The benefits of doing ultrasound exams in your office
Family medicine ultrasound is more accurate, more cost-effective, and less time-consuming than you might imagine. Here’s how it can improve your care.
Ultrasound in the obstetrician’s office—and the FP’s office, too
The use of ultrasound in obstetrics (FIGURE 2) is particularly well documented, with evidence supporting the use of FAMUS for various obstetrical indications dating back 30 years.17 The American Academy of Family Physicians has a position paper endorsing diagnostic ultrasound for women’s health care and has offered obstetric ultrasound courses organized by, and for, FPs since 1989.18
In a prospective observational study conducted in the United Kingdom, an FP and a nurse midwife used ultrasound to assess 240 pregnant women presenting with vaginal bleeding in early pregnancy.19 Fetal heartbeat detection by an office ultrasound scan predicted fetal progression to 20 weeks with a sensitivity of 97% and a specificity of 98%. The clinicians also detected anomalies such as molar pregnancy, blighted ovum, and ectopic pregnancy.
FAMUS and its ability to accurately estimate delivery date was examined in another prospective study involving 186 patients at a community health center.20 Accuracy for the estimated date of delivery was 96% using stratified confidence intervals for first-, second-, and third-trimester examinations. The office-based ultrasound scans also detected one case of placenta previa, one fetal death, and 2 unsuspected twin pregnancies. Another study showed no difference in estimations of gestational age provided by ultrasound performed by supervised FP residents with 3 years’ ultrasound training (including 3 lectures per year and an annual 4-hour workshop), and radiologists.21
Further evidence that FAMUS can confirm fetal death and multiple gestations was provided by a retrospective review of almost 498 obstetric ultrasound examinations.22 FPs accurately predicted the presence or absence of fetal death, multiple gestations, and the estimated date of confinement. Another study demonstrated that 86% of 248 FP obstetrical scans were judged acceptable by a radiologist, 10% were repeated due to technical errors and subsequently found to be acceptable, and 3% were unacceptable and referred for formal ultrasound.23 These scans were performed by FPs who completed 5 days of theory and hands-on training and 3 half-days of apprenticeship in an ultrasound laboratory.
In a study conducted in Tanzania, bedside ultrasound scans performed by nurse midwives had 100% agreement with scans performed by a sonographer when evaluating for twins, the presence of fetal heartbeat, or fetal positioning. Overall, bedside ultrasound aided in the diagnosis (39%) and management plan (22%) of 542 patients.24 It is important to note, as highlighted in a multisite study, that consultation with specialists when appropriate is paramount to the successful use of ultrasound by the FP for prenatal care.25
