Point-of-care ultrasound for evaluation of vaginal bleeding or abdominal pain in early pregnancy

Abstract

Objective To evaluate the use of point-of-care ultrasound (POCUS) for the assessment of patients experiencing first-trimester bleeding or abdominal pain by family physicians working in family medicine clinics following first-trimester POCUS training and certification. Design Multisite, retrospective chart review. Setting Two hospital-affiliated academic family medicine clinics in Toronto, Ont. Participants Twelve family physicians who completed a first-trimester POCUS training and certification course. Main outcome measuresThe primary outcome was the proportion of family physicians using POCUS during their evaluations of patients in the first trimester of pregnancy in the 6 months following the FPs' successful completion of the Family Medicine Obstetrical Ultrasound (FaMOUS) course. Secondary outcomes included indications for POCUS use, diagnostic accuracy of POCUS compared with radiologist-interpreted ultrasound, pregnancy outcomes, and emergency department visits within 10 days of the index family medicine clinic visit. ResultsOf the 12 certified family physicians, 7 (58.3%) used POCUS during their assessments of first-trimester patients during the study period. The FPs used POCUS with 56 patients for the following indications: 11 (19.6%) had only vaginal bleeding, 5 (8.9%) had only abdominal pain, and 8 (14.3%) had both vaginal bleeding and abdominal pain; the indication for 32 patients (57.1%) was unclear. Forty-six patients (82.1%) underwent a subsequent radiologist-interpreted ultrasound within 10 days of the index POCUS test. Compared with radiologistinterpreted ultrasound, POCUS had a sensitivity of 91.3% (95% CI 79.2% to 97.6%) for documenting intrauterine pregnancy and a sensitivity of 81.4% (95% CI 66.6% to 91.6%) for documenting the presence of fetal cardiac activity. ConclusionFollowing a first-trimester POCUS certification course, family physicians used POCUS for the assessment of first-trimester patients with varying frequency and for indications other than vaginal bleeding or abdominal pain. Further study is needed to assess the clinical impact of office-based POCUS, unforeseen barriers and facilitators to its use, and patient and provider preferences.This article has been peer reviewed. Cet article a fait l'objet d'une révision par des pairs.

Point-of-Care Ultrasound Facilitates Management of Ruptured Ectopic Pregnancy

“…Central to this evaluation is the ability to identify an IUP. Multiple studies have demonstrated POCUS to have excellent sensitivity and specificity for detecting an IUP 12–16 . In a large meta-analysis, the presence of an IUP by POCUS was able to rule out EP with a sensitivity of 99.3% and a negative likelihood ratio of 0.08 15 .…”

“…Multiple studies have demonstrated POCUS to have excellent sensitivity and specificity for detecting an IUP. [12][13][14][15][16] In a large metaanalysis, the presence of an IUP by POCUS was able to rule out EP with a sensitivity of 99.3% and a negative likelihood ratio of 0.08. 15 In the absence of assisted fertilization, where the risk of heterotopic pregnancy is roughly 1:4000 to 1:30,000, the presence of an IUP essentially excludes the diagnosis of an EP.…”

“…Finally, in ED patients with an "indeterminate" study, 10% to 15% went on to have an EP and 50% to 65% went on to have fetal loss. 16,27,28 The American College of Emergency Physicians advises that all patients with an indeterminate pelvic ultrasound obtain subspecialty consultation or close follow-up. 11…”

Immunopathological changes in case of the diabetes of the first type. The impact of the mother’s diabetes of the first type on the emryogenesis and fetogenesis of the fetus (Literature review, part II)

“…To the group of this markers we can include antibodies to insulin, beta-cells of the pancreas, and insulin receptors [28] modern studies have shown, that the autoantibodies to islet pancreatic cells are specific markers of the autoimmunization in case of diabetes [29] it is proved that in the preclinical stage of diabetes we can see changes in the immune system, including production of the antibodies, that lead to destruction of the insulin-secreting cells of the pancreas. The action of the antibodies is realized in the autoimmune insula, which develops gradually; destruction of the endogenous insulin and desencibilisation of the receptors [30]. In the implementation of the autoimmune insula the most important role is played by macrophages, T-helpers, Tcytotoxic-suppressors and natural killer cells [31].…”