Revolutionizing prenatal care with point-of-care ultrasounds

Revolutionizing prenatal care with point-of-care ultrasounds | Image Credit: © leszekglasner - © leszekglasner - stock.adobe.com.

Prenatal care is significantly improved by point-of-care ultrasounds (POCUS) that evaluate the viability and gestational age of first-trimester enhanced care, according to a recent article published in the Annals of Family Medicine.¹

Traditionally, appointments for ultrasound, risk assessment, and patient education have been separate during pregnancy care. Using the new approach, patients can receive comprehensive care during a single visit at under 14 weeks’ gestation.¹

During the visit, patients receive ultrasound-based pregnancy dating, pregnancy viability evaluation, risk evaluation, and on-site counseling. These services are all based on real-time ultrasound results.¹

The use of first-trimester POCUS allows for real time review of ultrasound results with the patient and immediate action.² Risk evaluation includes a symptom review and detailed history, and uterine contents are also evaluated through POCUS. This allows the presence and gestational age of intrauterine pregnancies to be confirmed.

The program was implemented at the M Health Fairview Bethesda Family Medicine clinic in St Paul, Minnesota. The clinic has a typical patient census of 55 to 80 patients, with many patients being non-English-speaking refugees. Patients were referred to an Early Pregnancy Dating & Risk Assessment Clinic (EPD-RA) from their pregnancy confirmation visit.²

POCUS has been linked to faster diagnosis of failed, ectopic, molar, and other abnormal pregnancies, alongside high-risk maternal medical conditions. Patients can receive timely care for options to manage miscarriage and education about how to safely manage vaginal bleeding at home.²

Patients in a familiar clinic setting with miscarriage can receive medication management for optimal support. First-trimester concerns such as vaginal bleeding and nausea may also be managed with consistent care and education.²

The rate of first-trimester emergency department visits, urgent clinic appointments, and telephone calls for concerns was reduced by 81% among patients without miscarriage following EPD-RA implementation. Additionally, the duration between initial concern and diagnosis among miscarriage patients decreased from a mean 5.8 days to 1.7 days.²

Reducing emergency care use during pregnancy is vital for preventing severe maternal morbidity (SMM).³ In a recent study, emergency department visits for hematologic and cardiovascular conditions were linked to SMM.

Patients with SMM had a hematologic condition-related visit rate of 6.4% and cardiovascular condition-related visit rate of 8.6%. In patients without SMM, these rates were 2% and 3.6%, respectively. This highlighted the association between prenatal hospital visits and SMM.³

“Our study demonstrates that the use of point-of-care ultrasound provides meaningful benefit to the patients we serve by addressing early pregnancy problems at the time they are identified,” said Allison Newman, MD, assistant professor at the U of M Medical School.¹

“POCUS in early pregnancy helps clinicians more efficiently and accurately diagnose problems without compromising the quality of needed first trimester assessments — saving time, money and stress for patients,” added Newman.¹

Following this program, experts have recommended a wider rollout for the process to other family medicine practices. A wider study across multiple sites should also be performed.¹

References

1. U of M Medical School study finds point-of-care ultrasound enhances early pregnancy care, cuts emergency visits by 81%. University of Minnesota Medical School. January 6, 2025. Accessed January 7, 2025. https://www.eurekalert.org/news-releases/1069580
2. Newman A, Berg M. Enhancing first trimester obstetrical care: The addition of point-of-care ultrasound. Annals of Family Medicine. 2024;22(6):569. doi:10.1370/afm.3180
3. Krewson C. Emergency care use during pregnancy linked to increased SMM risk. Contemporary OB/GYN. October 18, 2024. Accessed January 7, 2025. https://www.contemporaryobgyn.net/view/emergency-care-use-during-pregnancy-linked-to-increased-smm-risk