Accuracy of supervised measurement of fetal weight in a residency program.

OBJECTIVES: To evaluate the accuracy of ultrasound estimates of fetal weight made by residents. METHODS: A cross-sectional study was conducted on consecutive pregnancies attended in an obstetric ward. All participants provided their consent to participate. Inclusion criteria were singleton pregnancies with ultrasound evaluation and delivery within 14 days. Congenital abnormalities and stillbirths were excluded. Ultrasound scans were performed by two residents, one observer per subject, following standardized methodology and supervised by senior staff. Fetal weight was calculated using the four-parameter Hadlock 1985 formula. Birth weight was measured using a standard clinical scale. Bland-Altman and mixed-effects analyses were performed. RESULTS: In a 6-month period, 95 gestations were recruited at 30-41 weeks, and birth weights ranged from 1200 to 4080 g. The bias between methods was -28 g (CI95%, -74 to 18) with 95% limits of agreement of ±440 g. The 95% deviation between methods was of ±16%. Parity had the most significant effect on the bias between methods; operator and maternal weight had no significant effect. CONCLUSIONS: Supervised measurement of fetal weight by residents demonstrated high accuracy. Parity bias may be associated with visceral fat deposition independent of maternal weight gain. A methodology for medical evaluation is presented.

Feasibility study of minimally trained medical students using the Rural Obstetrical Ultrasound Triage Exam (ROUTE) in rural Panama.

BACKGROUND: Maternal and infant mortality rates reported in rural Panama are greater than those in urban regions. Bocas del Toro is a region of Panama inhabited by indigenous people at greater risk for pregnancy-related complications and deaths due to geographic isolation and limited access to health care. Portable ultrasound training programs have recently been implemented in low-resource settings to increase access to diagnostic imaging. The goal of this study is to determine the feasibility of teaching first-year medical students the Rural Obstetrical Ultrasound Triage Exam (ROUTE) to help identify pathology in pregnant women of the Bocas del Toro region of Panama. METHODS: Eight first-year medical students completed ROUTE training sessions. After training, the students were compared to professional sonographers to evaluate their accuracy in performing the ROUTE. Students then performed the ROUTE in mobile clinics within Bocas del Toro. They enrolled women pregnant in their 2nd or 3rd trimesters and measured biparietal diameter, head circumference, amniotic fluid index, fetal lie and placental position. Any abnormal measurement would be further analyzed by the lead physician for a potential hospital referral. RESULTS: A total of 60 women were enrolled in the study. Four women were detected as having a possible high-risk pregnancy and thus referred to a hospital for further evaluation. CONCLUSION: Based on our data, first-year medical students with additional training can use the ROUTE to identify complications in pregnancy using ultrasound in rural Panama. Additional studies are required to determine the optimal amount of training required for proficiency.