New Zealand College of Sexual & Reproductive Health

Abortion Training

Module 4: Point of care ultrasound in first trimester abortion (POCUS)

8. Key Learning Points

  • Point of care ultrasound is different from radiology performed diagnostic scanning. It should be used by trained practitioners to answer simple clinical questions. You should not attempt to make interpretations outside of your training.
  • Point of care ultrasound findings should always be integrated with clinical assessment; it is an extension of the examination, not an isolated investigation
  • Point of care ultrasound of early pregnancy is designed to help the clinician confirm that a pregnancy is intrauterine, and hence rule out ectopic pregnancy. However, the identification of an ectopic pregnancy is outside the scope of this module.
  • Whilst ultrasound of a pregnancy should be limited to necessary scans and scan time only, there is no evidence that exposure to ultrasound harms the fetus
  • A full bladder will allow the best transabdominal view of the uterus.
  • Transvaginal scans show greater resolution and scan with more accuracy. In general, an IUP can be seen 2 – 3 days earlier with transvaginal scanning than transabdominal scanning. However, this approach is more invasive and equipment may not be available; therefore transabdominal scanning is preferred for point of care ultrasound.
  • A gestation sac should be seen in the uterus with transabdominal scanning with a serum βhCG level above 3,500 MIU/L
  • Depth should be set on the scanner to include the entire uterus on the scan and for it to take up the whole depth of the screen
  • Clinicians should always perform a full survey, scanning through the uterus in two planes before proceeding to take measurements for gestational age
  • Scanning the entire uterus in two planes also helps to confirm that a pregnancy is intrauterine. Ensure that the gestational sac is surrounded by a thick rim of muscle through the entire scan. A gestation sac alone does not confirm an intrauterine pregnancy; you must see either a yolk sac or foetal pole inside it. Without these additional findings ectopic pregnancy has not been ruled out.
  • A gestation sac should be measured in three separate axes with these diameters averaged in order to ascertain most accurate gestational age

Made with by the bpacnz team

Partner links