Newsletter+October+2015

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** CCRMC Perinatal Newsletter October 2015: OB Ultrasounds **


 * __ ALERT: __****__ New quantitative HCG Test being used at CCRMC __**
 * ** A new quantitative HCG test being used at CCRMC has significantly higher HCG values than the old test. **
 * ** Normal pregnancies can have values > 200,000K without being a molar pregnancy **
 * ** The discriminatory zone where we expect to see a gestational sac or fetal pole is higher and currently unclear. The only solution is to do repeat labs every 48 hours to document sufficient increase before the pregnancy can be visualized by ultrasound. **


 * __ ALERT: Recent Cases of Heroin Use in Pregnant Women __**
 * ** Last week three women delivered at CCRMC with heroin addiction. **
 * ** Please be vigilant in prenatal clinic for this previously very rare condition at CCMRC. **
 * ** If tox screens are performed confirm positives and look at the final opiate results—one of the women had reported only Norco use. **

**__ Ultrasound Logistics __**
 * Ultrasound dating clinics are available at MHC, PHC, and WCHC to provide assessment or confirmation of gestational age early in pregnancy. Clinicians perform limited ultrasounds for dating purposes only. Patients are also evaluated for immediate prenatal interventions and the state screen program. **
 * • PHC- Wed AM, Thurs AM, Fri AM
 * • WCHC- Mon PM, Thurs AM
 * • MHC- Wed PM

Optimize time of scan--18-22 weeks is ideal. Please try to include the best dates on your request so they can schedule appropriately. Order and have patient schedule 6-8 weeks in advance to get an appointment in the correct time frame.
 * When should the anatomy ultrasound be ordered? **

Most patients opt for the integrated state screen program including a NT ultrasound. Ideally a dating ultrasound will confirm dates first so this can be scheduled appropriately. Patients are scheduled at EBPMA (East Bay Perinatal Medical Associates), DVPA (Diablo Valley Perinatal Associates) or AMI (Antioch Medical Imaging). Be aware that AMI does not have a perinatologist on site and does not provide results to the patient.
 * Where do we do NT scans? **

Many of the AMI sonos mention incomplete visualization due to technical difficulties. Sometimes a follow up is recommended. We have asked them to reschedule at AMI if they think it is only a manner of timing. If the incomplete visualization involves a critical area--e.g. heart, brain, placenta--then another limited ultrasound at CCRMC or fetal echo should be ordered promptly. The radiology group for AMI may be changing next month possibly improving the situation. If they see a possible anomaly then a level II ultrasound at EBPMA or DVPA is appropriate. Feel free to consult an OB Attending for assistance.
 * How do Interpret the findings of an AMI sono? **


 * How do I order a level II ultrasound, fetal echo or NT sono? **
 * Please order in ccLINK AND have nursing/healthy start schedule at EBPMA, DVPA, or CHO for fetal echo. The fetal echo order now goes to CCHP and should generate the appropriate PA. **
 * You will need to print and fill out the correct form AND schedule at the preferred site. **


 * • Type In “OB Level” or “OB EXT Imaging”
 * • You can order Level II, Nuchal Translucency (NT), and Fetal Echocardiogram by clicking on link below and printing the form
 * • Forms must be printed out and filled out. The clinic MA, nurse or Healthy Start staff can fax/call for an appointment.
 * CLICK the box and this will bring a drop down list and allow you to print forms **




 * What about a Fundal Height Discrepancy (Size less or greater than dates)? **


 * You MUST put all clinical information in the comments section of the order. If this is not done the contracted Radiologist Groups or CCRMC Radiologists will not comment on the growth percentile. Include: **
 * • What dating criteria you are using for the patient
 * • The last date and measured EFW
 * • If you suspect IUGR vs Macrosomia
 * • Keep in mind if not ordered URGENT it may not be scheduled for another 4 weeks
 * • Please Review reported EFW and calculate Percentile using: []
 * • Any questions about measurement contact OB staff at your clinic site or call L&D

Diabetes or GDM with suspected pregestational diabetes should be referred for fetal echocardiography in addition to level II anatomy screen if the __HbA1C is >8.0 or FBS is greater than 140__. This study is normally performed at about 22 weeks EGA
 * ****Please Remember**** **
 * • ** Order a growth sono in patients with GDMA2 and Pregestational GDM at 38-39 weeks if there is any suspicion of fetal macrosomia. **
 * • ** Growth sono(s) in women when the maternal BMI precludes accurate FH measurements **
 * • ** Record all ultrasounds in the dating section of the prenatal record with any relevant comments to let others know you reviewed the ultrasound report **
 * • ** Level II for: **
 * • Pregestational diabetes as determined by significantly elevated fasting blood sugars (consistently over 120) or HbA1C > 6.5 early in pregnancy.
 * • AMA (Advanced Maternal AGE > 35 at EDD)
 * • Monochorionic Twins
 * • ** Fetal ECHO ** :