COVE R S TORY
situations, because they boot up in seconds and are easy-to-use and move around in the tight spaces of delivery rooms.
All in all, transabdominal and transvaginal ultrasound are now essential skills for the labour ward and an integral part of training for doctors specialising in obstetrics. Current trainees are much more adept in performing ultrasound at an earlier stage of their training than was the norm 15-20 years ago and, in some trusts, midwives are also now trained in basic level competencies to carry out dating and growth scans, and to look at placental location and position when women are first admitted in labour.
Changing practices for changing times
The care plans described above are adhered to consistently across the country, however, new models of service delivery are being explored that would move some ultrasound procedures out of hospital and into the community, particularly in rural regions. Satellite clinics led by midwife-sonographers – or visited by sonographers – could be held to carry out simple checks, but they would depend on the right equipment, adequate training and strict auditing; compact, easy-to-use portable systems would be particularly suitable for this setting. This idea also fits with the repercussions of future outbreaks like the current COVID-19 pandemic, where there is an increased drive to decrease footfall in acute hospitals. Bookings for anomaly and growth scans are already stretched and do not always occur within the ideal timeframe, partly because of the thorough cleaning protocols now required between patients. If some of the simpler, routine and non-urgent ultrasound checks could be carried out remotely, with closer involvement of the
AUGUST 2020
community midwives, this could allow for greater continuity of care and would release hospital resources for more complex and high-risk patients.
Summary
There are clear clinical benefits for ultrasound scans in obstetrics and their use has grown significantly over the last three decades, far beyond the domain of routine scanning carried out by sonographers on huge, unwieldy, cart-based machines. Point-of-care ultrasound systems are now ubiquitous in labour wards, and offer excellent image quality with the added advantages of flexibility and portability for virtually all obstetric settings. Initiatives like Saving Babies’ Lives are fuelling the demand for more scans, and the capabilities of these compact, hand-carried instruments are ideal for meeting the current, ever-growing needs of antenatal monitoring and management of women in labour.
References 1
https://www.england.nhs.uk/mat-transformation/ saving-babies/
2
https://www.nhs.uk/news/pregnancy-and-child/ birth-complications-for-teen-mums
3
https://digital.nhs.uk/data-and-information/ publications/statistical/statistics-on-obesity- physical-activity-and-diet/england-2020/part-3- adult-obesity-copy
4
https://www.nhs.uk/conditions/pregnancy-and- baby/overweight-pregnant/
5
https://www.rcog.org.uk/en/guidelines-research- services/guidelines/gtg72/
6 RCOG_guideline_obesity_in_pregnancy.pdf 7
https://www.england.nhs.uk/wp-content/ uploads/2019/07/saving-babies-lives-care-bundle- version-two-v5.pdf
8
https://www.ncbi.nlm.nih.gov/pmc/articles/ PMC6467368/
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The Mindray TE7 ACE point-of-care ultrasound system
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