COVE R S TORY
Point-of-care ultrasound for obstetric care
The use of ultrasound in obstetric care has grown steadily since the 1950s, to the point where it is now a major part of managing pregnancy and helping to ensure a safe and healthy delivery for mother and baby.
Most pregnant women in the UK first experience ultrasound at their routine booking scan at 12-14 weeks for preliminary checks, a nuchal translucency test and to estimate a due date, and then again for an anomaly scan at 18-20 weeks to screen for abnormalities and monitor the baby’s growth. However, recent regional and national initiatives – notably the Saving Babies’ Lives care bundle1
– advise more
scans in later pregnancy for high-risk patients. In addition, ultrasound is now seen as an essential tool for every labour ward in the country. Traditionally, the majority of antenatal scans would have been performed by a sonographer on a large, cart-based system. However, in recent years, the technology behind easy-to-use, compact point-of-care ultrasound systems has advanced rapidly, giving excellent image quality and added flexibility to perform ultrasound wherever it
is needed – whether that’s in an outpatients clinic, a community hub, or the busy labour ward setting. This article looks at the role of these smaller, portable ultrasound systems in the highly regulated and litigious speciality of obstetrics, and discusses how their use is set to escalate in the next few years.
Screening those at risk The rise in ultrasound scans throughout pregnancy can be largely attributed to a better recognition of the importance of careful monitoring of women who can be categorised as high risk. This includes those with a greater chance of having small babies due to smoking or excessive alcohol intake, and women with a previous history of difficult pregnancies or labour, as well as teenage mothers who are more likely to have premature births and smaller babies.2
In
these cases, there are rigorous UK guidelines that recommend best practice scanning
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protocols for checking the growth of affected babies more frequently.
Clinical implications of obesity in pregnant women
At the other end of the scale, women with gestational diabetes or those who are obese need additional ultrasound scans because they are in danger of having large babies. Recent data suggests that 29% of women in the UK are obese,3
and these figures are
certainly reflected in obstetric departments across the country, which commonly see mothers with BMIs in the 40s and 50s or more.
Obesity carries with it a far greater risk of pregnancy complications overall, including miscarriage and stillbirth, gestational diabetes, raised blood pressure and pre- eclampsia, blood clots and post-partum haemorrhage (PPH), prolonged labour and a higher chance of needing instrumental delivery.4
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No wonder then that there are now clinics for these high-risk patients and additional ultrasound scans to size and
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