OBGYN I - Clinical Ethics for Sono

Ethics

defined as systematic reflection on and analysis of morality

Morality

concerns right and wrong conduct (what we ought or ought not do) and good and bad character (the kinds of persons we should become and the virtues we should cultivate in doing so)

Morality

reflects duties and values

Morality

learned through personal experiences and family traditions and from normative behavior within communities, ethnic and racial groups, geographic regions

Ethics

is a discipline of study that seeks to articulate clear, consistent, coherent, practical guidelines for conduct and character

what is good

Ethics tries to answer key question

Hippocrates

cautioned his students, “Primum non nocere,” which famously means, “First, do no harm.”

Nuremberg code

emphasized individual rights and autonomy, and it has become key element of modern ethics

SDMS

Code of Ethics for the Profession of Diagnostic Medical Sonography adopted and maintained

Nonmaleficence

Directs sonographer to not cause harm

cause unnecessary harm and undermine informed consent

Two problems result when obstetric sonographers do not maintain baseline level of competence in techniques and interpretation of sonographic imaging:

Beneficence

seeks to benefit patients, not simply avoid harming them.

Pain

often causes suffering

Beneficence

obligates obstetric sonographer to seek greatest benefit in care of pregnant patients

Clinical good for fetal patient

includes prevention of premature death, disease, handicapping conditions and unnecessary future pain and suffering

respect for person’s autonomy

In cases of Health professional’s duty of beneficence may suggest one course of action and patient may choose another must be balanced by

Veracity and integrity

may conflict with beneficence when truth-telling will cause undue stress and complications

Justice

or fair distribution of benefits may conflict with beneficence for individual patients who need extra resources

Autonomy

right to self-determination, has become key ethical principle.

Autonomy

refers to person’s capacity to formulate, express, and carry out value-based preferences

Infotmed consent

is autonomy-based right

Moral judgement should not be criticized and her autonomy demands respect by neutrality

Sonographer with moral objections to abortion should keep two things in mind:

elect abortion

Sonographer is free to follow his or her conscience and to withdraw from further involvement with patients who

Veracity

means truthfulness.

Integrity

means adherence to moral and ethical principles

Integrity

physicians willingness to refer to specialists when limits of their own knowledge being approached

truthful

If practitioner asks sonographer to perform examination he or she is not competent to do, it is essential for sonographer to be _____ about his or her limitations to protect patient.

Justice

means simply that sonographers must strive to treat all patients equally

Justice

is ethical principle that requires fair distribution of benefits and burden

Justice

served when protocols standardized.

Injustice

to provide this information to some women and not to other

Confidentiality

concerns obligation of caregivers to protect clinical information about patients from unauthorized access

HIPPA

determine acceptable conditions for releasing confidential information.

Yolk sac seen

>8-mm gestational sac

embryo seen

>16-mm gestational sac

abnormal

>8-mm yolk sac

positive cardiac activty

>7-mm fetal pole

Ovoid

Distended urinary bladder changes shape of yolk sac from round to

CRL

Is most accurate fetal age measurement

Embryonic heart rate

can be measured by Mmode from early fifth to early ninth gestational weeks when CRL <25 mm

3.3bpm/day

Normal EHR accelerates linearly

BPD

Obtain at level of midbrain to see Falx, cavum septi pellucidi, thalamic nuclei

AC

should be taken from round transverse image, perpendicular to fetal spine, with umbilical portion of left portal vein midline within liver

AC

least accurate measurement for fetal age

epiphyseal cartilages or DFP

should not be included in femoral length measurement

FL

may be used with same accuracy as BPD to predict gestational age.

FL

may indicate skeletal dysplasia or intrauterine growth restriction

Tibia

Is the tibia or fibula longer

Fibula

Which leg bones is lateral and thinner

Scapula

To identify ____, rotate transducer until long axis of humerus seen

humeral shaft

Only measure ___ shaft not PHP

Ulna

Is the ulna or radial longer

Cerebellum, vermis, 4th ventricle

Obtain length of cerebellum at level of