I was very disappointed at the lack of comments about the mystery case. I don't think there are many followers for this blog, but I did e-mail a lot of the so called movers and shakers in OB ultrasound about this case, but as expected, no one seemed willing to make a public mistake, even in an out of the way place like this. Really, guys, when you get to the point where protecting your fragile reputations is more important than learning, you might as well give up.
To be honest, I really didn't expect a lot of correct answers. Most places that do obstetrical ultrasound are mired in a limited set of anatomic issues and act as if a check list a items constitutes a medically acceptable exam. Consider the issue of selection of major congenital anomalies, where any number of large controlled studies have shown that average performance is really bad. Even if detection rates were very much better, anatomic findings would be relevant in perhaps 5 % of cases. What about the 95% majority of patients? How are they best served? What about the factors that can injure an anatomically "normal" fetus with life long behavioral, intellectual, or motor problems.
The idea is to go beyond an anatomic checklist and a few body measurements to examining a fetus ultrasonically in exactly the same way that a Pediatrician or, better yet, a Neonatologist would examine a newborn infant. Therein lies the strength and potential of ultrasound.
The challenge case is still open.
