The Utility of Maternal Point of Care Ultrasound on Labor and Delivery Wards

Algodi, Mohammed; Wolfe, Diana; Taub, Cynthia C.

doi:10.3390/jcdd9010029

Cited by 4 publications

(5 citation statements)

References 25 publications

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“…These include situations involving maternal abdominal hemorrhage in the case of uterine rupture. 2 Furthermore, research has shown that transabdominal sonography can play a crucial role in revealing retroplacental hemorrhage, even in the absence of vaginal bleeding, but when accompanied by fetal bradycardia. This allows physicians to make urgent decisions, such as the option to terminate pregnancy, performing C section, to reduce the risk of intrauterine fetal death or hypoxic brain injury resulting from delayed diagnosis.…”

Section: Discussionmentioning

confidence: 99%

“…In recent years, ultrasonography has become one of the most widely accepted devices by health care professionals in the field of critical care. 1,2 The utility of this method also extends to patients admitted to the intensive care unit (ICU) due to obstetric pathologies, 3 allowing for the diagnosis of pregnancy during focused assessment with sonography in trauma and the assessment of fetal vitality and viability. 4,5 Point-of-care ultrasonography (POCUS) is a real-time bedside sonographic evaluation used to quickly diagnose and treat patients.…”

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confidence: 99%

“…It can also be used to rule out the presence of ectopic pregnancy or free fluid in the Douglas pouch, proving to be highly valuable in the evaluation of pregnant or postpartum patients with hemodynamic instability. 2,6 This case report is centered on the use of POCUS and how this led to the diagnosis of Couvelaire uterus (CU).…”

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confidence: 99%

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Couvelaire Uterus: Point-of-Care Ultrasonography in the Diagnosis of an Uncommon Obstetric Emergency

Pina,

Tamagnone,

Cheong

et al. 2024

Journal of Diagnostic Medical Sonography

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Point-of-care ultrasonography (POCUS) is a key tool in critical care, including obstetric patients in intensive care units (ICUs). Point-of-care ultrasonography can aid in pregnancy diagnosis, fetal assessment, and detection of complications. This case study is based on a 39-year-old pregnant woman, admitted to critical care for preeclampsia. After cesarean delivery, the patient experienced decreased hematocrit levels, renal dysfunction, and uterine tenderness. The POCUS demonstrated uterine atony (inability of the uterus to contract after childbirth), leading to exploratory surgery that confirmed a Couvelaire uterus (CU). Hysterectomy was performed, and histology showed necrosis and bleeding. Couvelaire uterus is a rare complication of placental abruption, caused by placental vascular damage and uterine bleeding. Conservative management and uterine contraction-stimulating drugs are typically used to treat CU. In this case, POCUS provided real-time data for the diagnosis of this obstetric emergency and perhaps other conditions. This report underscores the significance of surveillance and prompt intervention to prevent adverse outcomes for both mothers and infants.

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Section: Discussionmentioning

confidence: 99%

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confidence: 99%

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Couvelaire Uterus: Point-of-Care Ultrasonography in the Diagnosis of an Uncommon Obstetric Emergency

Pina,

Tamagnone,

Cheong

et al. 2024

Journal of Diagnostic Medical Sonography

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“…Portable ultrasound machines are now almost ubiquitous in emergency departments. Clinicians increasingly use ultrasound for focused purposes such as peripheral arterial or venous access, central venous catheter insertion, focused assessment with sonography for trauma (FAST) scanning for intra-abdominal hemorrhage, and obstetric fetal assessment [5][6][7]. To date, uptake by surgeons in diagnosing other abdominal emergencies has been limited [8].…”

Section: Introductionmentioning

confidence: 99%

Surgeon-Performed Point-of-Care Ultrasound in the Diagnosis of Acute Sigmoid Diverticulitis: A Pragmatic Prospective Multicenter Cohort Study

Dumbrava¹,

Abdulla²,

Pereira³

et al. 2023

Cureus

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Background and purposeEarly diagnosis and risk stratification of sigmoid diverticulitis rely heavily on timely imaging. Computerized tomography (CT), the gold standard diagnostic test, may be delayed due to resource constraints or patient comorbidity. Point-of-care ultrasound (POCUS) has an established role in trauma evaluation, and could potentially diagnose and stage acute diverticulitis, thus shortening the time to definitive treatment. AimsThis study aimed to benchmark the accuracy of surgeon-performed POCUS against CT in diagnosing and staging acute diverticulitis. A secondary aim was to evaluate the duration between the POCUS and the confirmatory CT scan report. Patients and methodsA pragmatic prospective multicenter cohort study (ClinicalTrials.gov Identifier: NCT02682368) was conducted. Surgeons performed point-of-care ultrasound as first-line imaging for suspected acute diverticulitis. POCUS diagnosis and radiologic Hinchey classification were compared to CT as the reference standard. ResultsOf 45 patients with suspected acute diverticulitis, POCUS classified 37 (82.2%) as uncomplicated diverticulitis, four (8.8%) as complicated diverticulitis, and four (8.8%) as other diagnoses. The POCUSestimated modified radiologic Hinchey classification was largely concordant with CT staging with an accuracy of 88.8% (95% CI, 75.95-96.2%), a sensitivity of 100% (95% CI, 90.2-100%) and a specificity of 44.4% (95% CI, 13.7-78.8%). The positive predictive value (PPV) was 87.8% and the negative predictive value (NPV) was 100%. There was moderate agreement between CT and POCUS, with a Cohen's kappa coefficient of 0.56. The mean delay between CT and POCUS was 9.14 hours (range 0.33 to 43.5). ConclusionWe examined the role of POCUS in the management of acute diverticulitis and our findings suggest that it is a promising imaging modality with the potential to reduce radiation exposure and treatment delays. Adding a POCUS training module to the surgical curriculum could enhance diagnosis and expedite the management of acute diverticulitis.

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“…Additionally, echocardiography, even in low-risk individuals and especially in those who have hypertension or obesity, may reveal abnormal findings which could be important in risk stratification or treatment [ 7 ]. Lastly, a point-of-care ultrasound of the heart and lungs on the Labor and Delivery ward affords the quicker triaging of cardiac versus non-cardiac diagnoses, such as acute congestive heart failure [ 8 ].…”

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confidence: 99%