Madigan Army Medical Center recently earned national recognition for its excellent performance in prenatal ultrasounds when its Antenatal Diagnostic Center was recertified in January by the American Institute of Ultrasound in Medicine, making Madigan the only military treatment facility in the United States with this designation, said Supervising Sonographer Joann Acosta.
"We are providing our pregnant patients with the highest quality of ultrasound in our unit through our exceptional support staff, sonographic techs, and high-risk doctors," said Maj. Brad Dolinsky, the chief of the Antenatal Diagnostic Center, Maternal-Fetal Medicine. Madigan is also just one of five centers in Washington State with an AIUM certification for fetal echocardiography, which is an ultrasound test used to view a fetus' heart.
As the governing body for the use of ultrasound in medicine, AIUM sets forth the criteria for what should be checked during prenatal ultrasounds. These ultrasounds focus on thoroughly checking on the overall healthy development of babies, looking at everything from the brain to the heart, the diaphragm to the spleen, and the kidneys to the umbilical cord.
Madigan sonographers, or ultrasound technicians, tend to run these comprehensive checkups when the fetus is between 19 and 22 weeks old.
"That's when the baby is big enough that we can see everything, but not so big that it shadows us out. As the baby gets bigger, the bones get bigger and harder, and then we can't see through the bones as well as at 19 weeks," said Acosta.
Out of the about 675 prenatal ultrasound exams that Madigan conducts each month, they tend to find about two to four fetuses with anomalies. The more common anomalies involve heart, spine, renal or chromosomal defects, along with cleft lips and palates, and club feet.
Babies identified with anomalies are watched more closely in their development, and specialists start working closely with the parents to explain the condition as well as the medical options. The hope is to pre-plan what medical care the baby will receive once it's born as well as to increase the parents' peace of mind.
"(Doctors) prepare the patient for what's going to happen once the baby's born so they're not surprised," said Acosta.
Acosta emphasized that doctors will sit down with parents the day of a diagnosis to explain it, and will also make time for a follow-up appointment to give the parents options to decide how they want to proceed. When specialists need to be on hand shortly after birth, parents can opt for a controlled delivery -- a c-section or inducement is scheduled to better control the timing of the delivery to help ensure a specialist can be present.
If needed, anomalies detected in fetuses can sometimes be operated on while their mothers are still carrying them; fetuses with lower spinal defects, for instance, may be sent to specialists to operate on them so they can continue to develop properly in the womb.
Madigan's sonographers assist in these vital diagnoses by obtaining the best possible images to give to the doctors to diagnose, said Acosta.
"If we can't get the pictures, we're not going to have a diagnosis," she said. While there are minimal guidelines for conducting prenatal ultrasounds, she said that Madigan goes above even the AIUM guidelines.
Acosta said obtaining the national AIUM certification can give Madigan prenatal patients increased confidence in their care here.
"They can rest assured that Madigan can give them the proper care when it comes to their babies … We have state-of-the-art machines, the best-trained ultrasonographers, and the best-trained high-risk obstetrical physicians in the field of ultrasound," she said.
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