Interventional Ultrasound in Obstetrics & Gynaecology Narendra Malhotra, Kuldeep Singh
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IntroductionOne

  • 1.1 Filling forms
  • 1.2 Relevant history
  • 1.3 Machine and equipment
  • 1.4 Patient preparations
  • 1.5 Counselling and legal aspects
  • 1.6 Documentation and reporting
  • 1.7 Analgesia and anaesthesia
 
1.1 FILLING FORMS
Maintain a form for further follow up in your clinic. One never knows when the information is required.
The routine information required in these forms is:
  1. Name
  2. Age
  3. Address
  4. Telephone Number
  5. Referred by
  6. PNDT Act Form ‘F’ as required by Government of India law
  7. Undertaking by patient and doctor for obstetric ultrasound with Form ‘F’ and Form ‘G’.
  8. For genetic defects in for ventional procedures the clinic/Nace has to be specially registered and licenced by Govt. under the PNDT act as a genetic Lab.2
 
1.2 RELEVANT HISTORY
Always spend few minutes with your patient to take the details of the history. It gives confidence to the patient and you get your perspective of what all to expect.
The history to be taken routinely is :
  1. Previous obstetric history consisting of details of any abortions (spontaneous or missed), any second or third trimester losses (possible reasons), any previous deliveries (vaginal or caesarian). Try and look into the previous records which can throw any light.
  2. Any symptoms in this pregnancy.
  3. Any ultrasound done so far in this pregnancy. Check the records carefully.
  4. Last menstrual period and regularity of menstrual cycles.
  5. Any tests done and their reports.
  6. Referring doctors requisition slip (This is now a legal requirement with Form ‘F’).
 
1.3 MACHINE AND EQUIPMENT (FIGS 1.1 TO 1.5)
Any good resolution scanner is a requisite for interventional procedures and should have both probes (transabdominal and transvaginal) all standard accessories, biopsy guides for both probes, recording and documenting facility and different types of needles, etc.
  1. Machine with transabdominal and transvaginal probes.
  2. Minor operation theatre.
  3. Biopsy guides for transabdominal and transvaginal probes.3
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    Fig. 1.1: Machine with probes and biopsy guide
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    Fig. 1.2: Abdominal probes with biopsy guide and needle
    4
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    Fig. 1.3: Vaginal probes and biopsy guides with needles
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    Fig. 1.4: Various biopsy guides
  4. Biopsy needles of all sizes and lumen for abdominal and vaginal routes.
  5. Standard accessories.
  6. Standard equipment for minor O.T. procedure.
  7. Consent form.5
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Fig. 1.5: Ovum pick up set
 
1.4 PATIENT PREPARATIONS
Patient is prepared for as any other minor operative procedures.
  1. Admission charts and proper consent.
  2. Preoperative antibiotic and Tetvac injection.
  3. Preoperative part preparation, bowel and bladder evacuation.
  4. Supine/lithotomy position.
  5. Sterilized probe (Dipping in Cidex solution).
  6. Aspetic measures.
  7. Analgesia/anaesthesia.
 
1.5 COUNSELLING AND LEGAL ASPECTS
  1. Proper genetic registered centre (PNDT Act).
  2. Genetic counselling for chromosomal defects.
  3. Counselling for procedure and side effects.
  4. Legal consent.6
  5. Counselling for acceptable procedure related risks and abortions.
  6. Legal malpractices issues may be different in different countries.
A plaintiff must demonstrate that the physician breached the standard care and his action/inaction caused injury, since the standard care is so rapidly changing the physician must be alert to new developments and must inform these to the patient.
 
1.6 DOCUMENTATION AND REPORTING
  1. Proper hard copy/soft copy documentation.
  2. Detailed step wise procedure reporting.
  3. Report complications.
  4. Clear follow up of instructions.
 
1.7 ANALGESIA AND ANAESTHESIA
Usually these procedures are quick and relatively painless and require only reassurance, mild analgesia and local anaesthesia.
  1. Local anaesthesia.
  2. Analgesic injections.
  3. Short general anaesthesia with propofol, pentothal or ketamine.
  4. All standard resuscitation equipment.
  5. Trained anaesthetist.7
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Flow Chart 1.1: Showing approach to a pregnant patient for anomaly detection and confirmation