What role does point-of-care (POC) ultrasound play in managing Obstetrics (OB) and Gynecology (GYN) emergencies?

Point-of-Care Ultrasound in OB/GYN Emergencies

Point-of-care ultrasound should be used as a first-line diagnostic tool in OB/GYN emergencies to expedite diagnosis and treatment, with particular emphasis on ectopic pregnancy, early pregnancy complications, and maternal cardiopulmonary assessment. 1, 2

Core Emergency Applications

Ectopic Pregnancy Detection and Management

• Emergency physician-performed POCUS demonstrates 76-90% sensitivity and 88-92% specificity for detecting ectopic pregnancy, making it the optimal initial test for suspected ectopic pregnancy. 1

• POCUS significantly reduces time to treatment compared to formal radiology ultrasound alone—the average ED treatment time was 157.9 minutes with POCUS versus 206.3 minutes with radiology ultrasound only (p = 0.0141). 3

• For ruptured ectopic pregnancies specifically, POCUS reduces median time to operating room from 293 minutes to 203 minutes (p = 0.0002), which directly impacts morbidity and mortality in this life-threatening condition. 3

• When POCUS is positive for ectopic pregnancy, proceed directly to surgical consultation without waiting for formal imaging—this expedites definitive care and reduces the risk of rupture. 3

Early Pregnancy Assessment

• Transabdominal POCUS rapidly confirms intrauterine pregnancy and identifies free fluid from hemorrhage, providing immediate answers at the bedside without delays associated with radiology consultation. 3, 2

• The Society of Obstetricians and Gynaecologists of Canada supports POCUS as a readily accessible, low-cost imaging option that expedites appropriate patient management and enhances provider confidence in pregnancy-related emergencies. 2

• POCUS is particularly valuable for assessing fetal status, gestational age, and placental location in the setting of critical illness or trauma. 4

Maternal Cardiopulmonary Emergencies

Shock and Hypotension Evaluation

• POCUS should be performed immediately in pregnant patients presenting with hypotension or shock to differentiate cardiac causes (ventricular dysfunction, pericardial effusion), hypovolemia, or pulmonary embolism. 5, 4

• Cardiac POCUS demonstrates 96-100% sensitivity and 98-100% specificity for pericardial effusion detection, which can be life-saving in conditions like peripartum cardiomyopathy with tamponade. 1

• A systematic POCUS protocol rapidly differentiates causes of intraoperative or postpartum hypotension, including assessment of left and right ventricular function and volume responsiveness. 6, 4

Respiratory Distress Assessment

• Thoracic POCUS has 92-98% sensitivity and 99% specificity for pneumothorax detection and should be performed immediately in pregnant patients with respiratory distress or chest trauma. 1

• POCUS evaluation for pulmonary edema, pleural effusion, and pneumothorax can be performed in pregnancy using the same techniques as in nonpregnant patients, with knowledge of normal physiological changes. 5, 4

• The rising contribution of cardiopulmonary disorders to maternal mortality makes POCUS essential for evaluating pulmonary complaints in labor and delivery settings. 5

Life-Threatening Emergencies

• POCUS plays an essential role in diagnosing and managing amniotic fluid embolism, cardiac arrest, and massive pulmonary embolism—conditions with extremely high maternal mortality. 5, 4

• The Focused Assessment with Sonography in Trauma (FAST) examination in pregnancy is performed similarly to nonpregnant patients, with 90% sensitivity and 99% specificity for detecting peritoneal bleeding in blunt trauma. 1, 4

• FAST findings guide decision-making regarding operative versus nonoperative management of trauma in pregnant patients, with the same urgency as nonpregnant trauma patients. 4

Practical Implementation Advantages

Immediate Bedside Assessment

• The familiarity of obstetricians with ultrasound equipment, coupled with immediate availability without patient transport, makes POCUS particularly valuable in labor and delivery units. 5

• POCUS improves time to diagnosis (40 vs. 60 minutes in acute settings) and allows immediate integration with clinical findings. 6, 7

• Emergency ultrasound is supported for out-of-hospital settings and is particularly valuable for providers with limited access to diagnostic imaging or subspecialty consultation. 1, 5

Resource-Limited Settings

• POCUS is a low-cost imaging option requiring few resources, making it accessible even in austere environments or facilities without 24-hour radiology services. 1, 2

• The technology is portable and can be performed without radiation exposure, which is critical for pregnant patients. 1, 7

Critical Caveats and Quality Assurance

Training and Competency Requirements

• Operator skill significantly affects diagnostic accuracy—providers must have appropriate training in obstetric POCUS applications before performing independent examinations. 6, 7

• The I-AIM protocol (Indication, Acquisition, Interpretation, Medical decision-making) should be used to ensure consistent and reliable POCUS utilization. 6

• Clear scope of practice and quality assurance mechanisms must be established, including image documentation for quality review. 6

Limitations and Follow-up

• POCUS should not replace comprehensive imaging when detailed assessment is needed—if clinical suspicion remains high despite negative POCUS, do not delay definitive imaging or consultation. 6, 7

• There is potential for error in imaging or interpretation resulting in incorrect patient management, so indeterminate results should prompt formal radiology ultrasound or advanced imaging. 7, 2

• POCUS is a focused examination answering specific clinical questions, not a comprehensive anatomic survey—understand what you are looking for and what the examination can and cannot exclude. 1, 8

Integration into Clinical Workflow

• POCUS should be incorporated into the initial assessment of pregnant patients with suspected ectopic pregnancy, unexplained hypotension, respiratory distress, or trauma—not as an add-on after traditional evaluation. 3, 5

• When POCUS demonstrates drainable fluid collections or other actionable findings, bedside intervention can be performed under ultrasound guidance, providing both diagnostic and therapeutic benefit. 1

• Academic leaders should incorporate maternal POCUS teachings into existing obstetric curricula, as acquiring these clinical skills is requisite for reducing maternal morbidity and mortality. 5