Informed Consent for Dms Essay

678 Words Aug 17th, 2015 3 Pages
Informed Consent for Diagnostic Medical Sonography

Patient Name: ____________________________________ D.O.B.:______________________

Proposed Mode of Treatment:

I, ______________________, hereby give Harper Medical Imaging permission to perform an ultrasound which has been requested by my physician. I understand that I may receive either a standard, extensive or vaginal sonogram which are done with sound waves from the ultrasound probe that bounce off the uterus and the developing baby producing echo which the computer then converts to images.

Reason for treatment:

I understand the following:
A standard sonogram will provide information concerning the location, fetal position, twin pregnancies, gestational age and/or
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Amniocentesis is a procedure in which a needle is inserted into the uterus, and it removes a small amount of amniotic fluid surrounding the baby and then analyzed.

Amnio risks include:

Infection: Rarely this procedure may trigger a uterine infection.
Infection transmission: Infections such as hepatitis C, toxoplasmosis or HIV can be transferred.
Leaking amniotic fluid: rarely, amniotic fluid may leak through the vagina however, the pregnancy is lifeless to proceed normally. If chronic leakage, there may be orthopedic problems with baby.
Miscarriage: between 1 in 300 and 1 in 500 women during the second trimester and higher if done before the 15 weeks of pregnancy.
Needle Injury: the baby may move in the path of the needle. Serious needle injuries are rare.
Rh sensation: Rarely, this procedure may cause the baby’s blood cells to enter the mother’s bloodstream. If you are Rh negative, you will be given a drug to prevent you from producing antibodies against your babies blood cells.

Another test that can be done as an alternative is Chorionic villus sampling. This is a serious and invasive procedure that reveals whether the baby has a chromosomal and genetics condition. During this procedure, a sample of the cells are taken for biopsy and then checked for problems earlier in pregnancies, usually at 10 -12 weeks.

CVS risks include:
Infection: Rarely this procedure may trigger a uterine infection.
Miscarriage: 1 in 400

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