Dr. Michael Demishev
Improving care by enhancing fetal ultrasound imaging
July 30, 2019
By Dr. Michael Demishev
As a Maternal Fetal Medicine specialist, I have the privilege of caring for my patients at a special time in their lives. And while pregnancy is full of excitement about what lies ahead, it can also be a period filled with anxiety and concern should there be a complication.
While our department at NYU Winthrop Hospital sees many healthy pregnancies, the fact that we’re a referral facility means we also receive complex cases from other hospitals in addition to our own high-risk patients. Those cases include fetal abnormalities such as heart defects, chromosomal abnormalities and genetic conditions that require invasive testing such as chorionic villus sampling (CVS) or amniocentesis. CVS is a prenatal test of amniotic fluid used to test for chromosomal abnormalities in a fetus, in which a sample of chorionic villi is removed from the placenta for testing and amniocentesis.
Whether a typical or atypical pregnancy, for decades the standard device used to evaluate the development of the fetus has been ultrasound. Today, we use Samsung’s Hera W10. Throughout my career, I’ve seen the technological ability of ultrasounds progress, and, with it, I’ve seen clearer pictures of what’s happening inside the womb.
For example, I recently had a 36-year-old patient with monochorionic-diamniotic twin pregnancy who presented with twin-to-twin transfusion syndrome, a disease of the placenta that causes abnormal blood vessels, anastomosis on the placenta and affects the blood flow to both of the twins. The condition is serious and can lead to one fetus experiencing stunted growth and anemia, and, in some cases, even death. Our team needed to perform fetoscopy to locate abnormal blood vessel connections in the placenta and ablate the vessels using laser energy. By using a new technology on the Hera W10 that offers a detailed view of blood flow in relation to the surrounding tissues, we were able to map these vessels to improve the outcome for the patient. Just a few years ago, I wouldn’t have had technology like this to help plan the procedure.
As technology progresses in all areas of life, the practice of ultrasound, too, will continue to improve. Here is my take on where the field of maternal fetal ultrasound is going, how it will impact the standard of care, and why it matters to healthcare professionals and patients alike.
Earlier diagnosis
When caring for an expecting mom, the ability to share with her an accurate diagnosis earlier goes a long way in easing her mind. A simple shadowy effect in an ultrasound image can lead to an inaccurate diagnosis, or cause unnecessary concern. In short, image quality really matters.
Currently, care for pregnant women is like a pyramid, with the least amount of information being delivered at the beginning, or top, of the pyramid. With improvements to imaging technology, though, we are starting to be able to turn that pyramid upside down and deliver more information sooner.
This is beneficial to moms with routine pregnancies, but is especially helpful to women whose pregnancies require additional care. The quality of an image has a significant impact on the quality of patient care as well as on the patients’ experience because it gives them the information they need to mentally prepare for possible outcomes earlier in their pregnancy, when they have more options. Earlier diagnosis improves the types of interventions available during the pregnancy and helps prevent an odyssey of appointments with specialists searching for answers. Finally, it affords expecting moms additional time to search for a specialist who may be needed after the birth or to decide whether to continue the pregnancy.
By identifying an issue earlier, we can actually make a difference in how we deliver prenatal care.
Better design
Everyone in healthcare knows that our most valuable resources are our people. In maternal fetal medicine, that especially means sonographers, who are tasked with conducting ultrasound exam after exam, day in and day out. During an exam, there are times when the patient or sonographer needs to adjust to capture the best image. This means moving the device, which can be cumbersome and lead to discomfort for both parties, and, in the worst cases, lead to work time missed due to an injury for the sonographer.
I’ve noticed an increased focus on design and ergonomics that reduces the amount of strain on sonographers and doctors. Improved ergonomics helps with workflow because the sonographer can obtain usable images without moving the patient. By decreasing unwanted adjustments, it increases the time spent diagnosing the patient, which is of course the ultimate goal of the visit.
Expanded research
Improved ultrasound image quality has the ability to do more than diagnose patients and share with expecting mothers clearer pictures of their baby. It has the possibility to transform the ultrasound device into a research tool. For example, with technology that allows doctors to clearly examine both normal and abnormal vasculature of the fetus or placenta, it opens up the possibility to discover new advances that weren’t possible because we never had that level of detail. That information will allow us to think of new ways to treat complications, but it will also enable research opportunities with the potential to uncover information that will make an impact on the future of maternal fetal care.
Looking ahead
Technology around us is evolving constantly, so it makes perfect sense that the devices we use to evaluate the well-being of an expecting mom and her fetus will continue to evolve as well. These evolutions will allow institutions to deliver better care to patients by being able to provide more information, sooner, improve user experience, and benefit the field by turning an imaging device into much more. This will allow for better education and research opportunities to advance care for our pregnant patients. As a Maternal Fetal Medicine Specialist, I’m very excited about where the field is heading and what it means for the mothers and babies I care for.
About the author: Dr. Michael Demishev specializes in maternal fetal medicine at NYU Winthrop Hospital. He has been in academic practice for almost 7 years.
He completed his Obstetrics and Gynecology Residency at Rutgers/Robert Wood Johnson Medical School in New Jersey and completed a fellowship in Maternal Fetal Medicine at Stony Brook–Winthrop University Hospitals.
He is board certified in Obstetrics and Gynecology as well as Maternal Fetal Medicine. His main interests are prenatal ultrasound diagnosis with emphasis on invasive diagnostic testing and invasive fetal procedures.
As a Maternal Fetal Medicine specialist, I have the privilege of caring for my patients at a special time in their lives. And while pregnancy is full of excitement about what lies ahead, it can also be a period filled with anxiety and concern should there be a complication.
While our department at NYU Winthrop Hospital sees many healthy pregnancies, the fact that we’re a referral facility means we also receive complex cases from other hospitals in addition to our own high-risk patients. Those cases include fetal abnormalities such as heart defects, chromosomal abnormalities and genetic conditions that require invasive testing such as chorionic villus sampling (CVS) or amniocentesis. CVS is a prenatal test of amniotic fluid used to test for chromosomal abnormalities in a fetus, in which a sample of chorionic villi is removed from the placenta for testing and amniocentesis.
Whether a typical or atypical pregnancy, for decades the standard device used to evaluate the development of the fetus has been ultrasound. Today, we use Samsung’s Hera W10. Throughout my career, I’ve seen the technological ability of ultrasounds progress, and, with it, I’ve seen clearer pictures of what’s happening inside the womb.
For example, I recently had a 36-year-old patient with monochorionic-diamniotic twin pregnancy who presented with twin-to-twin transfusion syndrome, a disease of the placenta that causes abnormal blood vessels, anastomosis on the placenta and affects the blood flow to both of the twins. The condition is serious and can lead to one fetus experiencing stunted growth and anemia, and, in some cases, even death. Our team needed to perform fetoscopy to locate abnormal blood vessel connections in the placenta and ablate the vessels using laser energy. By using a new technology on the Hera W10 that offers a detailed view of blood flow in relation to the surrounding tissues, we were able to map these vessels to improve the outcome for the patient. Just a few years ago, I wouldn’t have had technology like this to help plan the procedure.
As technology progresses in all areas of life, the practice of ultrasound, too, will continue to improve. Here is my take on where the field of maternal fetal ultrasound is going, how it will impact the standard of care, and why it matters to healthcare professionals and patients alike.
Earlier diagnosis
When caring for an expecting mom, the ability to share with her an accurate diagnosis earlier goes a long way in easing her mind. A simple shadowy effect in an ultrasound image can lead to an inaccurate diagnosis, or cause unnecessary concern. In short, image quality really matters.
Currently, care for pregnant women is like a pyramid, with the least amount of information being delivered at the beginning, or top, of the pyramid. With improvements to imaging technology, though, we are starting to be able to turn that pyramid upside down and deliver more information sooner.
This is beneficial to moms with routine pregnancies, but is especially helpful to women whose pregnancies require additional care. The quality of an image has a significant impact on the quality of patient care as well as on the patients’ experience because it gives them the information they need to mentally prepare for possible outcomes earlier in their pregnancy, when they have more options. Earlier diagnosis improves the types of interventions available during the pregnancy and helps prevent an odyssey of appointments with specialists searching for answers. Finally, it affords expecting moms additional time to search for a specialist who may be needed after the birth or to decide whether to continue the pregnancy.
By identifying an issue earlier, we can actually make a difference in how we deliver prenatal care.
Better design
Everyone in healthcare knows that our most valuable resources are our people. In maternal fetal medicine, that especially means sonographers, who are tasked with conducting ultrasound exam after exam, day in and day out. During an exam, there are times when the patient or sonographer needs to adjust to capture the best image. This means moving the device, which can be cumbersome and lead to discomfort for both parties, and, in the worst cases, lead to work time missed due to an injury for the sonographer.
I’ve noticed an increased focus on design and ergonomics that reduces the amount of strain on sonographers and doctors. Improved ergonomics helps with workflow because the sonographer can obtain usable images without moving the patient. By decreasing unwanted adjustments, it increases the time spent diagnosing the patient, which is of course the ultimate goal of the visit.
Expanded research
Improved ultrasound image quality has the ability to do more than diagnose patients and share with expecting mothers clearer pictures of their baby. It has the possibility to transform the ultrasound device into a research tool. For example, with technology that allows doctors to clearly examine both normal and abnormal vasculature of the fetus or placenta, it opens up the possibility to discover new advances that weren’t possible because we never had that level of detail. That information will allow us to think of new ways to treat complications, but it will also enable research opportunities with the potential to uncover information that will make an impact on the future of maternal fetal care.
Looking ahead
Technology around us is evolving constantly, so it makes perfect sense that the devices we use to evaluate the well-being of an expecting mom and her fetus will continue to evolve as well. These evolutions will allow institutions to deliver better care to patients by being able to provide more information, sooner, improve user experience, and benefit the field by turning an imaging device into much more. This will allow for better education and research opportunities to advance care for our pregnant patients. As a Maternal Fetal Medicine Specialist, I’m very excited about where the field is heading and what it means for the mothers and babies I care for.
About the author: Dr. Michael Demishev specializes in maternal fetal medicine at NYU Winthrop Hospital. He has been in academic practice for almost 7 years.
He completed his Obstetrics and Gynecology Residency at Rutgers/Robert Wood Johnson Medical School in New Jersey and completed a fellowship in Maternal Fetal Medicine at Stony Brook–Winthrop University Hospitals.
He is board certified in Obstetrics and Gynecology as well as Maternal Fetal Medicine. His main interests are prenatal ultrasound diagnosis with emphasis on invasive diagnostic testing and invasive fetal procedures.