Displaying items by tag: medical

Is your Medical Director a Member of the American Association of Pro-Life Obstetricians and Gynecologists?

Board Certified. Professional. Pro-life.AAPLOG

If he or she is, thank them! If not, please pass on the following information to them. AAPLOG is a tremendous support and resource for pro-life physicians who often face difficult challenges and opposition in today's liberal medical environment and culture, providing research papers, articles and updates on current topics, educational opportunities, networking, legal defense of the unborn, and more. The following information is taken from the AAPLOG website. Heartbeat International Affiliates join for free!


Practicing in today's environment is incredibly challenging. We are with you. We exist to serve your need for accurate up to date information on prolife issues so that you will be able to answer with confidence the ethical challenges that you face on a daily basis. We provide a forum to network with likeminded colleagues from many different specialties. We are here to help make your job a little easier. Join us.

Our Mission is Clear:
You are not alone.

We are the largest organization of pro-life obstetricians and gynecologists in the world. We know what it is like to practice good medicine in a hostile academic environment. We understand the need for absolutely accurate and scientifically irrefutable information. We are committed to serving you.

We strive to provide you with a network of prolife physicians for mentoring and support and communication, and within that network to be able to mentor the next generation of pro-life physicians.

We want to make available to you the most accurate, up to date information on the effects of abortion on women, so that you will have an evidence-based response to the pressures to endorse abortion.

Check out our mission statement.

And Join us.

Evidence Based Education.

In the published medical literature, there is ample evidence of the effects of abortion on women. Abortion increases preterm birth in subsequent pregnancies, increases a woman's risk of suicide, substance abuse, major depression and all cause mortality, and increases a woman's risk of breast cancer if aborting a first pregnancy and delaying term pregnancy subsequently. Yet, many medical organizations are so politically invested in the abortion agenda that this information is not readily available to physicians or patients.

AAPLOG works to make available to physicians and patients the effects of abortion on women as evidenced in the peer-reviewed medical literature. The AAPLOG annual Matthew Bulfin Educational Meeting provides a forum for pro-life medical experts to discuss the latest and most important information on prolife topics, and has offered 8 credits of CME. These lectures are archived and available to members on the AAPLOG website.

Members can also avail themselves of prepared CME lectures on a variety of prolife topics, to equip members to be able to speak out professionally on a variety of topics including abortion complications, maternal mortality, abortion and preterm birth etc.

A Voice for the Silent

As Hippocratic Physicians, we are responsible to protect both the mother and her unborn child from fertilization until natural death. As Hippocratic Physicians we have a unique professional responsibility to publically speak for the weakest and most defenseless of the human race: the unborn child. AAPLOG takes that professional responsibility seriously.

As a non-profit educational organization, AAPLOG members participate in the public defense of human life from fertilization until natural death, by supplying accurate information from the peer-reviewed medical literature, especially in public forums where accurate information is often grossly lacking. AAPLOG is frequently called on by lawmakers and the media to give a professional pro-life perspective on current legislation, new research or breaking events.

A Defense for the Helpless.

The current laws in our nation do not defend the most helpless of human beings. AAPLOG works with many local, state and national legislators, legal organizations and policy makers in the United States who work to defend these tiniest of humans in law. AAPLOG members provide the professional pro-life expert opinions needed to defend these laws.

AAPLOG also networks with pro-life medical colleagues internationally to equip them to provide the evidence-based expert testimony required to defend human life.

A Message from Our Executive Director

Have you ever longed for colleagues who share a prolife worldview? You are not alone. We are pro-life ob-gyns and associates who are speaking out with a professional voice. And, we are making a difference. Come join us.
• Physicians and Para-Medical Persons
• Students & Residents
• Organizations
• Affiliates

Together we can effectively communicate the effects of abortion on women. We can communicate a professional second opinion which values life. And we can network together to bring that message to the medical, policy and pro-life community. Come join us.

Our Mission Statement

As members of AAPLOG we affirm:
1. That we, as physicians, are responsible for the care and well-being of both our pregnant woman patient and her unborn child.
2. That the unborn child is a human being from the time of fertilization.
3. That elective disruption/abortion of human life at any time from fertilization onward constitutes the willful destruction of an innocent human being, and that this procedure will have no place in our practice of the healing arts.
4. That we are committed to educate abortion-vulnerable patients, the general public, pregnancy center counselors, and our medical colleagues regarding the medical and psychological complications associated with induced abortion, as evidenced in the scientific literature.
5. That we are deeply concerned about the profound, adverse effects that elective abortion imposes, not just on the women, but also on the entire involved family, and on our society at large.

To learn more click here.
We invite you to Join us.

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Use of Hormonal Contraceptives Linked to Brain Cancer

by Susan Dammann, RN, LAS, Medical Specialisthormonal contraceptives

Does your center provide information about the possible side effects and risks of various birth control methods? If so, you may want to consider including the following information in your materials.

A Jan. 22 article published in Medscape News on January 22, 2015 discussed a study done in Denmark which found an association between hormonal contraceptives and an increased risk for glioma in younger women. The results were published in the print edition of the British Journal of Clinical Pharmacology. The reported risk increases with the duration of use, the study showed. "A nearly two-fold increased risk of glioma [a common type of primary brain tumor] was observed among long-term users of hormonal contraceptives."

The researchers highlight the fact that progesterone exposure was associated with the highest increased risk for glioma in their study. While the study had many strengths, its weaknesses are being identified, but are not expected to alter the results significantly.

"Oral contraceptives are known to influence the risk for certain cancers, but few studies have examined any link to central nervous system tumors", said David Gaist, MD, from Odense University Hospital and the University of South Denmark. He added that although the findings of this study must be interpreted with care, "We feel it is an important contribution and we hope that our findings will spark further research on the relationship between female hormonal agents and glioma risk."

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Called to Care

Looking for a great read?Called to Care

Check out Called to Care: A Christian Worldview for Nursing by Judith Allen Shelly and Arlene B. Miller

As one Amazon review states, "Bar none, this is the best work of its kind on the market."

There is much to learn in this excellent work, which starts by surveying nursing's historical roots as Christianity's response to caring for God's people. What do you know about the real Florence Nightingale? Deaconesses as some of the first nurses? How the ministry of nursing guidelines developed from the Christian faith?

After this fascinating look at nursing's historical roots in Christianity, the book examines how the practice of nursing has been experiencing challenges to bypass Christian roots by scientific and business models of care, as well as the current rise of alternative spiritualities among nursing leaders.

The authors have given us a great resource for re-examining the biblical basis of our commitment to serve the suffering and needy as nurses.

Publisher's Description

Nursing keeps changing. The role of the nurse grew out of a Christian understanding of the human person as created in the image of God, and viewed the body as a living unity and the "temple of the Holy Spirit" (1 Cor. 6:19). Contemporary nursing, however, is increasingly characterized by a diminished understanding of personhood. The impact on patient care has proven confusing and discouraging to many nurses. In the newly revised and expanded Called to Care: A Christian Worldview for Nursing, Judith Allen Shelly and Arlene B. Miller define nursing for today based on a historically and theologically grounded understanding of the nurse's call: Nursing is a ministry of compassionate care for the whole person, in response to God's grace toward a sinful world, which aims to foster optimum health (shalom) and bring comfort in suffering and death for anyone in need. Called to Care asserts that nursing is a vocation, giving nurses a framework for understanding their mission and living out their calling: service to God through caring for others.

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Introducing: Dr. Anthony Levatino

Honored member of Heartbeat International's Medical Advisory CouncilLevatino

A great man with an amazing testimony

Meet Dr. Anthony Levatino, honored member of Heartbeat International's Medical Advisory Council, who was featured in World Magazine January 22, 2015. The article details his journey from abortionist to pro-life advocate, including opening a pregnancy center and being medical director for two pregnancy center medical clinics. To read his full story click here. We are glad to recognize Dr. Levatino as part of our Medical Advisory Council.

Tweet this! Meet Dr. Anthony Levatino, honored member of Heartbeat International's Medical Advisory Council



On the left, Dr. Levatino is pictured giving testimony before a congressional subcommittee in support of a bill that would ban abortions after 20 weeks. To see his full testimony click here.


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What You Need to Know About the Dangers of Prenatal Tests

By Susan Dammann, RN, LAS, Medical Specialistprenatal testing

Reporting in Prenatal Tests: What Patients Should Know published in Medscape News and WebMD, Kathleen Doheny described a recent investigation revealing there are significant inaccuracies in non-invasive prenatal screening and that some women and doctors are misinterpreting the positive results from the new generation of prenatal tests including MaterniT21Plus, Verifi, Panorama and Harmony. In some instances, women are terminating their pregnancies because of it. This decision appears to be based on the screen alone without obtaining tests to confirm a negative diagnosis.

Beth Daley from the New England Center for Investigative Reporting in an excellent article Overused and Misunderstood stated "a three-month examination by the New England Center for Investigative Reporting has found that companies are overselling the accuracy of their tests and doing little to educate expecting parents or their doctors about the significant risks of false alarms."

"All claim to offer expectant parents the chance to know with almost 100% accuracy, and as early as 10 weeks into a pregnancy, the likelihood that the developing baby has any genetic abnormalities such as Down syndrome, Edwards syndrome (trisomy 18), Patau syndrome (trisomy 13), or a few other chromosomal anomalies" writes Nora Sullivan with the Charlotte Lozier Institute in her article Non-invasive Prenatal Screening Expands Disability Discrimination Abortion

Daley goes on to say: "A screen is a test given to a general healthy population and usually has high sensitivity so that any possible problems are flagged. Because of the high sensitivity, false positives are more common. Also, screens are not necessarily approved by the FDA. Because of a loophole from the 1970's, these types of screening tests are not subject to the same regulation as other medical devices or procedures. A screen is always supposed to be confirmed with a diagnostic test. A diagnostic test is designed with high specificity for a particular condition flagged by the screen. It is often more invasive and is meant as a tool to make a definitive diagnosis."

The problem appears to be not understanding a "statistical blip" in how the test results are reported or what is called "positive predictive value". What is critical for both health care providers and patients to understand is that the test is a "risk-based test" not a diagnostic test and a positive test result is only indicative that they have a higher risk of having that particular issue. The article reported that in the general population of women, a well-regarded study published in the New England Journal of Medicine showed that the test was correct for only about 40% of women who tested positive for Edwards syndrome (trisomy 18).

Daley said, "If companies are presenting these screens to be as good or better than a diagnostic test, doctors believe them and parents are aborting as a result, then the companies are seriously negligent."

Therefore if a patient comes into a pregnancy center considering abortion if/because test results come back positive, it is important to educate the patient that this test is only a screening for risk. A positive result is only an indication that their risk may be higher, but the test result could be wrong and a confirmatory test like a CVS (chorionic villus sampling) or an amniocentesis is needed to be sure. A patient should always get a confirmation with an FDA approved diagnostic test.

Aborting a child due to a genetic abnormality is disability discrimination. Prenatal tests should never be used for such purposes. When a disability is discovered rather than termination, options for the provision of treatment or hospice care should be offered.

Armed with the information above, we can help women who may be determined to abort due to a negative diagnosis to get further testing for verification. This will facilitate additional time to help them with alternative options should the diagnosis be positive.

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Diagnosing the Attempted NARAL Attack

by Susan Dammann, RN, LAS, Medical SpecialistDiagnosis

As we examine the symptoms exposed in the recent report unveiling the state chapter of NARAL Pro-Choice America colluding with Maryland government officials, a diagnosis becomes quite clear. This legal effort to shut down a local pro-life pregnancy care center, along with a seven-part plan developed by NARAL to shut down pregnancy help organizations across the country, reveal an infection with the intention to spread.

Miriam Webster defines diagnosis as"the act of identifying a disease, illness, or problem by examining someone or something."

First, there is definitely a primary source of infection, still seemingly localized, and the infection's focal point is limited to a small segment of the population. In 2010 when "Montgomery County passed an ordinance requiring Centro Tepeyac Silver Spring Women's Center and other pro-life pregnancy care clinics to post signs stating that they did not have doctors on staff," the outbreak was cured by three court decisions against the ordinance.

"Judge Deborah Chasanow, a Clinton appointee, noted that the people who accused the centers of spreading 'misinformation' were 'universally volunteers from a pro-choice organization sent to investigate practices' at the centers."

[Read Heartbeat President Peggy Hartshorn’s Op-Ed at LifeSiteNews.com here.]

When we learn of such outbreaks it is common to wonder if this will erupt into an epidemic or pandemic. Then we wonder how we can immunize ourselves from being attacked by the same germs.

The very best way to inoculate ourselves is to do just as they have already given us credit for doing!

The County responded to NARAL with the following statement: "I doubt my colleagues or the County Attorney will be interested in pursuing a truth-in-advertising statute...[these centers] are clearly very artful at devising strategies to avoid violating the law." Strategies to avoid violating the law simply put, means we obey the law and they recognize it. Your best immunization plan is to keep up your mission and the excellence with which you always work. You can always take your organization's vital signs by checking up on our Commitment of Care and Competence.

It would be a misdiagnosis if we thought we could treat these germs by pregnancy help organizations hiring doctors and nurses, putting in state of the art equipment and following all the best practices so that they will approve of us and stop the attacks. We have done just that and they are still manipulating women with lies and misleading information.

True choice and excellent healthcare for women are not their goal. The accurate diagnosis is that the abortion industry has a goal of permanently eliminating pregnancy centers because we are undermining their bottom line of profit.

Keep in mind that we do not live in a sterile environment and that germs abound. We can expect that by making inroads to bring health and wholeness into our world, there may be attacks. This is to be expected, but not feared. God even tells us in His Word that we may suffer for the sake of righteousness, but we are blessed.

"But even if you should suffer for the sake of righteousness, you are blessed. And do not fear their intimidation, and do not be troubled." 1 Peter 3:14 NASB

What Insurance Should We Carry?

Insuranceby Paula Burns, CIC, CRM, Insurance One Agency, LLC

Knowing what kind of insurance your Pregnancy Help Organization may need can be difficult. Beyond the general questions of what should be covered, each state has specific mandates or benefits about certain types of insurance. We sat down with Paula Burns from Insurance One Agency to find out what they would recommend.

Pregnancy Help Organizations (PHOs) are on the front line in the battle to save human lives and souls. They are the ultimate picture of the “Great Commission” coming to fruition and want every ministry dollar to go into the purpose and mission of the ministry, not into liability litigation. As a result, there are many questions frequently proposed regarding insurance for the centers and the wide scope of risk associated with them. This article includes a brief overview of insurance coverage a PHO should carry in their insurance coverage portfolio and addresses some of the most frequently asked questions.

Q: What is a general overview of insurance coverage a Pregnancy Help Organization (PHO) should carry?

A: Pregnancy Help Organizations should in general have the following in their insurance coverage portfolio:

  • Package Policy which includes:
    • Property coverage- covers contents, outdoor signs, computers & equipment, buildings, or if rented location can include rental space betterments and improvements. Business Income/Extra Expense are normally included to cover loss of income and extra expense to run the PHO should the organization be shut down for a period of time due to a covered claim, and resulting expenses if they have to relocate.
    • General liability coverage- premises liability, personal injury, advertising injury, and general liability for your day to day operations of running the PHO that are not professional in the scope of duties. Volunteers normally are included in this coverage as insured’s. (Very important that volunteers are included in the definition of “Who is an Insured” on the PHC General Liability coverage portion of the policy.)
    • Medical Payments –This coverage is very important in that it is a “no fault” coverage that will protect the PHC from minor slip and fall claims/incidents that result from NO negligence on behalf of the PHC.
    • Crime- covers employee theft, forgery, theft or burglary of money and securities.
    • Inland Marine – Specialty equipment scheduled here. Sonograms are one example of property commonly scheduled on an inland marine form. Mobile sonograms would be part of an inland marine form, but stationary sonograms are normally included in contents coverage.
    • Sexual Misconduct Coverage – Be sure this is included in the coverage to protect not only the Sonographers, but the Client Advocates as well. This coverage is important to protect staff and volunteers from false allegations. Insurance One has many resources to assist with training to reduce this risk.
    • Professional Liability Coverage- Many policies will cover the Professional Liability exposure for your Medical Director, Nurse, Sonographer, Executive Director,& Client Advocates. Be sure that this coverage includes vicarious liability. This topic is covered later in the article in further detail. Every insurer’s forms are different regarding Professional Liability; be sure to ask if the above Professionals are covered.
  •  Directors & Officers Including Employment Practices Coverage:
    • Directors & Officers coverage will extend to the individual Directors and Officers of the organization and protect them from errors or omissions in their governance of the organization. This is a very important portion of the coverage portfolio. There is a general misconception that the Directors and Officers are covered under the General Liability policy, but they are actually excluded on that policy, therefore leaving a huge exposure for the organization and Directors individually.
  • Employment Practices Coverage* in general will extend to cover the following claims of:
    • Wrongful termination / breach of employment contract
    • Wrongful failure to promote
    • Violation of employment discrimination laws (including harassment)
    • Sexual harassment
    • Employment related retaliation/ humiliation
    • Employment Related wrongful discipline
    • Negligent employee evaluation
    • Wrongful demotion/ Negligent reassignment

*Note: The insurance carriers are seeing a large number of claims resulting from Employment Practices. It is key to be sure your PHO is carrying this coverage.

  • Automobile Coverage
    • Even if the PHO does not own an auto they have two additional exposures:
      • Covers autos owned by the PHO
      • Hired Auto – when someone from the organization rents a vehicle this coverage will extend and cover the liability portion of the coverage for the car rental. This does not include damage to the rental car itself so it is always a best practice to purchase the Physical Damage coverage (also called the LDW – Loss Damage Waiver) from the rental car company directly.
      • Non-Owned Auto* – extends to cover the organization’s defense costs should a staff member or volunteer drive their own personal vehicle on behalf of the PHO.

*Note the employee or volunteer’s vehicle insurance is ALWAYS primary if they are driving their own vehicle on PHO business.

  • Umbrella Coverage
    • Additional layer of coverage normally carried in increments of $1,000,000 that extends additional coverage for liability driven claims, normally for the following:
      • General Liability
      • Professional Liability
      • Employer’s Liability
      • Automobile Liability
      • Sometimes this is also extended to include Sexual Misconduct Liability
  • Worker’s Compensation Coverage
    • Wikipedia’s definition is excellent and defines this coverage as follows; “Workers' compensation as a form of insurance providing wage replacement and medical benefits to employees injured in the course of employment in exchange for mandatory relinquishment of the employee's right to sue his or her employer for the tort of negligence.”
    • Every state’s laws vary regarding Worker’s Compensation. Some will mandate that Worker’s Compensation is carried by every employer with a certain number of employees. Texas, for example, does not mandate that employers have to carry Worker’s Compensation, however; the employer loses certain common law defenses if they do not subscribe to Worker’s Compensation. Be sure you understand the laws in your state and how it applies to your PHO operations.

Q: Should a PHO carry Worker’s Compensation Coverage? Will a PHO staff member’s personal health insurance coverage cover them if they are injured on the job?

A: As discussed in the section above, state law is going to mandate whether a PHO is required to carry Worker’s Compensation. If the state is not mandating that the PHO carry this coverage there are multiple considerations:

  • First of all, an individual’s personal health insurance normally excludes work related injuries. That personal health insurance will cover employees injured on the job is a huge misconception with many organizations. They think because the individuals they have on staff carry health insurance that they do not need to carry Worker’s Compensation coverage. Nothing could be farther from the truth.
  • Another common misconception is that this coverage is expensive. In fact, Worker’s Compensation is one of the cheapest coverages you can purchase in your entire coverage portfolio and it is a huge benefit to the employees. PHOs do not want to put their employees in the position of not having coverage should they be injured on the job. This could result in litigation against the PHO if there are medical bills that cannot be paid, loss of wages, and potentially even an injury that could result in the inability to continue working.
  • Many states will give additional defenses if the organization subscribes to Worker’s Compensation. In Texas, for example, the organization gains the common law defense of assumed risk. Assumed risk is a hazard assumed to be part of the job duty. For example, if the organization hires an employee to take care of the yard maintenance, it is assumed that they might get something in their eye from the mowing of the lawn or some other type of hazard related to yard work, etc. The employee then could not sue the employer because they had this type of injury.

Be sure to check your state laws regarding Worker’s Compensation!

Q: Will a physician’s insurance automatically cover the pregnancy center?

A: No, the physician’s insurance may not extend on a volunteer basis. Professional liability policies are not standardized and therefore, literally every insurance carrier’s forms are different. Please ask this question up front and find out if the physician’s coverage will extend. Even if their coverage extends it normally is only going to cover them individually, it does not normally extend to cover the PHO and release them from claims of vicarious liability. The PHO needs to do some due diligence to reduce their risk regarding this exposure and some recommendations are as follows:

  • Always make sure that you have on file a copy of the doctor’s license and that it is up to date and current.
  • Keep a copy of the doctor’s Certificate of Insurance on file and update it on an annual basis at renewal.
  • Verify if their coverage extends on a volunteer basis.
  • It is important that the PHO consult with an insurance agent who understands this exposure and can design a coverage portfolio to pick up the doctor while they are acting in the capacity of Medical Director for the PHO. Some coverage forms will extend to the doctor if they are formally named the Medical Director. This is literally the coverage trigger in the policy. Your insurance advisor can walk you through this and be sure that your coverage gaps are filled.
  • Be sure that your coverage includes vicarious liability. This is otherwise known as “guilty by association.” Be sure when you are referring clients to doctors or counselors that you give them a list as this will reduce your risk greatly. A claims example: The PHO refers a client to a specific doctor and there is a misdiagnosis resulting in some type of claim/loss. The PHO can be vicariously liable for this claim.
  • The best case scenario is for the doctor’s coverage to extend on a volunteer basis and also include them in the PHOs coverage as well so all gaps are filled in the event of a claim.

In conclusion, the PHOs are operating in one of the most litigious environments to date and need to understand how to take a proactive stance towards risk. One component of a good risk management plan is insurance, however, insurance should never be substituted for risk management. It is important that every PHC have a good comprehensive training program in place for their staff and volunteers. This is the first line of defense against liability claims and is for their protection as well as the PHO.

Matthew 28:19-20 “Therefore go and make disciples of all nations, baptizing them in the name of the Father and of the Son and of the Holy Spirit, 20 and teaching them to obey everything I have commanded you. And surely I am with you always, to the very end of the age.


Photo Paula BurnsPaula Burns specializes in insuring larger churches and non-profit organizations and has been in the insurance industry for 29 years. She has earned the designations of Certified Insurance Counselor (CIC) and Certified Risk Manager (CRM). Her career began in property and casualty claims laying a foundation for Paula to be an advocate for clients when they need her the most, during a claim or crisis.

Paula is a faculty member of The National Alliance and teaches classes to other insurance professionals, risk managers, and non-profit organizations regarding risk management. When she is not teaching, or at the agency, you can find her on her horse farm close to Whitney, TX with her husband of 23 years. She and her husband Gary have two children, Brandon and Lindsey. She joined Insurance One Agency in 2010 because they have a heart to serve those who serve.

Insurance One has a national program that includes state of the art coverage designed specifically for Pregnancy Help Centers and many Heartbeat International and Care Net affiliates use this coverage. They understand the risks associated with insuring PHC's and partner with centers from all over the nation to protect their ministries. You can reach Insurance One Agency by clicking here.

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Resources for Your Medical Director!

Our Medical Directors are a vital part of our Medical Clinics, and provide critical services for us often at their own expense and time. Here are some resources you can pass on to them to let them know how much we all appreciate them and their service to the clinics.

Physicians need 30-50 hours of AMA Category 1 CME to meet the AIUM requirements. Is your Medical Director looking for opportunities to sharpen his/her skills in reading Limited OB Ultrasounds?

American Institute for Ultrasound Medicine: www.aium.org

"Not to be missed is the 38th Annual Advanced Ultrasound Ob/GYN Seminar" http://www.aium.org/soundWaves/article.aspx?aId=865&iId=20150107
Learn From the Experts at the 38th Annual Advanced Ultrasound Seminar: Ob/Gyn
Come to Lake Buena Vista, Florida, this February if you want to expand your obstetric and gynecologic ultrasound knowledge with renowned experts in the field. View the program and register. Join Codirectors Lennard D. Greenbaum, MD, and Frederick W. Kremkau, PhD, along with ultrasound luminaries Alfred Z. Abuhamad, MD, Beryl R. Benacerraf, MD, Joshua A. Copel, MD, Steven R. Goldstein, MD, John C. Hobbins, MD, and Lawrence D. Platt, MD.
This seminar, hosted by the AIUM in collaboration with Orlando Health and the Wake Forest School of Medicine, will be held February 19-21, 2015, at Disney's Yacht and Beach Club Resorts in Lake Buena Vista, Florida. The seminar is filling quickly! Register today and earn up to 13.5 AMA PRA Category 1 Credits.

Do you have a physician who would like to serve your center as a Medical Director but is not trained to read OB scans? Please read through all the options available for them and pass the information along to them.

Below are some great options you can offer to them as resources for both initial training and refresher courses. While Heartbeat does not have any direct knowledge of the courses, these resources were recommended by an RDMS ultrasound trainer who serves in the pregnancy center ministry, and we are passing on the information for the physician to investigate and choose the course best suited for their needs.

Gulfcoast Ultrasound Institute: www.gcus.com 

Thomas Jefferson University: http://www.jefferson.edu/university/jmc/departments/radiology/education/cme/ultrasound_courses.html 

Wake Forest: http://www.wakeultrasoundeducation.com/courses-and-seminars/obstetrical-ultrasound/ 

IAME: https://iame.com/conferences/obgyn_ultrasound/

Another Great Resource From the AIUM:

Everything You Want to Know About First-Trimester Obstetric Ultrasound is a great learning tool for which physicians can earn up to 6.0 CME credits.

"After viewing this program, participants should be able to describe the sonographic signs of normal and abnormal gestations and define the role of ultrasound in the early diagnosis of fetal anomalies. The learner attributes are patient care, medical knowledge, and practice-based learning and improvement."

This DVD comes with 5 CME test and evaluation forms that allow you and up to 4 colleagues to earn credits at no extra charge. Need more than 5 tests? Purchase additional sets of 5 tests/evaluations for only $160.00.

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New FDA Consumer Update Urges Women to Obtain Medical Sonograms with Trained Operators

By Susan Dammann RN

The FDA has issued a warning. While the FDA's main focus in the warning is to advise pregnant women to avoid commercial sonogram services for nonmedical purposes that could pose a danger to the developing fetus, emphasizing that these are prescription medical devices, are to be used only by trained health care professional and only with a prescription, included within the warning are guidelines/recommendations which we in the pregnancy help medical clinics should be aware of.

Below are three excerpts from the 12/16/14 FDA Consumer Update which may pertain to the use of ultrasound imaging in the PMC, and a question for you to consider.

"Fetal ultrasound imaging provides real-time images of the fetus. Doppler fetal ultrasound heartbeat monitors are hand-held ultrasound devices that let you listen to the heartbeat of the fetus. Both are prescription devices designed to be used by trained health care professionals. They are not intended for over-the-counter (OTC) sale or use, and the FDA strongly discourages their use for creating fetal keepsake images and videos."

Question: Are the sonograms in your center being performed by trained health care professionals?

"The long-term effects of tissue heating and cavitation are not known. Therefore, ultrasound scans should be done only when there is a medical need, based on a prescription, and performed by appropriately-trained operators."

Question: Are the sonograms performed in your center based on a prescription for a medical need?

"Similar concerns surround the OTC sale and use of Doppler ultrasound heartbeat monitors. These devices, which are used for listening to the heartbeat of a fetus, are legally marketed as "prescription devices," and should only be used by, or under the supervision of, a health care professional."

Question: If your center uses Doppler, is it being used under the supervision of a health care professional?

As you consider the above FDA recommendations in relation to the ultrasound services performed in your PMC keep in mind also that one of the points in the Commitment of Care and Competence to which all Heartbeat Affiliates sign in agreement is:

Medical services are provided in accordance with all applicable laws, and in accordance with pertinent medical standards, under the supervision and direction of a licensed physician.

To read the full FDA Consumer Update click here.

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Ultrasound Safety – Revisited

by Kevin T. Rooker, RT(R), RDMS, RVT, Sonography Consultantsultrasound1

Is ultrasound safe? Will it hurt my baby? These are questions we sometimes hear from our clients. We need to be able to answer those questions with confidence for several reasons. First, because our patients deserve an honest answer, and second because we never know who is listening. We know that there are some that think you should not be performing limited OB ultrasound and will always be looking for reasons to justify their position. Let's not give them that opportunity on the issue of ultrasound safety. Unfortunately, we, the medical community, have not done as well as we can at educating ourselves on the safety of ultrasound1.

Ultrasound is a wave of mechanical energy that penetrates human tissue as an oscillating (alternating) wave of high and low pressure. As it does so, there are two potential types of biological effects; Mechanical and Thermal. In 1993, the FDA allowed ultrasound manufacturers to significantly increase the amount of ultrasound energy created in diagnostic ultrasound systems, as long as they displayed the MI (Mechanical Index) and TI (Thermal Index) on the screen for the operator (and our clients) to see. The premise being that if we know what the MI and TI are, what their limits are, and most importantly how to lower them, then we are being as safe as we possibly can.

The Mechanical Index is a safety metric which lets the operator know how much energy is being transmitted into the patient during a sonography examination. Remember that sound is created by pressure waves, so mechanical energy is transmitted into any object which receives sound. Sound waves can be quite powerful. For example, think of the thump on your chest when sitting next to a teenager's car with the high dollar stereo system. It is defined as the peak negative pressure (PNP) of the ultrasound wave (point of maximal rarefaction). In easier terms; think pressure change divided by time. Lots of pressure change over short periods of time can be damaging. The FDA has established a maximum MI of 1.9 for diagnostic imaging. Any machine capable of generating MI greater than 1.0 must display the MI onscreen. The FDA MI limit for obstetric sonography is 1.0.

The Thermal Index is another safety metric which lets the operator know the potential of creating heat (hyperthermia) with the ultrasound beam. Many assumptions are made in this calculation, and it is often thought that the heating potential is underestimated. So keep in mind that the TI formulation was not intended to, and cannot provide an accurate measure of temperature rise within a specific patient. Instead it was designed to provide the operator with a relative measure of risk for a particular imaging mode. A Thermal Index of one (TI 1) indicates conditions under which the rise in temperature would be likely to be 1°C. The thermal index is different for different types of tissue, and can be displayed on your system accordingly: soft tissue (TIs), bone (TIb) and cranium (TIc). In the first trimester, when using Doppler to hear and demonstrate the fetal heart, the TIs setting us used. The limit for TI varies with time, please reference the chart below from the British Medical Ultrasound Society, the entire document may be found here.

Ultrasound Safety

Enough about what the MI and TI are, how do we as operators keep them at safe levels? There are two basic concerns to remember.

First is the AIUM ALARA policy2; which is an acronym for As Low As Reasonably Achievable. Simply translated, it means to keep the output power settings as low as possible, that still allows for adequate images. Most ultrasound systems can operate with output power settings at about 50% and still produce quite satisfactory OB images. Have your system presets adjusted so that when you are performing OB sonography both (abdominally and transvaginally), the output power settings are set low. You can always increase them if clinically necessary. And keep in mind that you can increase the gain to make your image brighter, as gain is just how well the system is "listening", it has no effect on the TI.

The second concern is time. Keep the overall examination as short as is reasonable. If using Doppler to allow Mom to hear her baby's heartbeat, depending upon your ceter's policy, keep the Doppler exposure to about 5-10 seconds. Know where to find the MI and TI displays on your system. If you don't know, consult your operator's manual or contact the manufacturer of your ultrasound system for more information.

Diagnostic ultrasound in obstetrics has been around for the better part of 40 years. To date, no one has been able to prove (and many have tried) that diagnostic ultrasound, when used prudently (MI,<1.0 and TI<0.7), has had any adverse effects developing fetuses; and this includes the limited use of Doppler in the first trimester "Thus far, there have been no significant thermal effects documented in humans and at this time the possibility of having all the factors present to is highly unlikely 3." However, it has been shown that aborting a living fetus is fatal, every time.


1. Ultrasound Is Safe . . . Right? Resident and Maternal-Fetal Medicine Fellow Knowledge
Regarding Obstetric Ultrasound Safety. J Ultrasound Med 2011; 30:21–27
Sheiner E, Abramowicz JS. Clinical end users worldwide show poor knowledge regarding safety issues of ultrasound during pregnancy. J Ultrasound Med. 2008;27(4):499-501

2. As Low As Reasonably Achievable (ALARA) Principle Approved 4/2/2014 aium.org/officialStatements/39

3. FDA Recommendations for the Safe Use of Ultrasound in Obstetrics CNE article authored by Sherri A. Longo, M.D. Assistant Professor in the Department of Obstetrics and Gynecology, Division of Maternal-Fetal Medicine, Tulane University School of Medicine in New Orleans, Louisiana; e-edcredits.com/nursingcredits/article.asp?testID=29

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