APGO

Steller, Jonathan
University of California, Irvine School of Medicine, Orange, CA

Study Objective: The Rural Obstetrical Ultrasound Triage Exam (ROUTE) was developed as a diagnostic algorithm for the use of portable ultrasound in rural areas to triage obstetrical patients at risk for maternal or fetal complication. While the routine use of obstetrical ultrasound without a specific clinical indication is not currently the recommended standard of care for all obstetrical patients by our governing bodies (ACR, ACOG, AIUM, and SRU), it has been shown to decrease fetal morbidity and it has the potential to decrease maternal morbidity and mortality in settings where antenatal care is scarce. The purpose of our pilot study is to determine if students are capable of learning and performing all of the various components of ROUTE and defining such an exam for use in future studies. The students included in this study plan to travel to rural Panama to teach the ROUTE algorithm to mid-wives in order to improve prenatal care.

Methods: Medical students with ranging levels of ultrasound training received a 60-minute presentation on the ROUTE, followed by two-to-five 30-minute hands-on sessions with a standardized subject, and an average of 10 hours practicing the ROUTE algorithm on patients in an obstetrics clinic with an obstetrician. The students then completed two to ten ROUTE exams on obstetrical patients whom they were blinded to. All images were read in real-time by certified obstetrical ultrasound technicians or obstetricians to check for accuracy.

Results: Following the didactic sessions, the students were able to properly assess all elements of the ROUTE exam on 85.7% of the standardized patients (n= 42). They were additionally able to measure crown-rump length (CRL), biparietal diameter (BPD), amniotic fluid index (AFI), placental location, and fetal presentation accurately in comparison to certified ultrasound technicians who served as controls. Seven out of eight crown-rump lengths and thirty of thirty-two biparietal diameters had less than 6% error of that measured by controls, and six out of six amniotic fluid indexes obtained were within 16% error of that obtained by the sonographers. Additionally, the students correctly assessed placental location and fetal presentation 95.2% (n=21) and 100% (n=11) of the time, respectively.

Conclusion: This feasibility study found that medical students were able to successfully learn the ROUTE exam following approximately 12 hours of didactic and hands-on training. With this evidence to support its feasibility, the students plan to travel to Panama where they partner with physicians to teach obstetrical ultrasound to medical workers with the American Red Cross and local midwives. Future studies hope to learn how effective obstetrical ultrasound can be taught to non-obstetrician, non-radiologist medical workers in Panama, and how ultrasound might affect maternal and neonatal morbidity and mortality in rural low-resource areas.

Key Words: ultrasound, education, obstetrics.