[Evaluation of a proximity training program of nuchal translucency measurements and of self-scoring]. / Evaluation d'une formation de proximité à la mesure de la clarté nucale et à l'autoévaluation des clichés.

OBJECTIVE: Improvement in prenatal diagnosis of Down syndrome imposes to sonographers to realize good quality nuchal translucency measurements, which can be used for assessment of combined risk. The aim of our study was to evaluate a training program of 109 sonographers for measuring nuchal translucency and scoring their own image. STUDY DESIGN: After a proximity training program, trainees submitted 20 images scored by themselves with Herman image-scoring method. All images were reviewed by two experts. RESULTS: One hundred and nine sonographers have accomplished the training program (87.3%), collecting 2162 images. After reviewing, the mean score was 6.8+/-1.8. The rate of inacceptable scan (score< or =3) was in 6.0%. On the other hand, 48.1% of scans were excellent (score> or =8). Only 6.5% of scores were discordant for at least three points between self-scoring and reviewing. After the fourth scan, there was no significant scoring difference between self-scoring and reviewing. Finally, 84% of trainees were very satisfied of this program. CONCLUSION: As part of HAS evaluation of practitioners practices, it is possible to realize proximity training program for measuring nuchal translucency. Learning curve seems to be fast. Good handling of Herman scoring method by sonographers allows their accreditation after this kind of training program.

[Extrauterine pregnancies in patients with intrauterine devices (apropos of 9 cases)]. / Grossesses extra-utérines sur dispositifs intra-utérins (à propos de neuf observations).

PIP: The published literature reports an increase of ectopic pregnancies in patients wearing an IUD. Over the total number of pregnancies with IUD in situ, ectopic pregnancies account for about 10-17%. The incidence is lower for the first 6 months after insertion, and higher after that. The mechanism responsible for extrauterine pregnancies can be the appearance of infectious lesions in the genital tract, or the slow and continuous secretion of prostaglandin promoted by the presence of the IUD. Diagnosis of ectopic pregnancy is not always easy, and it usually follows episodes of pelvic pain and metrorrhagia.^ieng