627 Examining ultrasound diagnostic performance improvement when utilizing maternal-fetal medicine interpretation

Abstract

Telemedicine can extend essential health services to under-resourced settings and improve level and quality of care. Fetal anomalies often require subspecialty perinatal care, rendering prenatal diagnosis essential. This study examines the impact of a maternal-fetal medicine (MFM) tele-ultrasound program on diagnostic accuracy of fetal anomalies when in-person MFM is unavailable. This is a cross-sectional study of all patients receiving care at one of eleven private obstetric practices and imaging centers who had an obstetric ultrasound from January 1 - July 6, 2020. All ultrasounds were performed by sonographers remotely trained under a standardized protocol and interpreted by MFM physicians via telemedicine. Ultrasound characteristics and interpretation were extracted from ultrasound reports. Prior to introduction of tele-MFM, all ultrasounds were reviewed by general OB/GYN and family practitioners with reliance predominantly on the sonographer’s impression. The primary outcome was potential missed diagnosis of a fetal anomaly, defined as an ultrasound designated normal by the sonographer but diagnosed with an anomaly by tele-MFM. These serve as a measure for anomaly diagnoses that would be missed without MFM supervision. Characteristics of potential missed diagnoses were compared by type of scan and fetal organ system in univariable analysis. 6,403 ultrasounds were evaluated, 310 of which had a diagnosis of a fetal anomaly (4.8%) with 89 cardiac anomalies. 43 of the anomalies were diagnosed on anatomic survey (13.9%) (Table 1). The overall rate of potential missed diagnoses was 34.5% and varied significantly by type of ultrasound (p < 0.01). There were significant differences in the rate of potential missed diagnoses by organ system, with the highest rate for cardiac anomalies (p< 0.01) (Table 2). MFM expertise improves diagnostic performance of antenatal ultrasound throughout pregnancy. This has implications for improving quality of antenatal care by ensuring appropriate referrals and site of delivery, particularly for cardiac anomalies.View Large Image Figure ViewerDownload Hi-res image Download (PPT)