Short Femur on the Second Trimester Ultrasound Report: What to Include in the Management Plan?
Learning Objectives and CME/Disclosure Information
This activity is intended for healthcare providers delivering care to women and their families.
After completing this activity, the participant should be better able to:
1. Define the term ‘short femur’ 2. Discuss the management after a short femur is diagnosed on sonogram
Estimated time to complete activity: 0.25 hours
Susan J. Gross, MD, FRCSC, FACOG, FACMG President and CEO, The ObG Project
Disclosure of Conflicts of Interest
Postgraduate Institute for Medicine (PIM) requires instructors, planners, managers and other individuals who are in a position to control the content of this activity to disclose any real or apparent conflict of interest (COI) they may have as related to the content of this activity. All identified COI are thoroughly vetted and resolved according to PIM policy. PIM is committed to providing its learners with high quality CME activities and related materials that promote improvements or quality in healthcare and not a specific proprietary business interest of a commercial interest.
Faculty: Susan J. Gross, MD, receives consulting fees from Cradle Genomics, and has financial interest in The ObG Project, Inc.
Planners and Managers: The PIM planners and managers, Trace Hutchison, PharmD, Samantha Mattiucci, PharmD, CHCP, Judi Smelker-Mitchek, MBA, MSN, RN, and Jan Schultz, MSN, RN, CHCP have nothing to disclose.
Method of Participation and Request for Credit
Fees for participating and receiving CME credit for this activity are as posted on The ObG Project website. During the period from Dec 31 2017 through Dec 31 2021, participants must read the learning objectives and faculty disclosures and study the educational activity.
If you wish to receive acknowledgment for completing this activity, please complete the post-test and evaluation. Upon registering and successfully completing the post-test with a score of 100% and the activity evaluation, your certificate will be made available immediately.
For Pharmacists: Upon successfully completing the post-test with a score of 100% and the activity evaluation form, transcript information will be sent to the NABP CPE Monitor Service within 4 weeks.
Joint Accreditation Statement
In support of improving patient care, this activity has been planned and implemented by the Postgraduate Institute for Medicine and The ObG Project. Postgraduate Institute for Medicine is jointly accredited by the Accreditation Council for Continuing Medical Education (ACCME), the Accreditation Council for Pharmacy Education (ACPE), and the American Nurses Credentialing Center (ANCC), to provide continuing education for the healthcare team.
Physician Continuing Medical Education
Postgraduate Institute for Medicine designates this enduring material for a maximum of 0.25 AMA PRA Category 1 Credit(s)™. Physicians should claim only the credit commensurate with the extent of their participation in the activity.
Continuing Nursing Education
The maximum number of hours awarded for this Continuing Nursing Education activity is 0.2 contact hours.
A short femur is defined as a measurement below the 2.5 percentile for gestational age. This finding is typically identified on second trimester prenatal ultrasound, as femur measurements are part of the algorithm for pregnancy dating. While often there are no other abnormalities, the following should be included in the care plan:
Second trimester anatomical study to evaluate for short limb dysplasia
When short femur seen in isolation, with no other fetal abnormalities
If aneuploidy screening has not yet been done, then screening or diagnostic testing should be offered
If patient opts for aneuploidy testing and result is negative
Counsel patients that screening tests are not diagnostic and therefore there is still residual risk for chromosomal anomalies
ACOG guidance recommends offering prenatal screening for aneuploidy as an option for all pregnant women
Repeat sonogram in the 3rd trimester for growth
If aneuploidy screen result is positive, refer for genetic counseling and consideration of diagnostic testing options
If other anomalies are detected
Refer for genetic counseling and MFM assessment
ACOG guidance recommends offering invasive testing using microarray in the setting of fetal structural anomalies seen on prenatal ultrasound
The femur length should be measured with the bone perpendicular to the ultrasound beam and with epiphyseal cartilages visible, but not included in the measurement. The presence of a short femur may be associated with aneuploidy, intrauterine growth restriction and short limb dysplasia.
The likelihood ratio for Down syndrome is 1.2-2.2, which indicates a minimal to small increase in the likelihood that the fetus will actually have this chromosomal abnormality
Evaluation of all the long bones is suggested to rule out limb dysplasia
ACOG guidance recommends offering
All patients the option of prenatal invasive testing or prenatal screening
Invasive testing using microarray in the setting of fetal structural anomalies seen on prenatal ultrasound
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Disclosure of Unlabeled Use
This educational activity may contain discussion of published and/or investigational uses of agents that are not indicated by the FDA. The planners of this activity do not recommend the use of any agent outside of the labeled indications.
The opinions expressed in the educational activity are those of the faculty and do not necessarily represent the views of the planners. Please refer to the official prescribing information for each product for discussion of approved indications, contraindications, and warnings.
Participants have an implied responsibility to use the newly acquired information to enhance patient outcomes and their own professional development. The information
presented in this activity is not meant to serve as a guideline for patient management. Any procedures, medications, or other courses of diagnosis or treatment discussed or suggested in this activity should not be used by clinicians without evaluation of their patient’s conditions and possible contraindications and/or dangers in use, review of any applicable manufacturer’s product information, and comparison with recommendations of other authorities.
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