The last 3 decades have seen ultrasound evaluation become an integral part of obstetrics and gynecology. This diagnostic tool plays an essential role in the management of the pregnant woman during her entire pregnancy as well as on labor and delivery (L&D). However, while the ultrasound operative skill set continues to improve in most ultrasound units, the same cannot be said for most L&D floors. It is unfortunate that providers with greater ultrasound operating skills rarely participate in the care of patients outside the ultrasound unit, while the average “laborist” possesses limited sonography skills. In addition, it is the authors’ experience that the ultrasound machines used in most L&D units are usually old and often are rejected pieces from another service.
In the United States, most L&D units consists of a triage area (or obstetric emergency room), operating rooms, and delivery suites. The sonogram machines used at these units should ideally be portable and easily moved from patient to patient, with ultrasound knobology that is easily mastered by the average operator.
This chapter addresses how ultrasound can be utilized in the management of a patient that presents on L&D and how this management/diagnostic tool can be optimized in the care of the obstetric patient.
Ultrasound Equipment and Performing the Ultrasound
As aforementioned, this should be a portable machine, easily moveable from room to room or patient to patient. It is usually battery operated to enhance portability and rapidity of use. Curvilinear transabdominal probes at a frequency of 2 to 5 MHz and vaginal probes at a frequency of 5 to 10 MHz should be available. Departmental protocols should be created to maintain cleanliness and sterility of probes between uses. Documentation is essential for any ultrasound examination, whether in the ultrasound unit, the clinic, or on L&D. This is to allow later evaluation and follow-up, if necessary but is also imperative from a medico-legal standpoint. Unfortunately, in many L&D units, ultrasound is performed as a quick procedure with no archiving of images and no official record. Since clinical decisions are made, based upon this ultrasound, regulations and protocols must be in place for an official report, with clear permanently recorded images. as recommended by AIUM, for instance.1 The images may be stored on film, digital format, or, ideally, in a Picture Archiving and Communication System (PACS). In most cases of ultrasound carried out on L&D, this will consist of a “limited scan.”1 This is performed when a specific question requires investigation, such as confirmation of fetal heartbeat, fetal presentation, or placental location.2 According to AIUM, in most cases, a limited ultrasound exam is appropriate only when a prior complete examination is on record. The appropriate CPT code for such an examination is 76815 (“Ultrasound, pregnant uterus, real time with image documentation, limited, eg, fetal heartbeat, placental location, fetal position and/or qualitative amniotic fluid volume, 1 or more ...