. The prevalence of each mutation in the Italian general population is 3%. Homozygous carriers for each mutation are rare, and double homozygous carriers, expected in 1 in 1.200.000 individuals, has never been described in the literature so far. Patient. On March 3, 2005 a 30-year-old woman was admitted to the Unit of Internal Medicine, Valduce Hospital, Como, for swell and pain in the left leg. She was pregnant at the 25th gestational week. Ultrasound examination diagnosed a deep vein thrombosis of the left external and common iliac veins. She had no symptoms of pulmonary embolism. She was given nadroparin 6000 UI b.i.d. (her weight was 63 kg), elastic stockings, and was discharged on March 9, 2005. Because of worsening of the swell in the left leg, she was re-admitted on March 12, 2005 and the ultrasound examination showed an extension of the deep vein thrombosis to the left femoral-popliteal venous system. The dose of nadroparin was increased to 7000 UI b.i.d. Thrombophilia screening revealed a double homozygosity for factor V Leiden and prothrombin G20210A. Her past personal history was negative for thrombosis, but she was never exposed to high risk situations (surgery, bone fractures, prolonged immobilization, oral contraceptive use, long-haul flights) apart from a previous pregnancy which ended in miscarriage at the 6th gestational week. On June 14, 2004 she had an uneventful vaginal delivery after two hours of labour, with the last nadroparin injection in the evening before, The newborn was a female who weighted 3500 g. Her family history was also negative for thrombosis in first- and second-degree relatives despite both parents were double heterozygotes for factor V Leiden and prothrombin G20210A and brother and sister were homozygotes for factor V Leiden and heterozygotes for prothrombin G20210A. Conclusions. The relative risk of venous thrombosis in double homozygous for factor V Leiden and prothrombin G20210A is unknown but is predicted to be extremely high. However, the patient described here had her first episode during a trigger situation, i.e., pregnancy, and severe thrombophilia seems to run an uneventful cause in her family in spite of repeated exposures to high risk situations. Hence, we shall advise the patient to stop oral anticoagulant therapy, started soon after delivery, one year after the thrombotic event.

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