Incorporating Multiorgan Point-of-care Ultrasound into Obstetric Emergency Treatment Protocols.

Abstract

introduCtion Medical history records and physical examinations involving the inspection, palpation, percussion, and auscultation of different organs play an essential role in the decision-making process for disease diagnosis, management, and intervention in clinical medicine. However, advances in biomedicine and mechanical technology have led to an increasing number of traditional clinical examination methods being replaced. For example, medical ultrasound is being increasingly applied in various medical specialties. Bedside point-of-care ultrasonography (POCUS) performed by a clinician is often used to answer focused clinical questions instantly and to support decision-making in patient management.[1] In emergency and critical care medical settings, POCUS applied for patient examination primarily includes cardiac, lung, and abdominal ultrasounds used for the clinical assessment of specific symptoms or signs such as hypotension, shock, dyspnea, or chest pain.[2] Numerous structured protocols incorporating multiorgan POCUS (MOPOCUS) have also been proposed to guide assessment processes. In obstetrics and gynecology, a high-risk pregnancy can quickly develop into an obstetric emergency requiring urgent intensive care. However, although medical ultrasound is extensively applied in clinical obstetrics for maternal–fetal health care, POCUS protocols established in this field are generally limited to only the imaging of the fetus and pelvic organs. The incorporation of maternal POCUS into critical obstetric settings has the potential for preventing cardiovascular-associated maternal mortality.[3] This thus indicates that maternal POCUS should be incorporated into baseline obstetric ultrasound to ensure the more efficient diagnosis, treatment, and evaluation of obstetric emergencies; doing so can ensure that high-risk pregnant women obtain the same standard of care as their nonpregnant critical counterparts. Accordingly, the objective of this article is to present an avant-garde perspective on the incorporation of MOPOCUS into structured routine care protocols for the management of major obstetric emergencies, including postpartum hemorrhage (PPH), preeclampsia, and maternal sepsis; this can help clinicians and researchers more clearly understand the applicability of MOPOCUS in the clinical decision-making process for the management of obstetric emergencies.