Conflicting Ultrasound Standards Raise Legal Issues.

VAIL, COLO. -- The "limited" ultrasound examination as defined by the American College of Obstetricians and Gynecologists presents a legal minefield for obstetricians at a time when litigation involving ultrasound is increasingly common, Dr. Richard L. Berkowitz said during a conference on obstetrics and gynecology sponsored by the University of Colorado.

"ACOG is our union, our club. ACOG is out there trying to help us, trying to help people who take care of pregnant women from getting creamed in court. But I think this document, which was designed to help us, is in fact incredibly counterproductive," said Dr. Berkowitz, who is professor and chairman of ob.gyn. at Mount Sinai School of Medicine, New York.

That's because performing a limited ultrasound exam as described in ACOG Technical Bulletin No. 187 can place a physician at odds with the 1990 American Institute of Ultrasound in Medicine--American College of Radiology guidelines for performance of the antepartum obstetrical ultrasound examination. And it is clearly this AIUM-ACR document, not the bulletin, that is viewed by the courts as the standard of care, he said.

"When you go to court, the plaintiff's lawyer is going to be holding up that AIUM-ACR document and saying it's the standard of care for a radiologist who does an ultrasound exam. He'll ask, 'Do you as an obstetrician really believe that you can use the same equipment on the same type of patient and have a completely different standard?'

"And the answer is no," Dr. Berkowitz said.

ACOG distinguishes between the limited ultrasound exam and the basic exam, which provides information about placental location, amniotic fluid volume, gestational age, a survey of fetal anatomy and maternal pelvic organs, and other features.

A limited examination is "appropriate and desirable," according to ACOG, in the assessment of amniotic fluid volume, fetal biophysical profile testing, ultrasound-guided amniocentesis, external cephalic version, confirmation of fetal presentation, location of the placenta in antepartum hemorrhage, and confirmation of fetal life or death.