Department of Clinical Science, University of Bergen, Bergen, Norway.
Department of Obstetrics and Gynaecology, Haukeland University Hospital, Bergen, Norway.
Scand J Prim Health Care. 2021 Jun;39(2):123-130. doi: 10.1080/02813432.2021.1910643. Epub 2021 Apr 14.
Handheld point-of-care abdominal ultrasound (POCUS) may be used by primary care physicians while vaginal ultrasound is limited to use in specialist care. We aimed to compare abdominal handheld ultrasound to vaginal ultrasound in determining first trimester viable intrauterine pregnancy and estimate gestational length.
Prospective cohort study.
Gynaecologic outpatient clinic; women referred from GPs during early pregnancy. Handheld ultrasound using VscanExtend was performed by fourth-year medical students with limited training. Transvaginal ultrasound using high-end devices was performed by ordinary hospital staff.
Women in the first trimester of pregnancy referred for termination of pregnancy or with symptoms of early pregnancy complications.
Rate of confirming vital intrauterine pregnancy (visualizing foetal heart beats) and measurement of crown-rump length (CRL) using handheld abdominal versus vaginal ultrasound.
In all 100 women were included; 86 confirmed as viable intrauterine pregnancies and 14 pathological pregnancies (miscarriages/extrauterine pregnancies). Handheld abdominal ultrasound detected fetal heartbeats in 63/86 (73% sensitivity) of healthy pregnancies and confirmed lack of fetal heartbeats in all pathological pregnancies, total positive predictive value (PPV) 100% and total negative predictive value (NPV) 38%. From gestational week 7, handheld abdominal ultrasound confirmed vitality in 51/54 patients: PPV 100% and NPV 79%. CRL ( = 62) was median 1 mm shorter (95% confidence interval 1-2 mm) measured by handheld abdominal versus vaginal ultrasound.
Handheld ultrasound has an excellent prediction confirming viable intrauterine pregnancy from gestational week 7. Validation studies are needed to confirm whether the method is suitable in primary care assessing early pregnancy complications.KEY POINTSWhen early pregnancy vitality needs to be confirmed, women will traditionally be referred to secondary care for transvaginal comprehensive ultrasonography performed with high-end devices by imaging specialists.In this study personnel with limited former training (fourth-year medical students) performed transabdominal POCUS using a handheld device, investigating 100 first trimester pregnancies for confirmation of viability.Using handheld ultrasound viable pregnancy was confirmed from gestational week 7 with 79% positive and 100% negative predictive value.If handheld ultrasound used in primary care confirms vital intrauterine pregnancy, the need for specialist referral could be reduced.
基层医疗机构的医生可能会使用手持式即时床旁腹部超声（POCUS），而阴道超声仅限于专科医生使用。我们旨在比较腹部手持式超声和阴道超声在确定孕早期有活力的宫内妊娠和估计妊娠周数方面的作用。
前瞻性队列研究。
妇科门诊；早孕时由全科医生转诊的女性。使用经过有限培训的第四年医学生进行 VscanExtend 手持式超声检查。使用高端设备进行经阴道超声检查由普通医院工作人员进行。
早孕要求终止妊娠或有早孕并发症症状的女性。
使用手持式腹部超声和经阴道超声确定有活力的宫内妊娠（观察到胎儿心跳）和测量头臀长（CRL）的发生率。
共纳入 100 名女性；86 例确诊为有活力的宫内妊娠，14 例为病理性妊娠（流产/异位妊娠）。手持式腹部超声在 63/86 例（73%的敏感性）健康妊娠中检测到胎心，在所有病理性妊娠中均确认无胎心，总阳性预测值（PPV）为 100%，总阴性预测值（NPV）为 38%。从妊娠第 7 周开始，51/54 例患者的手持式腹部超声确认有活力：PPV 为 100%，NPV 为 79%。CRL（ = 62）经腹部测量比经阴道超声短 1 mm（95%置信区间 1-2 mm）。
从妊娠第 7 周开始，手持式超声对有活力的宫内妊娠有极好的预测作用。需要进一步的验证研究来确认该方法是否适合基层医疗保健机构评估早孕并发症。
当需要确认早孕活力时，传统上会将女性转诊至二级医疗机构，由影像专家使用高端设备进行经阴道全面超声检查。在这项研究中，具有有限先前培训（四年级医学生）的人员使用手持式设备进行经腹部 POCUS，对 100 例早孕妊娠进行活力确认。使用手持式超声，从妊娠第 7 周开始，妊娠阳性预测值为 79%，阴性预测值为 100%。如果手持式超声在基层医疗保健中用于确认有活力的宫内妊娠，则可能减少对专科医生的转诊需求。
