Thursday, August 29, 2013

OB S/D Ratio Useful In The Health Of The Fetus

I seldom write about OB-GYN ultrasound, though I am board certified by the ARDMS in this profession.  One reason is because I do not practice OB-GYN ultrasound much anymore.  The reason is complicated.  To be honest, I quit most of my OB/GYN practice because of where I live and the cultures that are present in the Houston area.  Many cultures here do not want a male person to perform medical examinations on the women of their culture.  Have any of you had similar experiences?  Please EMail me with your stories if you like. My E-Mail address is at the bottom,  I may post them without the name of the writer. For those of you who are seething here is the quick link to my Email address:  gallgizzard@gmail.com  

 I respect this, and have backed up like a crayfish on many occasion when confronted by this cultural issue.  I have no problem with it.  Back in the 80's I had no issues in this area because the technology was new and mesmerizing to the family which often came in to look at the anatomy.  Nowadays it is like watching TV.  Most expectant parents DEMAND a 3-D image, or 4-D (Moving image) of the fetus.  Most parents DEMAND to know what the sex of the baby is.  I quit doing most (not all OB-GYN ultrasound ) When I walked out of an imaging center and was accosted by a young male you whispered in my ear: "You did what to my girlfriend?  I almost lost my life...

His knife drew a bit of blood on my neck until I wrestled the knife away in a fit of panic and self-preservation.  I ran and found my car, and drove home with tachycardia, and never reported it to the police.  We sonographers do very intimate procedures on people we do not know.  We walk in and expect a patient in need to embrace our skills. I make it a point to tell the patient exactly what I will do.  It is the point of being a professional.  We sonographers are as professional as doctors in many instances.

  Enough of that stuff.  I respect the wonderful world of OB-GYN ultrasound, and I maintain my skills in more controlled places.  With that in mind, I came across a recent post that has validated my thinking for many years.  Systolic/Diastolic ratios.  The blood provided by the mother is filtered by the placenta, and nutrients are handed off in placental exchange.  The fetal blood is powered in the later stages of pregnancy by the fetal heart.  This exchange is important. When the pipeline becomes stiff for whatever reason, fetal circulation becomes compromised and IUGR can rear it's ugly head.  This does not allow nutrients and O2 to get to the fetus.  The result is a baby that is malnourished and feeble.  We can measure this using the S/D ratio.

SAN FRANCISCO – An umbilical artery systolic-to-diastolic ratio of less than 3 as measured on weekly Doppler ultrasounds in a fetus with 30 weeks’ or more gestation and suspected intrauterine growth restriction suggests that the fetus probably is doing okay, Dr. Vickie A. Feldstein said.
That "ballpark guideline" is most helpful if physicians at your institution have agreed to use the umbilical artery systolic/diastolic (S/D) ratio as the parameter for assessing fetuses with intrauterine growth restriction (IUGR) and have agreed on which anatomical location is preferred for the ultrasound interrogation, so that there is some uniformity in how results are presented and interpreted, she said.


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