transvaginal ultrasound limitations

On Feb 6, 5:11*pm, Anne Rogers wrote:
Thanks, everyone, for the replies. *It was a horrible 5 minutes... the
CNM started talking about miscarriage. *I was so relieved when the
baby showed up in the abdominal u/s that I didn't think about anything
else. *It makes me angry, now, that she was so quick to assume the
worse.

That sounds like pretty bad treatment, it makes you wonder if she needs
to update her education on ultrasound use. At 12 weeks 4 days, if you'd
not had any bleeding, seeing nothing would be a very unusual finding for
a miscarriage without symptoms, you'd see something, a small for dates
fetus, but with no heart beat and numerous other things.

Can you put pen to paper, however brief, just to let someone know that
you think she may be in need of an update. Usually transvaginal is more
accurate, it's often 2nd to be used and can provide reassuring info
after a transabdominal ultrasound has been unclear, that she got it so
wrong suggests either poor understanding of how to use the technology,
or poor understanding of what physical variations there can be that
might make a reading different.

Cheers
Anne

Grrr... I'm getting more and more angry about this. The nurse said
that at 12 weeks, I was close to the line between a transvaginal scan
and an abdominal one. She set the machine up for abdominal. When the
CNM came in and examined me, she said my uterus felt a little small
and wanted to start off with the transvaginal. She poked around for
15 seconds before she said, "Well, I'm not seeing much of anything in
there." Another minute or two and she asked if I was sure that I had
not had any bleeding or spotting, and that my uterus felt more the
size of 6 weeks than 12 weeks. I told her definitely not, and that I
had a urine pregnancy test at the hospital lab last week that was
positive. She said that it could take weeks after a miscarriage for
pregnancy hormones to leave my body. All of this took place in about
5 minutes of probing - which seemed like an eternity. I was about to
ask her to stop, and just try to find a heartbeat with the doppler or
something when she decided to try the abdominal u/s. Like I said
before, the baby was on the screen the second she placed it on my
stomach.

I vaguely remember somewhere in the back of my mind someone telling me
that I had a tipped uterus. I guess this would make sense as to why
she was having a hard time with transvaginal scan, and why my uterus
felt small for my dates. The crown to rump length was right on
target, though.

I probably won't say anything to the office, though. I live in a
small town - only 2 OBs. Staff at both offices have a reputation for
being quite callous about miscarriage. But she will not be doing
another ultrasound on me. She could have at least kept her mouth shut
until she tried all of the options.

Lynn

Lynn wrote:

I probably won't say anything to the office, though. I live in a
small town - only 2 OBs. Staff at both offices have a reputation for
being quite callous about miscarriage. But she will not be doing
another ultrasound on me. She could have at least kept her mouth shut
until she tried all of the options.

Speaking from the other end of the spectrum here, while it sounds like
she really shouldn't have said anything about miscarriage until she had
done everything...medical professional doesn't mean God, people do make
mistakes, the mistake was rectified with really nothing more than a few
minutes of anxiety on your part, and is it going to do you any good to
get THAT angry about it? Say something to her in a calm manner the next
time you see her, she'll no doubt take the rebuke well enough to heart
rather than a "You'll never do another ultrasound on me and you should
keep your mouth shut" kind of attitude for what may have been an honest
mistake or a thoughtless slip. (She DID palpate you and found that you
felt small, also.)

I'm not trying to minimize your upset, at all, but I guess I don't see a
ton of point in ripping the woman to shreds as incompetent over it at
this point, unless she's demonstrated some other gross incompetency, either.

Michelle
Flutist

"Lynn" wrote in message
Grrr... I'm getting more and more angry about this. The nurse said
that at 12 weeks, I was close to the line between a transvaginal scan
and an abdominal one. She set the machine up for abdominal. When the
CNM came in and examined me, she said my uterus felt a little small
and wanted to start off with the transvaginal. She poked around for
15 seconds before she said, "Well, I'm not seeing much of anything in
there." Another minute or two and she asked if I was sure that I had
not had any bleeding or spotting, and that my uterus felt more the
size of 6 weeks than 12 weeks. I told her definitely not, and that I
had a urine pregnancy test at the hospital lab last week that was
positive. She said that it could take weeks after a miscarriage for
pregnancy hormones to leave my body. All of this took place in about
5 minutes of probing - which seemed like an eternity. I was about to
ask her to stop, and just try to find a heartbeat with the doppler or
something when she decided to try the abdominal u/s. Like I said
before, the baby was on the screen the second she placed it on my
stomach.

I vaguely remember somewhere in the back of my mind someone telling me
that I had a tipped uterus. I guess this would make sense as to why
she was having a hard time with transvaginal scan, and why my uterus
felt small for my dates. The crown to rump length was right on
target, though.

I probably won't say anything to the office, though. I live in a
small town - only 2 OBs. Staff at both offices have a reputation for
being quite callous about miscarriage. But she will not be doing
another ultrasound on me. She could have at least kept her mouth shut
until she tried all of the options.

-------
I don't see how a mention of a miscarriage would constitute you deeming her
as incompetent and to never scan you again. She was finding out information
from you while examining you. She couldn't see anything with the
transvaginal probe probably because of your uterus, as you said or
positioning of the baby and/or placenta. Are you overweight at all?
Sometimes soft tissues get in the way and one cannot see as well. She then
used another probe and was able to see much better. I am not sure that I
would be angry over this, but that's me.
--
Sue (mom to three girls)

"Anne Rogers" wrote in message
Can you put pen to paper, however brief, just to let someone know that you
think she may be in need of an update. Usually transvaginal is more
accurate, it's often 2nd to be used and can provide reassuring info after
a transabdominal ultrasound has been unclear, that she got it so wrong
suggests either poor understanding of how to use the technology, or poor
understanding of what physical variations there can be that might make a
reading different.

Or Anne because of body habitus, position of the baby, placenta or other
factors she couldn't see as well. Doesn't sound to me as if she needs an
update, she used one probe, couldn't see anything and then got another probe
and saw what she needed to see. What is there to update? I think you guys
are too quick to blame hospital staff or doctors and I find it a shame.

--
Sue (mom to three girls)

On Feb 7, 6:41*am, "Sue" wrote:
"Anne Rogers" wrote in message
Can you put pen to paper, however brief, just to let someone know that you
think she may be in need of an update. Usually transvaginal is more
accurate, it's often 2nd to be used and can provide reassuring info after
a transabdominal ultrasound has been unclear, that she got it so wrong
suggests either poor understanding of how to use the technology, or poor
understanding of what physical variations there can be that might make a
reading different.

Or Anne because of body habitus, position of the baby, placenta or other
factors she couldn't see as well. Doesn't sound to me as if she needs an
update, she used one probe, couldn't see anything and then got another probe
and saw what she needed to see. What is there to update? I think you guys
are too quick to blame hospital staff or doctors and I find it a shame.

--
Sue (mom to three girls)

I was venting. Michelle, you are right - it was nothing more than a
few moments of anxiety. The baby is obviously fine. No, Sue, I am
not overweight, but I am more educated than the average patient here,
and DH thinks that I intimidate the doctor's staff (and sometimes even
doctors). Some medical people love that patients are informed, other
hate it. I honestly believe that I did not say anything that would
make the CNM defensive, but she has known me since I gave birth to
baby #1 (this is baby #3 for me). In general, she tends to be the
type of person that will always tell you the worst-case scenario. In
my opinion, this is better than the other end of glossing over
potential problems. She is also very good when it comes down to labor
and delivery. However, pregnancy makes me lean toward irrational
fears, and I believe it would be best if someone else in the office
who had a little more sensitivity did the remaining u/s.

Anyway... no one knows who I am talking about, I got all of my
thoughts out of my head in a way that does not create a scene, and I
received a satisfactory answer to my questions. Thanks to all again.


Lynn

"Lynn" wrote in message
...
On Feb 6, 5:11 pm, Anne Rogers wrote:
Thanks, everyone, for the replies. It was a horrible 5 minutes... the
CNM started talking about miscarriage. I was so relieved when the
baby showed up in the abdominal u/s that I didn't think about anything
else. It makes me angry, now, that she was so quick to assume the
worse.

That sounds like pretty bad treatment, it makes you wonder if she needs
to update her education on ultrasound use. At 12 weeks 4 days, if you'd
not had any bleeding, seeing nothing would be a very unusual finding for
a miscarriage without symptoms, you'd see something, a small for dates
fetus, but with no heart beat and numerous other things.

Can you put pen to paper, however brief, just to let someone know that
you think she may be in need of an update. Usually transvaginal is more
accurate, it's often 2nd to be used and can provide reassuring info
after a transabdominal ultrasound has been unclear, that she got it so
wrong suggests either poor understanding of how to use the technology,
or poor understanding of what physical variations there can be that
might make a reading different.

Cheers
Anne

Grrr... I'm getting more and more angry about this. The nurse said
that at 12 weeks, I was close to the line between a transvaginal scan
and an abdominal one. She set the machine up for abdominal. When the
CNM came in and examined me, she said my uterus felt a little small
and wanted to start off with the transvaginal. She poked around for
15 seconds before she said, "Well, I'm not seeing much of anything in
there." Another minute or two and she asked if I was sure that I had
not had any bleeding or spotting, and that my uterus felt more the
size of 6 weeks than 12 weeks. I told her definitely not, and that I
had a urine pregnancy test at the hospital lab last week that was
positive. She said that it could take weeks after a miscarriage for
pregnancy hormones to leave my body. All of this took place in about
5 minutes of probing - which seemed like an eternity. I was about to
ask her to stop, and just try to find a heartbeat with the doppler or
something when she decided to try the abdominal u/s. Like I said
before, the baby was on the screen the second she placed it on my
stomach.

I'm with the others here. I don't see what she was doing wrong.
She thinks you feel small-so maybe you're wrong with the dates so she tries
the transvaginal first-which has a better chance of seeing something if you
were closer to 6 weeks than 12. Yes, people have been wrong on dates before.
She can't see anything. But she's also got that you feel small. Much too
small, I'd guess. Maybe one of the drs here can tell us how different 6 and
12 weeks feel, but I'd guess quite a difference if you know what you're
looking for.
When you're told something is wrong the first reaction can be denial. When I
was told on a scan that #2 was missing her hand my first reaction was "I saw
it on the previous scan, that can't be right". In your case you said you
couldn't have miscarried because you'd had a test the previous week. To
which she let you know that that wasn't a guarantee.
If you had been closer to 6 weeks then there wouldn't have been much chance
of hearing anything on the doppler, I think the minimum age is about 10
weeks, I know people who haven't heard anything until 14 weeks.
Her reactions semed to be reasonable to me from the data you have given us
that she said. I'm not sure what you expected her to do. She wasn't to know
that the baby would be obvious on the abdominal u/s, so she was right to
continue trying with the other one.
Debbie

"Lynn" wrote in message
...
On Feb 7, 6:41 am, "Sue" wrote:
"Anne Rogers" wrote in message
Can you put pen to paper, however brief, just to let someone know that
you
think she may be in need of an update. Usually transvaginal is more
accurate, it's often 2nd to be used and can provide reassuring info
after
a transabdominal ultrasound has been unclear, that she got it so wrong
suggests either poor understanding of how to use the technology, or poor
understanding of what physical variations there can be that might make a
reading different.

Or Anne because of body habitus, position of the baby, placenta or other
factors she couldn't see as well. Doesn't sound to me as if she needs an
update, she used one probe, couldn't see anything and then got another
probe
and saw what she needed to see. What is there to update? I think you guys
are too quick to blame hospital staff or doctors and I find it a shame.

--
Sue (mom to three girls)

I was venting. Michelle, you are right - it was nothing more than a
few moments of anxiety. The baby is obviously fine. No, Sue, I am
not overweight, but I am more educated than the average patient here,
and DH thinks that I intimidate the doctor's staff (and sometimes even
doctors). Some medical people love that patients are informed, other
hate it. I honestly believe that I did not say anything that would
make the CNM defensive, but she has known me since I gave birth to
baby #1 (this is baby #3 for me). In general, she tends to be the
type of person that will always tell you the worst-case scenario. In
my opinion, this is better than the other end of glossing over
potential problems. She is also very good when it comes down to labor
and delivery. However, pregnancy makes me lean toward irrational
fears, and I believe it would be best if someone else in the office
who had a little more sensitivity did the remaining u/s.

While what the CNM did was not grossly negligent or malpractice or anything
like that, it certainly wasn't sensitive or tactful. Rather than scare a
pregnant woman with possible miscarriage fears, she could have scanned you
with the vaginal wand, said, "Hmmm, I'm not getting a good view. Let's try
the abdominal u/s" and then continued scanning you with the other machine
until a determination was made of fetal viability or not. Then if she saw
no heartbeat or fetus at that point, she could have told you that you had
likely miscarried or that there was a problem with the baby. Since she did
in fact then see the fetus after scanning with the abdominal u/s, she would
have said, "Okay, here is the baby, right on target," and you could have
skipped the whole 5 minutes worth of worry, fear and anxiety.

I think it's not only fair and reasonable for you to gently say something to
her about the incident, but could prevent her from repeating it again with
someone else. There are all sorts of ways to say something to her that
wouldn't **** her off or make her feel like you are "ripping her a new one."
One possible way would be say with a smile, in a joking way, "Gosh, Mary,
you really gave me a scare last time! Can we skip that part this time?"
Humor is a great tool for alleviating stress and lightening the mood, and
allowing you to get your point across without causing the other person to be
defensive.

Anyway... no one knows who I am talking about, I got all of my
thoughts out of my head in a way that does not create a scene, and I
received a satisfactory answer to my questions. Thanks to all again.


--

Jamie Clark

Sue wrote:
"Anne Rogers" wrote in message
Can you put pen to paper, however brief, just to let someone know that you
think she may be in need of an update. Usually transvaginal is more
accurate, it's often 2nd to be used and can provide reassuring info after
a transabdominal ultrasound has been unclear, that she got it so wrong
suggests either poor understanding of how to use the technology, or poor
understanding of what physical variations there can be that might make a
reading different.

Or Anne because of body habitus, position of the baby, placenta or other
factors she couldn't see as well. Doesn't sound to me as if she needs an
update, she used one probe, couldn't see anything and then got another probe
and saw what she needed to see. What is there to update? I think you guys
are too quick to blame hospital staff or doctors and I find it a shame.

Exactly, there are a gazillion and one reasons why she might see
nothing, which is exactly why she may need to update her knowledge on
this type of ultrasound scanning. She didn't see any evidence of a
miscarriage, which with the information given, if a miscarriage had
occurred, with no reported bleeding, she'd see something. It really does
sound like she interpreted the results of the transvaginal ultrasound
incorrectly, instead of interpreting them as "inconclusive", she
interpreted them as miscarriage, and told the patient. I think there is
enough question there for saying "she may" need to update her education,
she wasn't an ultrasound tech, we don't know what training she had in
the use of ultrasound, I think there is plenty of room for questions.

Anne

I probably won't say anything to the office, though. I live in a
small town - only 2 OBs. Staff at both offices have a reputation for
being quite callous about miscarriage. But she will not be doing
another ultrasound on me. She could have at least kept her mouth shut
until she tried all of the options.

you don't have to attach your name to it, look out and see if there is a
box for patient feedback. She's a CNM, maybe they have a website or
other practice information you could look at to see what her training is
on use of ultrasound, how often she carries it out etc. If you don't
carry something out on a regular basis, but have the need to
occasionally, training does have to be reviewed (like the way CPR
certification only lasts a short time), similarly carrying something out
regularly isn't a bypass to training.

Anne

"Anne Rogers" wrote in message
Exactly, there are a gazillion and one reasons why she might see nothing,
which is exactly why she may need to update her knowledge on this type of
ultrasound scanning. She didn't see any evidence of a miscarriage, which
with the information given, if a miscarriage had occurred, with no
reported bleeding, she'd see something. It really does sound like she
interpreted the results of the transvaginal ultrasound incorrectly,
instead of interpreting them as "inconclusive", she interpreted them as
miscarriage, and told the patient. I think there is enough question there
for saying "she may" need to update her education, she wasn't an
ultrasound tech, we don't know what training she had in the use of
ultrasound, I think there is plenty of room for questions.

I think you are reaching Anne. I intrepreted it different as the tech was
finding out information from the OP and because of who knows what, the tech
couldn't see anything at first with the first probe and then she went to the
second. Just because a tech has a hard time with something doesn't mean she
is at fault or needs updating. Why do you have such a hard time with the
tech using a different probe to see what is going on?
--
Sue (mom to three girls)