Re: OB Ultrasound

["david lichtman" <davidlichtman@medscape.com>]

The ability to identify whether or not the head of the 
fetus is lying with its head towards the birth canal is a 
fairly simple task that can be learn with minimal amounts 
of training; however, I am not sure why this is skill is 
deemed necessary by the average flight crew when caring for 
high-risk OB patients.  This is not the most important 
finding you can interpret during an in-depth OB examination.

More important aspects of great flight medicine for the OB 
patient would be include a detailed history of the 
pregnancy, interpretation of significant lab values, a 
thorough knowledge of ACOG protocols (particularly those 
pertaining to management of high-risk obstetrical patients 
designed to delay delivery and allow time for fetal lung 
maturation), and many others.

There are so many nuances to understanding obstetrical 
ultrasounds that unless you practice routinely on OB 
patients, your skills will not do you or your patient any 
good.  In fact, just because you find the head in a vertex 
position, many providers might feel overconfident in their 
abilities, and may find themselves lulled into a false 
sense of security.

The best course of action, for flight programs that do not 
have the luxury of an in-house OB team that manages the 
high-risk pregnancies, is to contact the hospital(s) that 
will be receiving your OB patients and coordinate a 
training program for your staff with their high-risk 
obstetricians or perinatologists and their neonatologists.  
This will allow your staff to implement care that will be 
in continuity with the care that will be provided upon your 
arrival.  These facilities have also (in most cases) 
reviewed and tested numerous pieces of equipment, and can 
be a valuable resource in helping determine which ones 
would best suit your program's needs.  Additionally, 
medicine changes and OB is no exception.  Having access to 
updates in protocols, equipment and technology will not 
only benefit you, but your patients as well.

I truly believe that most OB patients can be managed quite 
well by competant aeromedical providers that are not OB 
specialists.  I am just of the belief that you do not need 
to expend time and resources on ultrasound capabilities for 
these patients.  If you really find the need to learn and 
use ultrasound technology, I believe that the trauma 
population (both male and female) would be more 
significantly impacted by its use.

I hope this was of benefit to some of you who read it.

Be safe,
David Lichtman

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