In this review, we evaluate the published methodologies to describe a noninvasive technique for the quantitative assessment of umbilical venous blood flow in the human fetus. We identify a number of variations in the reported methodologies and address some of the common errors associated with Doppler assessment of umbilical venous flow volume. The potential role of umbilical venous flow volumetry in the management of intrauterine growth restriction is briefly evaluated including its utility and reliability in everyday clinical practice.

Introduction: Obstetric sonography is a highly skilled diagnostic medical examination. Pregnant women like to socialise their ultrasound experience with family, introducing distractions for the sonographer. Our objective was to survey ultrasound practitioners to identify concerns regarding interruptions and their opinions about socialisation during the examination. Methods: An online questionnaire was disseminated to study the views of Australian and New Zealand obstetric sonographers/ sonologists. It was informed by a pilot study of possible distractors with quality and safety concerns and operator opinions regarding family bonding. Results: The opinions of 393 obstetric sonographers/sonologists informed our results. Distractors with the most negative aspects included disruptive children (93.3%) and mobile phone conversations (84.3%). Most respondents (62%) believed that a distractor only had to be present for 5 min or less to have an impact. Small children were identified by 87.5% of respondents as safety risks to themselves, to the patient and to sonographers. Sonographers were concerned that distractors caused a loss of concentration, interruption to a systematic scanning approach and increased false negatives in screening, missing important diagnoses. Sonographers strongly agreed that obstetric sonography facilitated maternal-fetal bonding, but only 15% thought that siblings bond with the fetus during the scan. Conclusion: Obstetric sonographers in our study are concerned that distractors pose a negative impact on the quality and safety of ultrasound. They also recognise the importance of family bonding. Strategies to bridge the medical and social components of obstetric sonography should be developed to reduce quality and safety threats.

IntroductionDistraction during obstetric scanning is a concern to sonographers, impacting on the safety of ultrasound for the pregnant patient, observers, and themselves. Our objective was to survey obstetric ultrasound practitioners to determine the formulation of policy in this area to mitigate the potential negative impacts of distractors.MethodsAn online survey was disseminated through professional bodies to study the views of Australian and New Zealand obstetric sonographers/sonologists on policy to combat distractors.ResultsSeventy‐eight percent of the surveyed sonographers (n = 393) responded to the closed‐ended questions on policy, with ~1/3 offering qualitative data/comments on workplace policy. Current policy direction was aimed at: the number of observers, the presence of children, separation of the medical and social bonding components of the scan, use of electronic devices, and the concept of “sonographer discretion.” Predominantly, (~66% of responses) policy was not adhered to due to multiple factors including fear of patient complaints if the policy was enforced.ConclusionThe tension in obstetric sonography between medical diagnostics and social bonding is of concern to sonographers in our study. The way forward may involve a combination of patient education and a policy backed up by a professional authority, which is implemented and enforced by an employer.

Introduction and Objectives: Estimation of the umbilical venous blood flow volume relies on the diameter of the vein, which has been reported to be reduced in severely growth restricted fetuses. However, there is only limited information on the growth pattern of this vessel in the normal human fetus. The aim of this study is to examine the growth pattern of the umbilical vein across gestation in low-risk human pregnancies. Methods: In a prospective, longitudinal ultrasound study of 136 low-risk pregnancies, the internal diameter of the intra-amniotic portion of the umbilical vein was measured at 18, 26 and 34 weeks of gestation. To investigate the growth pattern of the venous diameter, the ratios of diameters at 26 weeks to diameters at 18 weeks (ratio 1) and the ratios at 34 to 26 weeks (ratio 2) were also calculated. A paired-sample t-test was performed to compare the means of the two ratios. Results: The mean diameter of the umbilical vein at 18 weeks was 2.8 mm (SD 0.40), 5.8 mm (SD 0.67) at 26 weeks and 7.6 mm (SD 0.98) at 34 weeks. The mean of ratio 1 was 2.06 (95% CI 2.01-2.14), which was significantly higher than ratio 2 (mean 1.33, 95% CI 1.29-1.36), P < 0.001. Conclusion: The umbilical venous diameter demonstrates a non-linear growth pattern between 18 and 34 weeks of gestation. The diameter doubled in size between 18 and 26 weeks but grew at a slower rate between 26 and 34 weeks of gestation. This study provides new data on the normal growth pattern of the umbilical vein by identifying a period of gestation where its growth is accelerated.