ANOMALY SCAN WHAT NOT TO EXPECT - Dr Neelam Jain

LIQUOR

• SUBJECTIVE/MVP
• AFI-after 26 wks

CERVIX

• Cervical length and internal os should be
assessed by transvaginal route

REPORTING

• Must after every scan
• Should reflect findings/inferences from each

step
• Clear meaningful message
• Always compare with previous scans

REPORTING

• HISTORY- Indications for scan
• SURVEY- Single live fetus…
• BIOMETRY- Values,& weeks GA

Must print biometry values
• TARGETED SCAN- All fetal organs imaged and

normal for the period of
gestation
(mention organs not seen)
• FETAL ACTIVITY- Fetal cardiac activity(HR)/fetal
movements normal
• FETAL ENVIRONMENT- Placenta anterior…

Liquor adequate
• FINAL IMPRESSION- Summary of relevant findings

IMAGE DOCUMENTATION

• Should aim to be as exhaustive as possible
• Electronic documentation
• Paper prints or X ray film documentation

TAKE HOME MESSAGE

• The final 3 for good TIFFA scan
-Good equipment
-Committed Radiologist
-USG friendly fetus

• Following this rule ensures that no major
abnormality will be missed.

HOW DO WE DEAL WITH THIS WHOLE
SITUATION OF POSSIBILITY OF
MISSING AN ANOMALY

Failure to diagnose a fetal anomaly on a routine ultrasound scan at 20
weeks Prepared by: Z. ALFIREVIC
Wiley InterScience (www.interscience.wiley.com). DOI: 10.1002/uog.2631

 EUROCAT QUOTES A DETECTION RATE FOR SPINA BIFIDA OF ONLY
68%, WHILST A RECENT SYSTEMATIC REVIEW REPORTS A DETECTION
RATE FOR AVSD OF JUST 42%.

ALWAYS COMMUNICATE
ALWAYS DOCUMENT

COMMUNICATION WITH THE
PATIENT

ALWAYS HAVE A DOCUMENTED EVIDENCE THAT THE PATIENT WAS
INFORMED ABOUT THE POSSIBILITY OF FALSE-NEGATIVE RESULTS BEFORE
THE SCAN. •

THERE IS NO DIAGNOSTIC TEST IN MEDICAL PRACTICE, HOWEVER
DILIGENTLY PERFORMED, WHICH IS FREE FROM FALSE-NEGATIVE
FINDINGS, AND THIS INFORMATION SHOULD BE COMMUNICATED TO
PATIENTS BEFORE ANY TEST IS ATTEMPTED. •

THE PROBLEM IS MAINLY WHEN THE REPORTS STATES ‘EVERYTHING
NORMAL’ WHILE AN ANOMALY IS PRESENT.

(Failure to diagnose a fetal anomaly on a routine ultrasound scan at 20 weeks
Prepared by: Z. ALFIREVIC
Wiley InterScience (www.interscience.wiley.com). DOI: 10.1002/uog.2631)

DOCUMENTATION

 IMAGES SHOULD BE RECORDED.
 IF THE IMAGES SHOW THAT THE ENTIRE ANATOMY WAS VISUALIZED

AND NO DEFECTS ARE DETECTABLE THEN YOU WOULD HAVE NO
PROBLEMS DEFENDING YOUR CASE.

(Failure to diagnose a fetal anomaly on a routine ultrasound scan at 20 weeks
Prepared by: Z. ALFIREVIC
Wiley InterScience (www.interscience.wiley.com). DOI: 10.1002/uog.2631)

BOTTOM LINE

IT IS UNREALISTIC TO EXPECT THAT OBSTETRIC
ULTRASOUND HAS A DIAGNOSTIC ACCURACY OF
100% AND DOCUMENTATION SHOULD REFLECT
THIS ELEMENT OF UNCERTAINTY.

CLINICIANS WHO ARE NOT PREPARED TO SHARE
THIS INFORMATION WITH THEIR PATIENTS DO SO AT
THEIR PERIL.

(Failure to diagnose a fetal anomaly on a routine ultrasound scan at 20 weeks
Prepared by: Z. ALFIREVIC
Wiley InterScience (www.interscience.wiley.com). DOI: 10.1002/uog.2631)

THANK YOU

POSITIVE CASES



ACRANIA AND ANENCEPHALY

CISTERNA MAGNA

SAG – CORPUS CALLOSUM AND VERMIS

NOT MANDATORY TO TAKE IN ROUTINE ANOMALY SCAN



PERSISTENT BLAKES POUCH CYST

VERMIAN DYSGENESIS

DANDY WALKER MALFORMATION

FACE

 MINIMUM EVALUATION OF THE FETAL FACE SHOULD INCLUDE AN
ATTEMPT TO VISUALIZE THE UPPER LIP FOR POSSIBLE CLEFT LIP
ANOMALY .

 IF TECHNICALLY FEASIBLE, OTHER FACIAL FEATURES THAT CAN BE
ASSESSED INCLUDE THE MEDIAN FACIAL PROFILE ,ORBITS , NOSE AND
NOSTRILS.



WHATS HAPPENING TO THE
FRONTO-NASAL ANGLE ?

ANYTHING UNUSUAL IN MAXILLA ?

FLAT NOSE, PROTRUDING LIPS



ABERRANT RIGHT SUBCLAVIAN
ARTERY



















NOT EVERY SCAN IS CLEAR

 REASONS INCLUDE MATERNAL HABITUS, PARTICULARLY
OBESITY, WHICH IS ENCOUNTERED WITH INCREASING
FREQUENCY.

 REPEAT SCANS SHOULD CLEARLY BE ASKED FOR .

WHEN A BABY WITH AN UNEXPECTED
ABNORMALITY IS BORN,

 DO NOT MAKE RASH STATEMENTS SUCH AS: ‘I CAN’T UNDERSTAND HOW
THE SCAN MISSED THAT’, OR ‘WEREN’T YOU OFFERED AN
AM NIOCENTESIS?’

 SUCH COMMENTS ARE OFTEN TOTALLY INAPPROPRIATE AND CAN
DAMAGE THE RELATIONSHIP BETWEEN THE PARENTS AND THE DOCTORS.

 Risk management Congenital abnormalities: failure to detect and treat Author
Pamela Loughna. The Obstetrician & Gynaecologist 10.1576/toag.10.1.033.27375
www.rcog.org.uk/togonline 2008;10:33–37

CONCLUSIONS

 IT IS IMPORTANT TO REALISE THAT NOT EVERY ANOMALY CAN BE
DETECTED BY CURRENT SCREENING PRACTICES.

 IF A WOMAN DECLINES SCREENING OR DIAGNOSTIC OPPORTUNITIES,
THIS MUST BE CLEARLY RECORDED.

 DIFFICULTY IN OBTAINING ADEQUATE ULTRASOUND VIEWS MUST ALSO
BE NOTED AND EXPLAINED TO THE MOTHER.

 ADVICE CAN, AND SHOULD, BE SOUGHT FROM GENETICISTS AND
FETAL MEDICINE SUBSPECIALISTS AT AN EARLY STAGE, TO ENSURE
OPTIMAL MANAGEMENT.

THANK YOU