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ISUOG 2020 – Celebrating 30 years Virtual poster abstracts
when time of return Tr to LV takes a certain percentage of the
cardiac cycle T. Our objective was to assess WCN and reflection
timing Tr/T in the human fetus.
Methods: Based on the WCN relation: WCN =HR×L/PWV,
energy consumption of pulsatile LV action is optimised for WCN
≈0.1 (HR: heart rate, L: effective aortic length, PWV: aortic PW
velocity; Pahlevan 2014, 2020). Rearranging with Tr =2L/PWV
(figure) yield Tr/T =0.2 as optimal reflection timing.
To obtain Tr in the fetus by Doppler, hemodynamic modelling
is required (figure): PWs arrive twice at cerebral circulation: 1st
as a primary wave and 2nd after reflection and return. A systolic
shoulder (S) in MCA Doppler (MCA-S) represents this 2nd impulse
and delay t corresponds to Tr (Mills 1970).
Results: Tr data of IUGR fetuses with MCA-S were obtained by this
method (Gonser 2018): Tr =96 ±15ms (GA 31 ±3w). T =423ms
(FHR 140bpm) yield Tr/T =96ms/423ms =0.23, showing good
agreement with optimal reflection timing of 20%, as suggested
by the WCN.
Conclusions: In spite of circulatory stress, IUGR fetuses maintain
nearly optimal pulsatile timing, probably due to the priority of
minimal energy consumption. Thus appearance of MCA-S is not an
artifact, but a sign of nearly optimal timed PW reflection.
Supporting information can be found in the online
version of this abstract
VP34.07
Competency-based assessment of obstetric Doppler training
outcome in an ISUOG-accredited program in Nigeria
I.O. Awowole1, E. Enabudoso2,H.O.Raji
6,O.H.Adams
3,
A. Njoku5, J. Akinmoladun4
1Obstetrics, Gynecology and Perinatology, Obafemi Awolowo
University, Ile-Ife, Osun, Nigeria; 2Obstetrics and Gynecol-
ogy, UBTH, Benin City, Edo, Nigeria; 3Radiography and
Radiation Science, University of Benin, Benin City, Edo, Nige-
ria; 4Radiology, University College Hospital, Ibadan, Nigeria;
5Department of Obstetrics and Gynecology, Ambrose Alli Uni-
versity, Ekpoma, Edo, Nigeria; 6Obstetrics and Gynecology,
University of Ilorin, Ilorin, Nigeria
Objectives: The ratio of trained personnel in fetal assessment to
obstetric population is suboptimal in developing countries. This
study aims to assess the improvement in fetal Doppler skills of
participants at an ISUOG-accredited advanced obstetric ultrasound
workshop, using four fetal vessels.
Methods: During the 5-day program at Benin, Nigeria between
17– 21 June 2019, 17 out of 55 participants were randomly
selected for pre- and post-workshop assessment of competence on
fetal middle cerebral artery (MCA), umbilical artery (UA), uterine
artery (UtA) and ductus venosus (DV) Doppler. Pre-assessment
scoring standardisation on vessel acquisition, Doppler-gate and
angle-orientation, sonogram quality and Image optimisation was
done for four accredited trainers that conducted the assessment.
Possible overall score ranged between 4–16, with 12 as cut-off
for proficiency. Scores were compared with paired t-test while
determinants of outcome were assessed with regression analysis.
p<0.05 was taken as statistically significant.
Results: There was significant improvement in the mean
post-workshop scores compared with the initial assessment for the
UA (12.1 ±1.8 vs. 4.7 ±1.6; p <0.001), UtA (9.5 ±1.0 vs. 4.1 ±0.1;
p<0.001) and MCA (9.0 ±0.7 vs. 4.47 ±0.2; p <0.001) but not
with DV (4.2 ±0.2 vs. 4.1 ±0.1; p =.543). None of the partici-
pants demonstrated competence pre-training, while 12 (70.65%), 6
(35.3%) and 4 (23.5%) of them achieved competence post-training
for UA, UtA and MCA Dopplers respectively. There was none for
DV. Previous practical training on obstetric ultrasound (p =0.02)
was the only significant predictor of competence.
Conclusions: Although there was significant improvement among
the participants for UA, UtA and MCA Doppler post-assessment,
training to competence within five days only appeared feasible with
the umbilical artery Doppler. Continuous training is advised to
achieve a critical mass of personnel needed to improve obstetric
care in Nigeria.
VP34.08
Long-term evaluation of retention of acquired ultrasound
theoretical knowledge and skills following an intensive
ISUOG ultrasound course in the Sultanate of Oman
N. Vrachnis1, A.T. Papageorghiou2,V.Pergialiotis
3,
T.E. Cohen-Overbeek4, K. Billardo8, A. Abuhamad9,
R. Abu-Rustum12,L.Hanson
5,A.Tabor
6, A. Johnson11,
E. Xilakis7,F.Mates
7, S. Johnson7,J.Hyett
10
1School of Medicine, National and Kapodistrian University
of Athens, Palaio Psychiko, Attiki, Greece; 2University of
Oxford, Oxford, United Kingdom; 3National and Kapodis-
trian University of Athens, Athens, Greece; 4Obstetrics and
Gynecology, Erasmus University Medical Center, Rotter-
dam, Netherlands; 5Colleagues In Care, Miami, FL, USA;
6Obstetrics, Copenhagen University Hospital, Rigshospitalet,
Copenhagen, Denmark; 7ISUOG, London, United Kingdom;
8Amsterdam University, Amsterdam, Netherlands; 9Eastern
Virginia Medical School, Eastern Virgina, VA, USA; 10Royal
Prince Alfred Women and Babies, Sydney, NSW, Australia;
11Obstetrics and Gynecology, UTHSC, Houston, TX, USA;
12University of Florida, Gainesville, FL, USA
Objectives: Current practice in the theoretical knowledge and
practical skills in the field of gynecological and obstetrical ultrasound
is of paramount importance. Outreach programs aim to provide
essential skills in countries where ultrasound is infrequently practice;
however, participants ifrequently encounter knowledge and skills
retention difficulties, after completion of the program. The purpose
of the present study is to present data on long-term retention
of knowledge and skills following the completion of a structured
program of obstetrical and gynecological ultrasound offered by
ISUOG.
Methods: The study was based on data retrieved following the
completion of an intensive ultrasound course carried out by ISUOG
Outreach and which took place in Oman. Retention of theoretical
knowledge and practical skills were assessed at 5 and 14 months
following the completion of the initial course.
Results: During the second week, we noted a decline in the
theoretical knowledge and practical skills, which was attributed to
the limited use of ultrasound in clinical practice of trainees. Taking
this limitation in mind, a structured electronic communication using
instant messaging educational media was formed in order to help
increase trainees’ confidence and knowledge as well as their practical
skills. Following this, a significant improvement in theoretical and
practical skills was observed, with the exception of the achievement
of competence in retrieving and analysing difficult sonographic
planes/images, such as abdominal circumference or the 4-chamber
view of the heart.
Conclusions: Intensive outreach ultrasound training programs aim
to offer condensed knowledge and skills to trainees. However, their
retention on a long term basis is difficult to achieve. Close monitoring
of trainees and follow-up courses are essential to help boost
knowledge, confidence, and skills so that trainees may effectively
improve their clinical services.
VP34.09
Abstract withdrawn
©The Authors 2020
198 ©Ultrasound in Obstetrics & Gynecology 2020; 56 (Suppl. 1): 57–378.