Pregnancy complications can be identified using masked ultrasound sweeps

Reference

Toscano M, Marini T, Lennon C, et al. Diagnosis of pregnancy complications using blind ultrasound sweeps performed by individuals without prior ultrasound training. Obstet Gynecol 2023;141(5):937-948.

Synopsis

This prospective cohort study included pregnant people (N = 168 with a total of 194 sonographic studies) who were referred for obstetric ultrasound during the second and third trimester of pregnancy. In addition to a reference standard diagnostic ultrasound by an ultrasound technician, the pregnant persons were also scanned by minimally trained personnel using the portable Butterfly iQ+ ultrasound system connected to Apple iPads. Reference standard sonography confirmed or excluded 1 of 4 conditions: multiple gestation (n = 52), noncephalic presentation (n = 81), placenta previa (n = 30), or amniotic fluid abnormality (oligo- or polyhydramnios; n = 36). There were 49 ultrasonograms with normal results (control group). Excluded were patients with fetal congenital abnormalities, fetal death, English not the primary language, severe SARS-CoV-2 infection, medical emergency, or who presented at a time of high clinical volume. The minimally trained personnel were medical students who received 3 hours of training, consisting of a 1-hour training video and 2 hours of hands-on training. They learned to perform 8 masked sweeps using the ultrasound probe guided by external body landmarks only. Maternal fetal medicine (MFM) specialists evaluated the images. They were masked to the images and reports from the reference standard diagnostic sonograms. Overall sensitivity for correct diagnosis was 92% (95% CI 87% - 96%). The results for multiple gestation were sensitivity 100%, specificity 95%; and for noncephalic presentation: sensitivity 92%, specificity 84%. Detection rates were lower for low-lying placenta or placenta previa (sensitivity 76%) and abnormal fluid volume (sensitivity 57%). Interrater agreement by 5 MFM specialists was moderate to high overall, but fair for low-lying placenta.