Will the Scan Change the Plan? Point of Care Ultrasound for Timely Decision Making in a Rural Obstetrics and Gynecology Department

Abstract

In rural and remote hospitals, access to urgent ultrasound especially out-of-hours can pose a barrier to timely clinical decision making. Focused Assessment with Sonography for Trauma (FAST) is a common practice in emergency departments to quickly identify abnormal free fluid in trauma patients and can allow targeted, early intervention. Where intraabdominal free fluid is present in the non-trauma population, a similar technique to FAST scanning called Focused Assessment for Free Fluid (FAFF) can be a simple and time-saving tool to facilitate and escalate emergency management. A ruptured ectopic pregnancy is a common gynecology emergency that may be associated with significant intraabdominal bleeding. This bleeding may be seen on FAFF as free fluid in the pelvis or upper abdomen allowing early decision making including surgical intervention, especially where there may be a delay in attaining formal sonographic assessment. In this case report, we describe the management of ectopic pregnancy presenting in a rural emergency department where FAFF ultrasound provided the diagnostic confidence to proceed to theater when access to formal sonography was delayed.

J Clin Gynecol Obstet. 2022;11(4):108-112
doi: https://doi.org/10.14740/jcgo816