Fetal structural anomalies — breaking a soft-marker finding

Communication station: break and contextualise soft-marker findings (echogenic focus and possible hyperechogenic bowel) for a distressed, internet-informed woman, plan a proportionate work-up, and avoid both over-investigation and false reassurance. Includes assessor key and marking domains.

Prompt

A 23-year-old first-time mother attends after her 20 week scan. The sonographer told her there is 'a bright spot on the baby's heart and possibly bright bowel' but gave no further explanation. She is in tears, has searched the internet, and is convinced her baby has Down syndrome and will not survive. You are the registrar; fetal medicine is available this week.

Station brief

Format. Communication station, approximately 12 minutes. You are the obstetric registrar. An actor plays the woman; the assessor feeds new information. Fetal medicine is available this week. ^[1]

Candidate instruction. Break the findings, separate the reassuring echogenic focus from the bowel finding needing work-up, correct the internet-driven misinterpretation, and arrange a proportionate plan. ^[1]

References3Show

[1]Salomon LJ, Alfirevic Z, Berghella V, et al. ISUOG Practice Guidelines (updated): performance of the routine mid-trimester fetal ultrasound scan Ultrasound Obstet Gynecol, 2022.PMID 35592929
[3]Agathokleous M, Chaveeva P, Poon LC, et al. Meta-analysis of second-trimester markers for trisomy 21 Ultrasound Obstet Gynecol, 2013.PMID 23208748
[4]Lorente AMR, Moreno-Cid M, Rodríguez MJ, et al. Meta-analysis of validity of echogenic intracardiac foci for calculating the risk of Down syndrome in the second trimester of pregnancy Taiwan J Obstet Gynecol, 2017.PMID 28254219

Fetal structural anomalies — breaking a soft-marker finding

Station brief

Format. Communication station, approximately 12 minutes. You are the obstetric registrar. An actor plays the woman; the assessor feeds new information. Fetal medicine is available this week. ^[1]

References3Show

[1]Salomon LJ, Alfirevic Z, Berghella V, et al. ISUOG Practice Guidelines (updated): performance of the routine mid-trimester fetal ultrasound scan Ultrasound Obstet Gynecol, 2022.PMID 35592929
[3]Agathokleous M, Chaveeva P, Poon LC, et al. Meta-analysis of second-trimester markers for trisomy 21 Ultrasound Obstet Gynecol, 2013.PMID 23208748
[4]Lorente AMR, Moreno-Cid M, Rodríguez MJ, et al. Meta-analysis of validity of echogenic intracardiac foci for calculating the risk of Down syndrome in the second trimester of pregnancy Taiwan J Obstet Gynecol, 2017.PMID 28254219