Wrong diagnosis:How ultrasound scan centres mislead pregnant women, others

2010-03-31
THE PUNCH Newspaper-Niyi Odebode

Awokoya Alice was delivered of a set of twins (a girl and a boy) in a hospital in Yaba, Lagos four weeks ago. Before the delivery, the 30-year-old petty trader underwent several ultrasound scans and she was told that she was carrying a baby boy. ”Based on the result I got from the ultrasound scan centre, I never envisaged that I would give birth to twins,” said Awokoya, who already had four children before the birth of the twins.



Her case is an example of misdiagnoses associated with the use of ultrasound scans in Nigeria. In February last year, Amudat Bello gave birth to a set of sextuplets (three boys and three girls) at the Olabisi Onabanjo University Teaching Hospital, Sagamu, Ogun State. She died a day after she was delivered of the babies.



Amudat’s husband, Lukman, said that when the 32-year-old woman underwent an ultrasound scan in a private hospital in Lagos, she was told to expect twins. Lukman, who is a battery charger, sent the woman to Ijebu-Igbo, to stay with his mother because of his poor financial situation.



When Amudat was in labour, she was taken to Victory Hospital, Ijebu-Igbo, where the medical director directed her to OOUTH. In the teaching hospital, after an examination, doctors said that she was carrying six babies.



Lukman, who was very surprised on hearing that his wife was carrying sextuplets, said, ””I learnt about two babies during the scan in Lagos and because I had no money to take proper care of even my first child, Ahmed, I decided to send my wife to my mother in Ijebu-Igbo. I am yet to pay the balance of the school fees of Ahmed(the first son). We have been facing untold hardship.” The man did not only lose his wife, but also three of the sextuplets.



An ultrasound scan is an indispensable tool for safe maternal and infant health. Among other uses, it can be used in dating pregnancy, assessing its viability and detecting abnormalities in foetus.



But because of the errors associated with the device in Nigeria, many people are losing confidence in it. For example, Alice‘s husband, Ayo said, ”I do not think it is reliable because of the experience of my wife.”



With the increase in the number of ultrasound centres, particularly in major cities such as Lagos, Abuja and Port Harcourt, the problems of missed diagnoses in pregnancies should not arise.



The Managing Director of Nordica Fertility Centre, Dr. Abayomi Ajayi, said to prevent such a problem, gynaecologists should acquire skills in the use of the scans. Ajayi, whose centre, has been organising workshops on the use of ultrasound scans, called for continuous medical education in the country.



Also, the Managing Director of Crestview Radiology Limited, Lagos, Dr. Biodun Fatade, said that the picture was not as simple as it was being painted. Fatade explained that ultrasound scans were needed for investigations before carrying out surgeries such as removal of fibroids.



Fatade agreed that there had been cases where surgeons opened up patients and did not find anything, thus turning such patients to guinea pigs. He said, ”I think it depends on who is doing what and what the person is looking for.



”If you investigate your patients appropriately; you carry out all investigations that are needed--you should be able to know where the problem is before opening up the patients. If the patients are properly investigated, the issue of wrong operations will not arise.



Medical experts, including Fatade and a Consultant in Foetal Medicine at High Rocks Prenatal Diagnostic Centre, Dr. Femi Oloyode, identified reasons for missed diagnoses of pregnant women and other patients that needed the device. Such reasons include incompetence of some operators and use of obsolete machines.



Fatade said, ”But in most cases, most people try to cut corners. They will not do appropriate investigations. They do surgeries based on the complaints of the patients.”



He noted that medical practice these days placed emphasis on evidence-based therapies. ”When you suspect something, you must investigate. You do not just assume. Whatever the illness is, you must be able to confirm it based on proper investigations.”



Explaining reasons why there was a prevalence of missed diagnoses, he said, ”Most of our patients are under investigated. We are not carrying out enough investigations before treatments.”



One of the reasons, Fatade said, was high cost of investigation. According to him, investigations are not cheap and in a country like Nigeria, where the poverty rate is high, many people cannot afford it. In a city like Lagos, an ultrasound scan can be done for about N1,000.



Fatade also explained why a woman could be carrying triplets and the ultra-scan would pick up only one. According to Fatade, ”The truth of the matter is that the people who conducted such scans were not appropriately trained.



”Investigations are operator-dependent. You must be adequately and appropriately trained before running an ultrasound scan centre. You must also use appropriate equipment.



”If you use a machine that is obsolete-about 10 or 15 years old – you will not pick up what a new machine will pick up. Go round the country, you will see tokunbo (second hand) machines everywhere. Some of them are completely obsolete. They are not useful, but nobody seems to be regulating anything.”



Fatade added that there were many quacks running ultrasound scan centres. ”We have a lot of people, who are not trained doing ultrasound scans. It is only in a country like Nigeria that an untrained person can run an ultrasound scan centre.”



According to him, for anybody to run an ultrasound scan centre such a person must not only be a doctor or a radiographer, but must also be trained in the use of the machine.



Oloyede blamed errors in ultrasound scans on both patients and physicians. ”For example, ultrasound scan is not reliable for dating a pregnancy that is 20 weeks old, but some women will insist on it even when they have been advised.”



The medical consultant also said that some multiple pregnancies could be missed during ultrasound scans even in advanced countries. He, however, said that if the operator was skilled and the scan had high resolution, the chance of not missing multiple pregnancies is slim.



”Ultrasound scan is the bedrock of obstetrics and gynaecology. There should be regulations. There are too many junk ultrasound scan centres in the country,” Oloyede said.



A consultant obstetrician and gynaecologist at the University of Leicester, United Kingdom, Dr. Adebimbe Matiluko, in an interview with our correspondent at the workshop organised by Nordica, said that a trans-virginal scan was pivotal in the management of patients.



According to her, it can be used in diagnosing ectopic pregnancies (pregnancies in wrong places), which are responsible for the death of many women. ”Its application is mainly in early pregnancy: to know whether the pregnancy is alive or not.



”Through trans-virginal scans, from about five weeks from the last period (menstruation), you will find what is called a sack within the womb. From six weeks, if the pregnancy is alive, you will be able to confirm.”



Matiluko also explained that through trans-virginal scans, abnormalities in babies could be detected right from early pregnancy. She explained, ”Downs syndrome is a chromosomal abnormality and during 11 - 14 weeks certain features can be visualised to determine the risk associated with this abnormality, such as measuring the back of baby‘s neck.



”If the woman is not going to terminate the pregnancy, you can prepare her ahead so that she will not be surprised during delivery.”



For her, ultrasound care should be an integral part of health care, particularly for reducing maternal and infant deaths in the country.











 

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