A patient came to me recently for an obstetric scan at 39 weeks of gestation. She already had anomaly scan (at 19 weeks) from one of the prominent fetal medicine expert in city. Later, he had two scans before coming to me. Fortunately, all the scans were normal. As I first focused my probe at the cranium to measure BPD and HC parameters, I saw enlarged occipital horns bilaterally, measuring 2.5 cm each - colpocephaly. Well, then other things started unfolding, as corpus callosum was not well visualized and paralleling of lateral ventricles was seen. I reviewed the images of previous scans. Although, it seemed evident on later two scans, anomaly scan images were ambiguous. In fact, it was mentioned to review for fetal skull at 24-26 weeks.
Either the fetal medicine specialist had a foresight, or he was playing safe. If anomaly scan was done by expert hands at 24-26 weeks, it would have been conclusive enough. Indian dilemma is - Medical termination of pregnancy can only be done before 20 weeks. Obstetricians are bound to send patient to rule out anomalies before 20 weeks, and sonologist still struggles to see things, which has not yet developed. I personally have missed cleft lip in anomaly scan, which I later picked up incidentally during interval growth scan at 30 weeks. But, our mindset in those scans, is just to calculate the fetal weight, check the placental location and cervix. We ourselves are assured of anomaly scan, if the report was normal.
My suggestions:
To the radiologist: Please double check all the anomalies during 28-30 weeks scan (Always recommend in the reports too).
To the obstetrician: Please classify the anomaly scans as a) Gross anomaly scan (19 weeks) b) Detailed anomaly scan (26 weeks).
To the government authority: Please amend the law accordingly.
Either the fetal medicine specialist had a foresight, or he was playing safe. If anomaly scan was done by expert hands at 24-26 weeks, it would have been conclusive enough. Indian dilemma is - Medical termination of pregnancy can only be done before 20 weeks. Obstetricians are bound to send patient to rule out anomalies before 20 weeks, and sonologist still struggles to see things, which has not yet developed. I personally have missed cleft lip in anomaly scan, which I later picked up incidentally during interval growth scan at 30 weeks. But, our mindset in those scans, is just to calculate the fetal weight, check the placental location and cervix. We ourselves are assured of anomaly scan, if the report was normal.
My suggestions:
To the radiologist: Please double check all the anomalies during 28-30 weeks scan (Always recommend in the reports too).
To the obstetrician: Please classify the anomaly scans as a) Gross anomaly scan (19 weeks) b) Detailed anomaly scan (26 weeks).
To the government authority: Please amend the law accordingly.
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