Abstract
Study objective
The objective of this study is to evaluate the accuracy of emergency providers (EPs)
of various levels of training in determination of gestational age (GA) in pregnant
patients using bedside ultrasound measurement of crown-rump length (CRL).
Methods
We conducted a prospective, cross-sectional, observational study of patients in obstetrical
care at an urban county hospital. We enrolled a convenience sample of women at 6 to
14 weeks gestation as estimated by last menstrual period. Emergency providers used
ultrasound to measure the CRL. Repeat CRL measurements were performed by either an
obstetrical ultrasound technician or senior obstetrician and used as the criterion
standard for true GA (TGA).
Results
One hundred five patients were evaluated by 20 providers of various levels of training.
The average time required to complete the CRL measurement was 85 seconds. When CRL
measurements performed by EPs were compared with the TGAs, the average correlation
was 0.935 (0.911-0.959). Using standard accepted variance for CRL measurements at
different GAs according to the obstetrics literature (±3 days for 42-70 days and ±5
days for 70-90 days), correlation between EP ultrasound and measured TGA was 0.947
(0.927-0.967).
Conclusions
Emergency providers can quickly and accurately determine GA in first-trimester pregnancies
using bedside ultrasound to calculate the CRL. Emergency providers should consider
using ultrasound to calculate the CRL in patients with first-trimester bleeding or
pain because this estimated GA may serve as a valuable data point for the future care
of that pregnancy.
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References
- United States emergency department visits for vaginal bleeding during early pregnancy, 1993-2003.Am J Obstet Gynecol. 2008; 198: 523.e1-523.e6
- A comparison of LMP-based and ultrasound-based estimates of gestational age using linked California livebirth and prenatal screening records.Paediatr Perinat Epidemiol. 2007; 21: 62-71
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Article Info
Publication History
Published online: February 10, 2012
Accepted:
December 2,
2011
Received in revised form:
November 28,
2011
Received:
September 2,
2011
Footnotes
☆Equipment used: Sonosite M-turbo, Bothell Washington.
Identification
Copyright
© 2012 Elsevier Inc. Published by Elsevier Inc. All rights reserved.
