AFJOG

REVIEW African Journal of Obstetrics and Gynaecology | Volume 3 | Issue 2 | 2025 | The Role of Point-of-Care Ultrasound (POCUS) in improving maternal outcomes: An overview INTRODUCTION Maternal mortality and morbidity continue to be significant global health challenges, especially in low- and middle-income countries (LMICs). Early diagnosis and prompt treatment of critical pregnancy conditions are essential. POCUS has transformed bedside diagnostics by providing immediate, actionable clinical insights, particularly in resource-limited settings. This overview examines how POCUS can improve maternal care by demonstrating its clinical value in various obstetric and medical emergencies. Obstetricians and gynecologists are well-positioned to adopt POCUS, as they can quickly learn it using their existing ultrasound expertise. POCUSPROTOCOLS Several POCUS protocols have been developed over the years for emergency medicine and critical care; many have been adapted for specific clinical specialties and situations, often with variations of the original protocol names. The basic protocols aim to answer yes/no questions, such as whether the left ventricle is contracting effectively. However, as these basic protocols evolve and the sonographer's skillset improves, more advanced measurements become possible, providing additional clinical information obtained at the bedside. Themost well-known POCUS protocols include the following: The Extended Focused Assessment with Sonography in Trauma (E-FAST) was originally developed and used in trauma cases to detect intra-abdominal bleeding caused by blunt force injuries. It has now been expanded to include thoracic conditions such as hemopericardium with or without tamponade, hemothorax, and pneumothorax. The E-FAST has been integrated into the Advanced Trauma Life Support (ATLS) framework for trauma care. It is performed alongside resuscitative efforts and can be repeated if the initial assessments are negative. (1, 2) Professor Eric Sloth developed the Extended Focus Assessed Transthoracic Echo (E-FATE) in 1989. The protocol aims to provide a straightforward and quick method for evaluating cardiac function in peri-operative and critical care settings using four standard transthoracic echocardiographic views. (3, 4) Daniel Lichtenstein created the Bedside Lung Ultrasound in Emergency (BLUE) protocol in the late 1990s to assess dyspnea. Using a standardized set of lung ultrasound findings, the protocol develops profiles based on artifact patterns and signs, each linked to a specific lung condition. It has proven to be highly accurate in diagnosing pneumonia, pulmonary edema, pneumothorax, and other respiratory conditions. (5, 6) The original POCUS protocols were integrated into other protocols that include additional views, such as the Rapid Ultrasound Assessment of Shock (RUSH) protocol. This protocol offers a comprehensive evaluation of the heart, lungs, inferior vena cava (IVC), and abdomen to identify the cause of undifferentiated shock in patients. (7) Essentially, the clinical applications remain the same, and the fundamental principles behind these protocols can also be applied in obstetric care. However, a dedicated obstetric POCUS protocol has not yet been established. CLINICALAPPLICATIONS 1. Lung ultrasound andDyspnea in pregnancy Lung ultrasound (LUS) surpasses physical exams and chest X-rays, often approaching the accuracy of CT scans in certain cases. Research indicates that LUS is especially effective at diagnosing pneumonia (sensitivity 91-96% for LUS versus 57- 73% for chest X-rays), pleural effusions (sensitivity 83-100% for LUS with volumes as small as 50ml), and pneumothorax (sensitivity 9.6% for LUS compared to 68.8% on supine chest X-ray). Pregnant patients with dyspnea can be quickly evaluated using POCUS, which reduces exposure to ionizing radiation and allows for prompt, appropriate treatment. It also assists in monitoring and documenting pathological findings until they are fully resolved. (8) 2. Cardiac Ultrasound andMaternal Heart Disease Cardiac disease contributes to 1-4% of maternal morbidity and mortality. In LMICs, rheumatic heart disease remains prevalent. Cardiac POCUS can be crucial for screening and detecting asymptomatic valvulopathies and other conditions, such as rheumatic mitral stenosis and regurgitation, peripartum cardiomyopathy, pulmonary embolism, aortic dissection, and cardiac tamponade. During acute emergencies—such as postpartum collapse, undifferentiated shock, pregnancy-related tachycardia, dynamic left ventricular outflow obstruction, and sudden-onset heart failure—cardiac POCUS is extremely useful in determining the likely cause. It is also useful for evaluating hypertension during pregnancy, helping the clinician determine if it is chronic (by observing left ventricular hypertrophy) or identify poor prognostic or high-risk indicators in pre-eclampsia, such as diastolic dysfunction and B-lines that indicate potential pulmonary edema. Cardiac views include the parasternal long- and short-axis, apical four-chamber, subxiphoid views, and IVC assessment. The IVC assessment during pregnancy presents unique challenges because it is larger early on but decreases as pregnancy progresses. After 16 weeks, the IVC size remains unchanged L Bösenberg Department of Internal Medicine, University of Pretoria, Pretoria, South Africa CORRESPONDENCE: L Bösenberg | Email: liesel.bosenberg@up.ac.za The Role of Point-of-Care Ultrasound (POCUS) in improving maternal outcomes: An overview ABSTRACT Point-of-care ultrasound (POCUS) has become a transformative tool in obstetric medicine, enabling accurate diagnosis and monitoring. Its uses include assessing respiratory and cardiac issues, abdominal pain, vascular emergencies, and undifferentiated shock during pregnancy. Its portability and real-time visualization allow for immediate treatment decisions. As non-radiologists expand their skills, POCUS has the potential to significantly improve maternal outcomes. This overview highlights some current protocols, clinical applications, and evidence supporting the integration of POCUS into routine obstetric care. Keywords: POCUS, lung ultrasound, focused cardiac ultrasound, undifferentiated shock, obstetric emergencies African Journal of Obstetrics and Gynaecology | Volume 3 | Issue 2 | 2025 | 06