Having the heart to help

Sonographers teach others to detect fetal abnormalities

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Watching the flicker of a fetal heartbeat, Karen Letourneau realized how she could save babies' lives.

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Hey there, time traveller!
This article was published 17/03/2011 (4222 days ago), so information in it may no longer be current.

Watching the flicker of a fetal heartbeat, Karen Letourneau realized how she could save babies’ lives.

She just had to know where to look — and help teach others how to look there, too.

Her push to help educate her colleagues about rarely used techniques has made Manitoba a success story in detecting fetal heart abnormalities and it may soon spread across the country.

MIKE.DEAL@FREEPRESS.MB.CA Karen Letourneau and colleagues including Keith McDonald (above) launched education program to better detect heart defects.

It isn’t easy. On an ultrasound screen and to a layperson, the fetal heart is a formless blob, pulsing in grainy grey rhythm.

To expectant parents, it is a promise of a life to come; but the image can hide nightmares as well as dreams, obscuring life-threatening heart defects that impact about 30 Manitoba babies a year.

Until 2004, most of those defects went undetected in Manitoba until the baby was born, triggering a mountain of emergency interventions and, sometimes, a parent’s heartbreaking loss.

Shortly after beginning her career as a sonographer in 2003, Letourneau started wondering how that could change. “I had this uncomfortable feeling that I might not be able to recognize an abnormal heart in a fetus,” Letourneau said. “I just thought I could be doing a better job.”

She wasn’t alone. Across Canada, the St. Boniface Hospital sonographer’s colleagues spoke a similar refrain, expressing a lack of confidence in detecting abnormal hearts.

Letourneau thought she knew how to change that. Armed with passion and a dream, she obtained a grant from the Health Sciences Centre Foundation to give Manitoba’s sonographers a leg up on detecting fetal heart abnormalities: education.

Together with a team including fellow St. Boniface Hospital sonographer Keith McDonald, Dr. Fern Karlicki, pediatric cardiologist Dr. Reeni Soni and others, Letourneau launched a seminar teaching sonographers how to perform a series of challenging and little-taught techniques to see a baby’s heart.

The extra views can take a year or more to master, but reveal defects the traditional “four-chamber” image doesn’t always show, potentially boosting detection rates by 30 or 40 per cent.

The project was a hit: At the first seminar in 2004, every sonographer in Manitoba attended.

Within a week, Letourneau said, Dr. Soni was inundated with possibly abnormal ultrasounds. In the first eight months of that year, four abnormal fetal hearts were detected by sonographers in Manitoba; in the four months after the workshop, sonographers found 15.

“Our pickup rate went through the roof,” Letourneau said. “We were blown away. We were really making a difference.” Detecting an abnormal heart before a baby is born means giving a family months to prepare, to plan, to make sure their babies are born in the right place. It means not having to rush a baby to Winnipeg from a rural hospital; sometimes it means not having to fly a sick infant and a team of health-care workers to Alberta by air ambulance, a pricey and stressful option.

Sometimes, detecting an abnormal heart early means the difference between a baby who lives and a baby who dies. The promise of saving families that pain, that fear keeps Letourneau committed to expanding the education program. She knows first-hand what is at stake: In 2006, her son, Paul, who had been born with severe mental and physical disabilities, died after a sudden complication from kidney cancer. He was 21.

“When Paul died, we were in the right place at the right time with the right resources available,” Letourneau mused. “There was room in the operating room for him, room in the ICU. Everything that could have gone wrong, didn’t. And still he died.”

But the fact Paul died in hospital under excellent care, Letourneau said, meant the questions that often follow such sudden losses never came. “I feel quite a lot of peace, because we’re not agonizing over ‘what if,’ ” Letourneau said. “Can I spare someone else grief? That motivates me a lot.”

Now, five years into the project, Letourneau and her colleagues know they have saved Manitoba parents the same grief and the same unanswerable questions. Soon they will publish their findings and show the world how a steadfast shift in education focus can make such a significant impact on detection rates.

And every day, there is more proof their affordable approach works — in fact, some data suggest Manitoba has one of the best detection rates in the country, Letourneau said.

“Yesterday, (Dr. Soni) had four referrals of fetuses with abnormal hearts,” she mused. “All four were from rural hospitals… All four would be told they would have to deliver their babies in Winnipeg.

“In one day, we just prevented four babies from being born in the wrong place, at the wrong time.”

melissa.martin@freepress.mb.ca

Melissa Martin

Melissa Martin
Reporter-at-large

Melissa Martin reports and opines for the Winnipeg Free Press.

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