Today, the Royal College of Obstetricians and Gynaecologists has launched a new eLearning resource to support midwives and obstetricians who perform basic fetal presentation examinations using Point of Care ultrasound (POCUS) during pregnancy.
In this blog, Professor Asma Khalil (Vice President for Academia and Strategy at the RCOG) shares the benefits of Point of Care Ultrasound and the importance of this new resource.
Point of Care Ultrasound – that is, the use of a handheld ultrasound device – is revolutionising obstetric care worldwide. This portable and convenient tool enhances the care we can provide for our patients by facilitating more accessible and timely diagnostic ultrasound in remote settings, in emergencies, and in underserved communities, particularly in low- and middle-income countries.
Point of Care Ultrasound is cheaper than traditional ultrasound and can be used to assess fetal presentation and viability, the number of fetuses, chorionicity (if there are multiple pregnancies and the type of twins), placental location and amniotic fluid volume.
Point of Care Ultrasound for fetal presentation
We know that 3-4% of babies present in a breech position at term1 and this is a position that can be associated with excess perinatal mortality and morbidity.2 In 30–50% of these cases, this breech positioning can only be detected when the mother is in labour. Identifying this situation late can lead to an emergency caesarean section and increases the risks of poor outcomes for both the mother and baby.
A large study compared the rate of unexpected breech births and the health of the newborn babies after different third-trimester scan policies were introduced at two UK hospitals. St George’s University Hospital NHS Foundation Trust used traditional scans performed by a sonographer, whilst Norfolk and Norwich University Hospital NHS Foundation Trust used handheld ultrasound devices by midwives in the community.3
Both types of third-trimester ultrasound scan reduced the rate of unexpected breech birth dramatically in comparison to not doing third-trimester scans at all: the rate of unexpected breech birth was 71% lower after the standard type of ultrasound was used, and 69% lower when the handheld portable ultrasound device was used.3
In addition, the babies of women who underwent third-trimester ultrasound were 16% less likely to be admitted to the neonatal unit for closer monitoring, and were 40–77% less likely to have a low Apgar score at 5 minutes after being born. The Apgar score assesses the baby’s overall wellbeing soon after birth looking at factors like skin colour, heart rate, reflexes, muscle function and ability to breathe. Mothers who had an ultrasound via a handheld device were also less likely to need an emergency caesarean.3
This research demonstrates the benefits of Point of Care Ultrasound for both the mother and baby. Use of Point of Care Ultrasound in this scenario also enables patient-centred care that can be localised in the community.
RCOG’s Point of Care Ultrasound eLearning resource
To maximise the benefits of handheld ultrasound for women in our care, we need to ensure that O&G professionals are trained and competent in its use. This is why the RCOG has developed a Point of Care Ultrasound eLearning resource, with funding from GE Healthcare, which is freely accessible via our RCOG Learning platform.
The resource offers advice and helpful tips for probe positioning and image optimisation, including detailed video demonstrations. It also covers the common diagnostic challenges you might experience, as well as exploring patient safety and regulatory considerations. It includes assessments to check your knowledge and awards a certificate on completion.
Whether you’re a midwife, a trainee or you are involved in another aspect of obstetric care, we hope you’ll find this a useful guide to performing Point of Care Ultrasound during pregnancy and can put this knowledge into practice to improve patient outcomes within your area.
Please email elearning@rcog.org.uk if you have any queries.
- View the new resource here.
- Visit the RCOG eLearning platform here.
- You can find out more about RCOG training here
- Royal College of Obstetricians and Gynaecologists. Management of Breech Presentation. Green-top Guideline No. 20b. London: RCOG; 2017.
- Macharey G, Gissler M, Rahkonen L, Ulander V-M, Väisänen-Tommiska M, Nuutila M et al. Breech presentation at term and associated obstetric risks factors-a nationwide population based cohort study. Arch Gynecol Obstet 2017; 295(4):833–8.
- Knights S, Prasad S, Kalafat E, Dadali A, Sizer P, Harlow F, Khalil A. Impact of point-of-care ultrasound and routine third trimester ultrasound on undiagnosed breech presentation and perinatal outcomes: An observational multicentre cohort study. PLoS Med 2023;20(4):e1004192.