Who Performs Obstetric Ultrasound
Obstetric ultrasound is performed by qualified healthcare providers whose credentials vary by facility level, including obstetrician-gynecologists, maternal-fetal medicine specialists, family physicians, certified nurse-midwives, radiologists, and appropriately trained sonographers, with the specific provider type determined by the complexity of the examination and the care setting. 1
Provider Qualifications by Facility Level
Level I Facilities (Basic Care)
- Obstetric ultrasonography services must be accessible at all times as part of support services 1
- Primary maternity care providers include:
- Obstetrician-gynecologists
- Family physicians
- Certified nurse-midwives (CNMs)
- Certified professional midwives (CPMs) in birth center settings 1
Level II Facilities (Specialty Care)
- Basic ultrasonographic imaging services for maternal and fetal assessment are required capabilities 1
- Obstetrician-gynecologist must be available at all times 1
- Maternal-fetal medicine (MFM) specialists available for consultation onsite, by phone, or by telemedicine as needed 1
Level III Facilities (Subspecialty Care)
- Advanced imaging services available at all times 1
- MFM specialists with inpatient privileges available continuously, either onsite, by phone, or by telemedicine 1
- Board-certified MFM serves as director of MFM service 1
Skill Level and Training Considerations
Detection Rates and Expertise
- Highest rates of congenital anomaly detection occur in tertiary care settings such as university medical centers 2
- Perinatologists are most likely to integrate ultrasound findings with rational management plans for high-risk pregnancies 2
Training Requirements
- Appropriate education and demonstrated competence are essential regardless of provider type 1
- Family physicians can perform obstetric ultrasound when they select appropriate equipment, observe indications, understand limitations, and work toward performance mastery 3
- Many private obstetricians perform in-office sonography 2
Common Pitfalls to Avoid
- Insufficient training remains a significant barrier to quality ultrasound services, even among physicians who commonly perform examinations 4
- Ultrasound should not overshadow other clinical examinations in the assessment of pregnant women 5
- Access to ultrasound varies significantly by facility level, with limited availability in lower-level facilities and rural areas 4, 5
Emerging Practice Patterns
- Task-shifting to midwives for basic ultrasound examinations is being explored to improve maternity care access, particularly in resource-limited settings 4, 5
- The vast majority of health professionals agree that maternity care would improve if midwives learned to perform basic ultrasound examinations 4