Perinatology Ultrasound
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Perinatology is a sub-specialty of obstetrics and gynecology. Perinatologists complete an undergraduate degree and then attend medical school. After completing a four-year residency training in obstetrics and gynecology, perinatologists complete an additional two- or three-year fellowship in perinatology. Perinatology fellowships focus on how to treat pregnancy complications and how diseases affect the pregnant person and the fetus.
It depends on your condition and why you were referred to a perinatologist. In most cases, your first appointment will be used to collect your health history or go over details of your condition and how it impacts your pregnancy. Your perinatologist may counsel you on genetic or congenital conditions the fetus has and discuss the type of medical care it needs at birth. Sometimes a perinatologist will provide genetic testing, ultrasounds, fetal monitoring and other tests to diagnose a condition.
The perinatology definition is a subspecialty of obstetrics that focuses on the care of a fetus and the mother if there are any concerns with the pregnancy. A perinatologist is an obstetrician-gynecologist (OB/GYN) who has completed two to three additional years of education that focuses on pregnancy complications and treatments. Perinatology and maternal-fetal medicine (MFM) are the same thing.
The visit may begin with an ultrasound or a visit with other healthcare team members such as nurses, nurse practitioners, or genetics counselors. Most often you will see the perinatologist near the end of your visit after all of the information has been collected.
Perinatologists are Maternal-Fetal Medicine specialists in the department of Obstetrics/Gynecology who specialize in the care and treatment of women with high risk pregnancies. Services we offer include preconception counseling, prenatal diagnostic procedures, non-stress testing, and ultrasound.
In either case, these women may be referred to a perinatologist. These physicians specialize in high-risk pregnancy care and perform detailed ultrasounds for women when requested by the obstetrician.
Our perinatology team is highly skilled at performing ultrasounds throughout pregnancy. Your obstetrician may send you to a perinatologist (also called a maternal-fetal medicine specialist) for many reasons, such as routine ultrasounds or to further evaluate concerns about the health and safety of your pregnancy.
Scripps perinatology specialists are experts in managing a full range of pregnancy complications. Our goal is to reduce the risk of complications with high-risk pregnancies. Depending on your specific needs, your treatment plan may include:
The nationally recognized Scripps Whittier Diabetes Institute collaborates with the perinatology team to help you manage your blood sugar during pregnancy and help ensure a safe delivery. For more information call 858-956-7719.
To ensure you receive the best care, our perinatology team may work with the following departments to ensure you and your baby receive an optimal outcome and support. Our Maternal Team includes but is not limited to the following:
We welcome referrals from obstetricians, gynecologists and other physicians. If you would like to refer a patient to Scripps for perinatology care or schedule a consultation with one of our maternal-fetal medicine specialists, please call 858-956-7719.
Each new consultation starts with a comprehensive ultrasound examination by one of our specialized obstetric sonographers. This is followed by an in-depth visit with our perinatology nurse, Katheryn Kreidermacher, and Dr. White.
Maternal-fetal specialists Dr. Alexander Allaire, and Dr. Francis Nuthapalaty have been granted accreditation in obstetric ultrasound by the American Institute of Ultrasound in Medicine (AIUM). Recipients of this prestigious designation reflect commitment to providing care of the highest quality.
Point-of-care ultrasound (POC-US) is increasingly used especially in emergency and critical-care medicine. It is focused, quick and does not expose patients to ionizing radiation. It encompasses all organ systems and has well-defined indications. Lung ultrasound (LUS) represents one of the most exciting applications in the field of POC-US. It is particularly important to emphasize the role of LUS in neonatology due to the specific pathology inherent in lung immaturity as well as in the particular sensitivity of neonates to repeated radiation exposure. One of the main barriers to the more extensive use of the ultrasound technology is a lack of efficient and attractive training solutions followed by the structured quality-check assurance. In an effort to help bridge this gap, based on the most current literature, we developed creative and intuitive neonatal LUS algorithms. We hope they can serve as a clinical imaging guidelines and a valuable complement to the history and physical exam.
In the past several years lung ultrasound (LUS) has become one of the most exciting applications in the field of the neonatal point-of-care ultrasound (POC-US). Several recent articles have found ultrasound imaging to be an equal, if not a more effective diagnostic modality than X-ray. LUS is quicker, less expensive and it does not expose patients to the increased risks inherent in exposure to ionizing radiation.1
One of the challenges to widespread use of LUS is a paradigm shift in which physicians have to accept a fundamentally different way of thinking. Therefore, there is a need to develop creatively engaging strategies that would allow us this practice transition. Clinical guidelines modeled through decision-making algorithms have proven to simplify diagnostic and management processes. LUS algorithms or protocols have been described in the adult population.2 They cover vast amount of data and knowledge that are well validated and reproducible. On the other hand, no such algorithm exists for the neonatal population known to have relatively specific lung pathology. Acknowledging this fact, we reviewed neonatal LUS literature and developed neonatal LUS algorithms that serve as guidelines for LUS application in the neonatal population (Figure 1 and 2). The goal is to better help neonatologists embrace the daily use of the ultrasound as a diagnostic modality. Further, the algorithms should allow neonatologists to transfer their insights and experiences into new research ideas and better patient outcomes.
Lung US exam is performed on a neonate in the incubator or on the radiant warmer. The transducer is oriented in a sagittal plane. Bilateral lungs are examined in the supine and lateral positions. In addition, prone position is commonly used. Each side is divided into three areas: anterior area between sternum and anterior axillary line, lateral area between anterior and posterior axillary line and posterior area between the posterior axillary line and the spine.3 In adults, an image map of the lungs created with the use of the ultrasound has been found to have a much higher sensitivity and specificity than the physical exam or chest radiography.4, 5
Current neonatal lung literature describes the normal and abnormal LUS imaging based on the several principles described by Lichteinstein and Mauriat.6 There are few articles that summarize neonatal findings, encourage LUS use and offer insights into further research.3, 7, 8 Aside from diagnosing specific lung diseases, ultrasound has shown a great promise in the functional monitoring of lung processes and predicting the development of complications.9, 10, 11, 12, 13, 14, 15, 16
Rib cage consists of the skin, subcutaneous tissue and muscles that overlie the ribs. Below the ribs are parietal and visceral pleura that slide against each other with every respiration. Multiple interlobular septae arise from the visceral pleura and create lobules that consist of many alveolar acini filled with air. In a healthy lung, air completely scatters ultrasound waves.
A-lines are horizontal, hyperechogenic, equidistant lines distal to the pleural line. It is a reverberation artifact due to the ultrasound waves being repetitively reflected between the pleura and the transducer (Figure 3b).6 A-line pattern together with lung sliding assures the absence of lung pathology in the area of the lung scanned.
Pleural effusion. Pleural effusion appears as an anechoic space between the visceral and parietal pleura. Further, ultrasound allows identification of the adjacent structures: diaphragm, liver or spleen.
Our board-certified experts are ready to help with advanced diagnostic and treatment options for the most complex pregnancies. We offer the perinatal services you need, including pregnancy consultations, ultrasounds and other screenings, and genetic counseling.
Additionally, perinatologist can provide screening services for chromosomal or genetic disorders with maternal blood tests and/or ultrasound or with diagnostic testing like amniocentesis. Finally, your obstetrician may request that a perinatologist do a detailed ultrasound evaluation of your baby to evaluate for birth defects.
Perinatologists work with patients at high risk, including those with a history of previous complicated pregnancies, chronic health conditions and those for whom medical issues arise unexpectedly. Perinatologists typically work with a woman's regular obstetrician to develop a care plan, perform ultrasounds and provide consultations. The University of Rochester Medical Center explains that, at the first visit with a perinatologist, the doctor will likely perform a specialized Level II ultrasound, which is a safe, high-resolution ultrasound that will confirm the initial obstetrician's diagnosis and bring to light any new concerns. The perinatologist may also perform a fetal echocardiogram, a cervical or transvaginal assessment or other specialized imaging.
No. While there are a few circumstances wherein 3-D ultrasound can provide valuable extra information, in most cases it is simply not as good or informative as conventional 2-D ultrasound. Our 2-D equipment and techniques are of the highest quality available in medicine today, and in most cases provides better, more definitive answers than 3-D sonography. However, 3-D ultrasound can be utilized in those rare cases where it may be medically indicated. 59ce067264
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