Martins Juliana G, Waller Jerri, Horgan Rebecca, Kawakita Tetsuya, Kanaan Camille, Abuhamad Alfred, Saade George
Department of Obstetrics and Gynecology, Division of Maternal-Fetal Medicine, Eastern Virginia Medical School, Norfolk, VA, USA.
J Ultrasound Med. 2024 May;43(5):951-965. doi: 10.1002/jum.16425. Epub 2024 Feb 6.
To synthesize the current evidence of maternal point-of-care ultrasound (POCUS) in obstetrics. A scoping review was conducted using PubMed, Clinicaltrials.gov, and the Cochrane library from inception through October 2023.
Studies were eligible for inclusion if they described the use of POCUS among obstetric or postpartum patients. Two authors independently screened all abstracts. Quantitative, qualitative, and mixed-methods studies were eligible for inclusion. Case reports of single cases, review articles, and expert opinion articles were excluded. Studies describing detailed maternal nonobstetric sonograms or maternal first trimester sonograms to confirm viability and rule out ectopic pregnancy were also excluded. Data were tabulated using Microsoft Excel and summarized using a narrative review and descriptive statistics.
A total of 689 publications were identified through the search strategy and 12 studies met the inclusion criteria. Nine studies evaluated the use of lung POCUS in obstetrics in different clinical scenarios. Lung ultrasound (LUS) findings in preeclampsia showed an excellent ability to detect pulmonary edema (area under the receiver operating characteristic 0.961) and findings were correlated with clinical evidence of respiratory distress (21 of 57 [37%] versus 14 of 109 [13%]; P = .001). Three studies evaluated abdominal POCUS, two of the inferior vena cava (IVC) to predict postspinal anesthesia hypotension (PSAH) and fluid receptivity and one to assess the rate of ascites in patients with preeclampsia. Patients with PSAH had higher IVC collapsibility (area under the curve = 0.950, P < .001) and, in patients with severe preeclampsia, there is a high rate of ascites (52%) associated with increased risk of adverse outcomes. There were no studies on the use of subjective cardiac POCUS.
POCUS use in the management of high-risk obstetrics has increased. LUS has been the most studied modality and appears to have a potential role in the setting of preeclampsia complicated by pulmonary edema. Cardiac and abdominal POCUS have not been well studied. Trials are needed to evaluate its clinical applicability, reliability, and technique standardization before widespread use.
综合目前关于产科床旁超声（POCUS）的证据。通过检索PubMed、Clinicaltrials.gov和Cochrane图书馆，从建库至2023年10月进行了一项范围综述。
如果研究描述了在产科或产后患者中使用POCUS，则符合纳入标准。两位作者独立筛选所有摘要。定量、定性和混合方法研究均符合纳入标准。排除单病例报告、综述文章和专家意见文章。描述详细的母体非产科超声图像或用于确认存活能力和排除异位妊娠的母体早孕期超声图像的研究也被排除。使用Microsoft Excel将数据制成表格，并通过叙述性综述和描述性统计进行总结。
通过检索策略共识别出689篇出版物，12项研究符合纳入标准。9项研究评估了在不同临床场景下产科中肺部POCUS的使用情况。子痫前期患者的肺部超声（LUS）检查结果显示，检测肺水肿的能力很强（受试者工作特征曲线下面积为0.961），且检查结果与呼吸窘迫的临床证据相关（57例中有21例[37%]，而109例中有14例[13%]；P = 0.001）。3项研究评估了腹部POCUS，其中2项评估下腔静脉（IVC）以预测脊麻后低血压（PSAH）和液体接受度，1项评估子痫前期患者的腹水发生率。PSAH患者的IVC塌陷性更高（曲线下面积 = 0.950，P < 0.001），在重度子痫前期患者中，腹水发生率较高（52%），且不良结局风险增加。没有关于使用主观心脏POCUS的研究。
POCUS在高危产科管理中的应用有所增加。LUS是研究最多的模式，似乎在子痫前期合并肺水肿的情况下具有潜在作用。心脏和腹部POCUS尚未得到充分研究。在广泛应用之前，需要进行试验以评估其临床适用性、可靠性和技术标准化。
