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Abstract Objective: The objective of this study was to characterize patients with early onset gestational diabetes and compare outcomes to patients diagnosed with standard gestational diabetes and pregestational diabetes. Methods: This is a retrospective cohort study of patients diagnosed with gestational or pregestational diabetes. All patients received a glucose challenge test at their first prenatal visit to diagnose early onset gestational diabetes and were recommended to have postpartum glucose tolerance tests to detect undiagnosed type 2 diabetes. Outcomes were compared between patients with early onset gestational diabetes and both standard gestational diabetes and pregestational diabetes with p< 0.05 was used for significance. Results: 424 patients met the inclusion criteria. 9% of patients with early onset gestational diabetes were found to have undiagnosed type 2 diabetes based off of postpartum testing and 91% to have resolution in the postpartum period. No patient with early onset gestational diabetes and resolution in the postpartum period had abnormal screening for renal or ophthalmologic disease, but 5% had abnormal fetal echocardiograms. These patients were more likely to require pharmacotherapy for glycemic control than patients with standard gestational diabetes and less likely than patients with pregestational diabetes (55% vs 39% vs 81%). Conclusion: Most patients diagnosed with early onset gestational diabetes do not have undiagnosed type 2 diabetes but do have unique characteristics and obstetrical outcomes.

This paper honors the centennial of a case, Schloendorff vs Society of New York Hospital, that became a landmark in the history of consent for clinical care. For a century, Schloendorff has been understood as a case of surgery done without consent on an anesthetized patient when a pelvic mass was discovered. We honor the centennial of this case by retelling the story of what actually was a case that illustrates the clinical ethical errors that occur when physicians fail to communicate with each other and with their patient. To retell this story, we review the original medical and surgical records, letters of key participants in the case, and the trial-court record. Contrary to what is commonly thought, Ms Schloendorff actually lost her legal case and, indeed, her surgery might not have been performed at all, had her clinicians known, communicated, documented, and reaffirmed what the patient actually wanted. This new perspective on Schloendorff is important for obstetric and gynecologic care, because it vividly documents the perils of the medical errors of implicit consent, delegating the obtaining of consent, and miscommunication among clinicians. In the context of Schloendorff, the modern culture of patient safety and quality that has come to define excellent obstetric and gynecologic care, including ultrasound, should be understood as a powerful preventive to the clinical ethical perils of miscommunication that reduce the quality of patient care and unnecessarily compromise professional obstetric and gynecologic ultrasound.

This article addresses the perils of miscommunication and the beginnings of informed consent in a landmark United States common law, Schloendorff vs Society of New York Hospital. For a century, Schloendorff has been understood as a case of surgery performed without consent on an anesthetized patient after a pelvic mass was discovered. This case illustrates the clinical ethical errors that occur when physicians fail to communicate with each other and with their patient. To support this interpretation, we review the original medical and surgical records, letters of key participants in the case, and the trial court record. Ms Schloendorff actually lost her legal case. Indeed, her surgery might not have been performed at all had her clinicians known, communicated, documented, and reaffirmed what the patient actually wanted. This new interpretation of Schloendorff is important for contemporary obstetric and gynecologic care, because it documents the perils of the medical errors of implicit consent, delegating the obtaining of consent, and miscommunication among clinicians. From the perspective of the lessons taught by Schloendorff, the modern culture of patient safety and quality that has come to define excellent obstetric and gynecologic care, including ultrasound, should be understood as a powerful preventive measure against the clinical ethical perils of miscommunication that reduce the quality of patient care and unnecessarily compromise professional obstetric and gynecologic ultrasound.

Schloendorff v Society of New York Hospital is regarded widely as a landmark in the history of informed consent because it is thought to have established individual self-determination as the legal basis of consent and respect for patient autonomy as the ethical basis of consent. For a century, it has been understood as a laparotomy done without consent when a pelvic mass was discovered unexpectedly in an anesthetized patient after an examination. We believe it was a case of surgeons failing to communicate properly with each other and their patient. To support this reinterpretation, we present evidence from the original medical and surgical records, letters of key participants in the case, and the trial court record. We also consider the case from the perspective of the modern culture of safety in gynecologic surgery. Contrary to what is commonly assumed, Ms Schloendorff lost her legal case, and her surgery might not have been performed at all had her clinicians known, understood, communicated, documented, and reaffirmed what the patient actually wanted. This new perspective on Schloendorff is important for gynecologic surgeons because it vividly documents the perils of implicit consent, delegating the obtaining of consent, and miscommunication among clinicians. The Schloendorff case underscores the constant need for continuous quality improvement to reduce medical errors and the risk of litigation by improving communication among surgeons.

OBJECTIVES: Fetal anatomic surveys are difficult to perform on obese patients. However, there are limited data available on methods to improve the rate of complete anatomy scans in these patients. The objective of this study was to determine whether the addition of an early second-trimester fetal anatomy scan improves the rate of complete anatomy scans in obese patients. METHODS: We conducted a prospective cohort study of 100 obese patients at a city hospital who were scheduled for a fetal anatomy scan using transvaginal and transabdominal sonography at 14 to 16 weeks (early anatomy scan) and an anatomy scan at 18 to 22 weeks ("routine" anatomy scan). Inclusion criteria were a body mass index of 30 kg/m(2) or higher, singleton pregnancy, and presentation for prenatal care before 16 weeks. Data for the routine anatomy scan alone versus a combination of early and routine anatomy scans was calculated by the McNemar chi(2) test for categorical variables and the Wilcoxon signed ranks test for continuous variables. RESULTS: The addition of the early anatomy scan significantly increased the rate of complete anatomy scans from 42% to 51% (P < .01). It also significantly improved visualization of the head, thorax, and abdomen and significantly increased the mean number of items seen (P < .05). CONCLUSIONS: The addition of an early second-trimester fetal anatomy scan to a routine anatomy scan performed later in the second trimester significantly improves the rate of complete anatomy scans in obese patients.

Professional liability risks exist in the practice of ultrasound. In this article, basic aspects of medical negligence are reviewed. The guidelines published by ACOG and AIUM are presented and discussed relating to the importance of instrumentation and safety, documentation, and indications for first, second and third trimester ultrasound examinations as well at the content of these examinations. Litigation related to ultrasound is presented and the controversial nonmedical use of ultrasonography is discussed. Jaypee Brothers Medical Publishers (P) Ltd