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“Lung Ultrasound in The Third Trimester of Pregnancy: A Feasibility and Descriptive Study”
Abstract Number: T-26
Abstract Type: Original Research
Introduction: Lung ultrasound (LUS) a diagnostic, point-of-care modality providing rapid, accurate, repeatable and non-invasive determination of pathology leading to lifesaving interventions. The use of LUS in the intensive care and emergency medicine is increasing in popularity. Furthermore, evidence demonstrates its superiority in the diagnosis of pneumothorax and interstitial syndrome when compared to chest radiographs.1 The use of non-ionizing radiation for the rapid diagnosis of various pulmonary complaints in the pregnant population is extremely appealing. Nevertheless, there is scarcity in the literature pertaining to the feasibility of performing ultrasound in the pregnant women and the ability to adequately identify sonographic features. The purpose of this study was to assess the feasibility of performing this technique in pregnant women, judge inter-rater variability and review ultrasonographic findings in this population.
Methods: We conducted a prospective, descriptive study in non-laboring women during the third trimester of pregnancy. Three anesthesiologists undertook a training program and competency assessments by an expert in LUS. Operators followed a standardized and systematic protocol (2-5 MHz curvilinear array transducer, semi-recumbent or supine position,) using eight pre-defined anterolateral chest areas.2. At least two anesthesiologists scanned each patient independently. Primary outcome: feasibility of performing the LUS examination and description of the sonographic features. Secondary outcomes: inter-rater reliability of sonographic findings among anesthesiologists and presence of abnormal sonographic features (e.g. > 3 B lines and pleural effusions). The sample size will include 40 women. The analysis will include Kappa statistics and proportions of specific agreement.
Results: The training and competency assessments were completed successfully. We have recruited 23 out of the 40 planned subjects totalling 46 scans. Data collection is ongoing. Age, height, weight, BMI, gestational age and examination time: mean (SD) of 34 (5.9) years, 79 (17.1) kg, and 29 (5.7) kg/m2, 32+4 (2.9) weeks, and 11 (3.6) min. No patient had clinical signs or symptoms suggestive of pneumothorax, effusion or interstitial syndrome. Semi-recumbent position was the most comfortable position during examination. When B-lines were observed (n=23/46), they presented preferentially in the upper lateral zones bilaterally (n=14) and left upper anterior zone (n=6). However, only two patients had an abnormal B lines pattern in one single zone with no clinical significance. Inter-rater reliability will be judged when the sample size is completed.
Discussion: Training clinical anesthesiologists in LUS appear to be feasible. This diagnostic modality may be a promising tool in the management of various complications observed in pregnancy.
1)Intensive Care Med. 2012:38:577-91
2)Am J Emerg Med 2006;24:689-96