Obstetrical Ultrasound During Pregnancy

No relevant evidence was identified comparing the safety of frequent obstetrical ultrasounds compared to the routine use of obstetrical ultrasound during pregnancy. This review identified 10 evidence-based guidelines that provided recommendations regarding various indications for obstetrical ultrasound, as well as the frequency of obstetrical ultrasound; however, the methodological rigour of these guidelines is limited and recommendations should be interpreted with caution. One guideline recommended against obstetrical ultrasound for non-medical purposes and recommended that ultrasound exposure be as low as reasonably possible during pregnancy. These recommendations were based on moderate-quality evidence and expert opinion, and should be interpreted with caution. The guidelines made recommendations for specific patient populations for whom more frequent obstetrical ultrasound examinations may be required. These populations included pregnancies affected by certain congenital infections, people pregnant with twins, pregnant adolescents, and pregnant people at high risk for fetal anomalies or for whom mid-trimester transabdominal ultrasound would be challenging.

Perinatal Outcome in Term Pregnancies with Isolated Oligohydroamnios

Objective: To evaluate the frequency of adversative perinatal outcome in pregnancies with oligohydramnios isolation at term. Study Design: Case series Place and Duration of Study: Department of Obstetrics & Gynecology, Sadiq Abbasi Hospital Bahawalpur from 1st January 2021 to 30th June 2021. Methodology: Two hundred women with term pregnancy 37+0 to 41+6 weeks, pregnancy with isolated oligohydramnios, active phase of labour were included. CTG and obstetrical ultrasound for biophysical profile were done. Patient’s labour was monitored closely and followed till delivery. Results: Majority of the patients 87 (43.5%) were between 20-25 years with mean age was 28.43±4.27 years. Seventy six (38%) were between para 1-2, 83 (41.5%) were para 3-4, while 41 (20.5%) were para >4. Perinatal outcome reveals that APGAR score <6 at 1 minute was calculated in 21 (10.5%) and <7 at 5 minutes in 17 (8.5%) which is not very significant. Conclusion: Oligohydramnios Isolation was not related with adversative perinatal consequences. Keywords: Isolated oligohydramnios, Perinatal outcome, Amniotic fluid index, Term pregnancy, APGAR score

Sociodemographic and Geographic Factors Associated With Non-Obstetrical Ultrasound Imaging Utilization: A Population-Based Study

Objective: Ultrasound is one of the most commonly used imaging modalities, though some populations face barriers in accessing ultrasound services, potentially resulting in disparities in utilization. The objective of this study was to assess the association between sociodemographic and geographic factors and non-obstetrical ultrasound utilization in the province of Saskatchewan, Canada. Methods: All non-obstetrical ultrasound exams performed from 2014 to 2018 in Saskatchewan, Canada were retrospectively identified from province-wide databases. Univariate and multivariate Poisson regression analyses were performed to assess the association between ultrasound utilization and sex, age, First Nations status, Charlson Comorbidity Index, urban vs. rural residence, geographic remoteness, and neighborhood income. Results: A total of 1,324,846 individuals (5,857,044 person-years) were included in the analysis. Female sex (adjusted incidence rate ratio [aIRR], 2.20; 95% confidence interval [CI], 2.19-2.22), age (aIRR, 4.97; 95% CI, 4.90-5.05 for ≥57 years vs. <11 years), comorbidities (aIRR, 4.36 for Charlson Comorbidity Index >10 vs. 0; 95% CI, 3.78-5.03), and higher neighborhood income (aIRR, 1.04; 95% CI, 1.02-1.05 for highest vs. lowest quintile) were associated with higher rates of ultrasound utilization. Individuals who were status First Nations (aIRR, 0.91; 95% CI, 0.90-0.92) or resided in geographically remote areas (aIRR, 0.87 for most vs. least remote; 95% CI, 0.83-0.91) had lower rates of ultrasound utilization. Individuals who lived in a rural area also had lower rates of ultrasound utilization (aIRR, 0.93; 95% CI, 0.92-0.94). Conclusion: Substantial disparities exist in non-obstetrical ultrasound utilization among individuals in low-income neighborhoods, status First Nations individuals, and individuals in rural and remote communities.

Developing and using a smartphone-app to support the teaching of technical basics for 3D/4D obstetrical ultrasound applications in medical education

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Telerobotic ultrasound to provide obstetrical ultrasound services remotely during the COVID-19 pandemic

Introduction Obstetrical ultrasound imaging is critical in identifying at-risk pregnancies and informing clinical management. The coronavirus disease 2019 (COVID-19) pandemic has exacerbated challenges in accessing obstetrical ultrasound for patients in underserved rural and remote communities where this service is not available. This prospective descriptive study describes our experience of providing obstetrical ultrasound services remotely using a telerobotic ultrasound system in a northern Canadian community isolated due to a COVID-19 outbreak. Methods A telerobotic ultrasound system was used to perform obstetrical ultrasound exams remotely in La Loche, Canada, a remote community without regular access to obstetrical ultrasound. Using a telerobotic ultrasound system, a sonographer 605 km away remotely controlled an ultrasound probe and ultrasound settings. Twenty-one exams were performed in a five-week period during a COVID-19 outbreak in the community, including limited first-, second- and third-trimester exams ( n = 11) and complete second-trimester exams ( n = 10). Participants were invited to complete a survey at the end of the telerobotic ultrasound exam describing their experiences with telerobotic ultrasound. Radiologists subsequently interpreted all exams and determined the adequacy of the images for diagnosis. Results Of 11 limited obstetrical exams, radiologists indicated images were adequate in nine (81%) cases, adequate with some reservations in one (9%) case and inadequate in one (9%) case. Of 10 second-trimester complete obstetrical exams, radiologists indicated images were adequate in two (20%) cases, adequate with some reservations in three (30%) cases and inadequate in five (50%) cases. Second-trimester complete obstetrical exams were limited due to a combination of body habitus, foetal lie and telerobotic technology. Discussion A telerobotic ultrasound system may be used to answer focused clinical questions such as foetal viability, dating and foetal presentation in a timely manner while minimising patient travel to larger centres and potential exposure to severe acute respiratory virus coronavirus 2 during the COVID-19 pandemic.