Ultrasound during Pregnancy: At the Bedside and in the Office
Nurses wishing to expand their practice scope with regard to ultrasonography during pregnancy had the opportunity to receive some guidance from Marilyn Stringer, PhD, WHNP-BC, RDMS, FAAN, Professor, Women’s Health Nursing, University of Pennsylvania, and Clinical Educator, University of Pennsylvania Health System School of Nursing, Philadelphia, during her presentation at the 2010 meeting of the Association of Women’s Health, Obstetric and Neonatal Nurses (AWHONN).
Dr Stringer, who is also Associate Editor of the Journal of Obstetric, Gynecologic, & Neonatal Nursing, said that nurses have good reason to expand their ultrasound assessment skills. “Timely intrauterine fetal assessment may be life-saving and can lead to more appropriate management plans,” she said. “It’s often the nurse who is there when the patient presents with a problem. Being able to put a scanner on the belly will often give you an answer.”
The AWHONN practice guidelines recommend that nurses have 8 hours of didactic instruction and demonstrate clinical competence in this area. “When you do, you need documentation of how you learned,” she said, “including what courses, sessions, and so forth that you attended. It’s no different from documenting your education, for example, in fetal monitoring.”
Nurses can determine if they can conduct bedside ultrasound by first checking their state’s guidelines, which vary, and the guidelines of their professional organization. “Most states do not forbid nurses from doing this, and AWHONN’s guidelines support nurses doing ultrasonography in their own practice settings,” she noted.
Proper Use of Ultrasound
Dr Stringer described the indications for ultrasound in the OB/GYN setting. (The updated information is in bold type.)
Ultrasound in gynecologic and reproductive medicine is meant to provide targeted, rather than diagnostic, data. It is used to evaluate ovarian follicles, for intrauterine device placement, to contribute to postvoid assessments, and to evaluate endometrial thickness.
Obstetric first-trimester ultrasound is performed to define the number and measurement of the yolk sac, gestational sac, and embryo/fetus; to determine fetal cardiac activity; and to differentiate intrauterine from extrauterine pregnancy. It also provides adjunctive visual guidance for a number of interventions in the first trimester.
In the second and third trimesters, ultrasound determines fetal number, location, and presentation; describes fetal cardiac activity; defines placental location; measures amniotic fluid volume; is part of the biophysical profile; estimates fetal age and weight; measures cervical length; and serves as an adjunctive visual guide to certain interventions.