Point-of-care ultrasound (POCUS) has rapidly become an essential advancement in modern clinical practice. By bringing real-time imaging directly to the bedside, POCUS allows the same clinician who examines the patient to also visualize anatomy, assess pathology, and immediately act on findings. This integration of imaging and decision-making has made POCUS indispensable across multiple specialties, and obstetrics and gynecology are no exception.
The American Institute of Ultrasound in Medicine (AIUM) has long recognized the importance of standardization and quality in ultrasound practice. Its Practice Parameter for the Performance of Point-of-Care Ultrasound1 provides clear specifications for evaluating the abdomen, retroperitoneum, thorax, heart, and extremities for deep venous thrombosis. These guidelines form the foundation for ensuring that the benefits of POCUS—speed, accuracy, and accessibility—are balanced with safety and quality.
POCUS in Everyday OB/GYN Practice
Within obstetrics and gynecology, POCUS is a natural extension of bedside care. On labor and delivery units, it enables rapid assessment of fetal presentation, amniotic fluid, and placenta and fetal well-being through biophysical profiles. In emergency and postoperative settings, clinicians can use POCUS to quickly evaluate for intraperitoneal free fluid, aiding in the diagnosis of ruptured ectopic pregnancy or postoperative bleeding.
Evidence continues to support the diagnostic reliability of POCUS in OB/GYN. For instance, Boivin et al2 evaluated its accuracy in diagnosing retained products of conception in 265 patients. They found that point-of-care ultrasound demonstrated a sensitivity of 79% and specificity of 93.8%, validating its value in streamlining diagnosis and guiding timely management.
Training Gaps and the Case for Structured Education
Despite its broad applicability, ultrasound training in OB/GYN residency and MFM fellowship remains highly variable. Currently, emergency medicine is the only specialty with formal requirements for ultrasound training and credentialing. This gap has led to inconsistent proficiency among new OB/GYN graduates, even though ultrasound is fundamental to the specialty.
A structured curriculum in POCUS can address this gap. Training should combine didactic instruction, hands-on scanning, and supervised image review, building both technical skills and diagnostic reasoning. Defining competency benchmarks and maintaining image portfolios reviewed by credentialed sonographers or MFM faculty can help standardize skill acquisition and ensure quality.
Expanding POCUS Applications in Obstetric Critical Care
POCUS offers unique advantages beyond fetal and gynecologic imaging, particularly in the management of acutely ill obstetric patients. In the setting of hypertensive disorders, sepsis, or peripartum cardiomyopathy, bedside ultrasound can provide immediate insights into maternal cardiopulmonary status.
- Lung ultrasound helps identify pulmonary edema, distinguishing cardiac from non-cardiac causes of dyspnea.
- Cardiac views allow assessment of contractility and pericardial effusion.
- Inferior vena cava (IVC) measurements help estimate fluid status and guide resuscitation in acutely ill patients.
Learning Early, Learning Effectively
Training in ultrasound doesn’t have to wait until residency. Vyas et al3 demonstrated that even first-year medical students could perform a basic obstetric triage scan after only twelve hours of training. Students correctly identified fetal lie, placental location, amniotic fluid index, biparietal diameter, and head circumference in more than 90% of cases, showing that structured, feedback-driven instruction can produce reliable results even among novice learners.
Sustaining Competence Through Practice
Ultrasound is a skill that requires repetition, reflection, and review. A comprehensive program should integrate longitudinal opportunities for scanning, image storage, and expert feedback. Access to curated image archives can help trainees build pattern recognition and diagnostic confidence. Incorporating POCUS assessments into rotations, such as emergency triage, obstetric critical care, or ultrasound electives, reinforces learning through real-world application.
Conclusion
Point-of-care ultrasound represents both an art and a science, merging clinical intuition with immediate visual data. For OB/GYN residents and MFM fellows, POCUS is not simply a diagnostic adjunct but a core competency that enhances patient safety, efficiency, and confidence at the bedside.
By embedding structured POCUS training and competency assessment into OB/GYN education, we can ensure the safe and effective use of ultrasound in medicine. Doing so ensures that the next generation of clinicians will not only interpret images but truly see their patients more completely, more immediately, and more compassionately.
References
1. American Institute of Ultrasound in Medicine. AIUM Practice Parameter for the Performance of Point-of-Care Ultrasound Examinations. J Ultrasound Med 2021; 40(8):E34–E52. https://doi.org/10.1002/jum.14972
2. Boivin J, et al. Utility of Point-of-Care Ultrasound in the Diagnosis of Retained Products of Conception. J Obstet Gynaecol Can 2020; 42(4):440–446. https://doi.org/10.1016/j.jogc.2019.08.026
3. Vyas KS, et al. Point-of-Care Obstetric Ultrasound Training for First-Year Medical Students in Rural Settings. J Ultrasound Med 2018; 37(3):715–722. https://doi.org/10.1002/jum.14404
Ruchira Sharma, MBBS, MD, FACOG, is a Maternal-Fetal Medicine Specialist, Director of MFM Fellowship, and Director of the Obstetric Ultrasound and Antenatal Testing Unit at Rutgers Robert Wood Johnson Medical School.
Sara Buhmaid, MD, is a Maternal-Fetal Medicine Fellow at Rutgers Robert Wood Johnson Medical School.
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