Point-of-care ultrasound (POCUS) encompasses an umbrella term for the use of ultrasound for diagnostic, monitoring, or therapeutic purposes. The evolution of ultrasound devices from large cart-based machines to handheld pocket probes has expanded the pool of users for this technology as well as its range of applications.1 Obstetric anesthesiologists have a wide range of use for POCUS in both low- and high-risk parturients. The routine application of POCUS may encompass its use for facilitating procedures, such as vascular access, regional anesthesia techniques as well as assessing airway/lung/cardiac/intracranial and abdominal pathologies that may be encountered in the peripartum period (Fig. 22-1). The integration of POCUS into clinical practice was once deemed a desired skill but is fast becoming a prerequisite skill for obstetrical anesthesiologists to provide best patient care. This chapter will focus on the current and evolving use of ultrasound within obstetric anesthesia. Detailed description of ultrasound technology along with descriptive methods of obtaining and optimizing views is beyond the scope of this chapter.
Scope of POCUS used by obstetric anesthesiologists for diagnostic, monitoring, and procedural guidance purposes. DVT, deep vein thrombosis; ICP, intracranial pressure.
Neuraxial anesthesia is the most common procedure performed by obstetric anesthesiologists and is traditionally performed using a landmark technique. Patient characteristics such as obesity, scoliosis, lordosis, and previous spine surgery along with pregnancy-related changes such as edema can sometimes make this procedure difficult and result in a higher incidence of complications such as inadvertent dural puncture and paresthesia. In patients with difficulty to palpate landmarks preprocedural ultrasound has been shown to reduce the number of attempts, improve the efficacy of neuraxial anesthesia, and result in improved patient satisfaction.2
Hypoxia due to pulmonary edema can often complicate pregnancy-related diseases such as preeclampsia or patients undergoing massive transfusion due to postpartum hemorrhage. Point-of-care lung ultrasound has proven itself to be both sensitive and specific in the diagnosis of pulmonary edema and can direct and monitor care in these patients. Lung ultrasound can also be used to assess for pneumothorax in patients who may have had a central venous catheters placed for their peripartum care.
Difficult and failed intubations are more common in obstetric patients undergoing general anesthesia. Surgical airway access may be required for patients in whom the airway cannot be secured, and oxygenation is unable to be achieved. In this emergency situation, ultrasound identification of the cricothyroid membrane has been shown to be superior to digital palpation and may lead to a higher success rate if emergency cricothyroidotomy.3
Hemodynamic instability may occur for a multitude of reasons in the peripartum ...