Legal Aspects of Obstetric Sonography.

PIP:The combination of rapid innovation and high risk obstetric sonography has resulted in increased potential for litigation: 80% of suits in sonography are obstetric-related. These suits come under the category of tort law, where damages are sought to compensate those whose interests have been harmed. To win a claim the plaintiff must prove that a legal duty has been breached, that damages have been incurred, and that the breach was the legal as well as the actual cause of the damage. Although it is not possible to claim that the radiologist caused the damage, damages to a living being, the fetus, are being awarded for several types of claims. Wrongful pregnancy claims are being awarded costs of the pregnancy and childbirth in cases of failed sterilization or abortion. Wrongful birth suits arise from negligent genetic counseling when the infant is born defective, and the anomalies are diagnosable but overlooked. Wrongful life suits, brought by the defective individual, are controversial for their large monetary awards, as well as the ethical question whether impaired life is better than no life at all. Only 4 states recognize these claims. Wrongful death suits are applicable where therapy under sonographic guidance causes death of the fetus. Agency law applies where an error is committed by a technologist in a radiologist\u27s employ. It is recommended that the radiologist follow American College of Radiology guidelines for fetal surveys; obtain follow-up or a 2nd opinion in case of an abnormality; keep written notes of normal fetal structures; keep abreast of local case law and legislation; rescan patients after the technologist\u27s exam; and document and report promptly all normal and abnormal findings

Fibroid tumors are not a risk factor for adverse outcomes in twin pregnancies

OBJECTIVE: Uterine fibroids have been associated with adverse outcomes in singleton pregnancies. We aimed to estimate risk for adverse obstetric outcomes associated with fibroids in twin pregnancies. STUDY DESIGN: A retrospective cohort study of twin pregnancies with ≥ 1 fibroid on second trimester ultrasound. Outcomes included small for gestational age (SGA) fetal growth, preterm delivery, preterm rupture of membranes, abruption, preeclampsia, and intrauterine fetal death. Univariable and multivariable analyses were used to evaluate the impact of fibroids on outcomes in twin pregnancies compared to twin pregnancies without fibroids. RESULTS: Of 2,378 nonanomalous twin pregnancies, 2.3% had fibroids. Twin pregnancies with fibroids were no more likely to have SGA growth (40.0% vs. 36.0%, aOR 1.1, 95%CI 0.7-2.0) or preterm delivery < 34 weeks (25.0% vs. 24.0%, aOR 1.0, 95%CI 0.5-1.9) than twin pregnancies without fibroids. Other adverse outcomes were no more likely to occur in twin pregnancies with fibroids than twin pregnancies without fibroids. Post hoc power calculations suggested greater than 97% power to detect 2-fold differences in small for gestational age and preterm delivery <34 weeks. CONCLUSIONS: In contrast to data suggesting an increased risk for adverse outcomes in singleton pregnancies with fibroids, twin pregnancies with fibroids do not appear to be at increased risk for complications compared to those without fibroids