Expecting mothers typically experience ultrasound throughout their pregnancy providing an elating glimpse of the fetus, often marked by printed scan images on the refrigerator.
Amidst the ongoing pandemic, uncertainties about the virus and resulting anxieties have dramatically changed the pregnancy and patient care experience. The introduction of new cleaning protocols and preventative medical techniques have been implemented to protect both mom and baby.
To help ease these concerns and improve care for pregnant patients during the pandemic, a team of clinicians in Bologna, Italy have come together to develop a new ultrasound protocol for expecting mothers that goes beyond a typical pregnancy exam, now including insights into another key organ: the lungs.
The new ultrasound guidance developed in partnership by Aly Youssef, M.D., Ph.D., Carla Serra, M.D., Ph.D., and Gianluigi Pilu, M.D., Ph.D., faculty members at the University of Bologna, was recently published in in the July 2020 issue of the American Journal of Obstetrics and Gynecology.
The technique allows clinicians who are currently using ultrasound during their obstetrical exams to also examine and monitor the lungs, providing quick answers to mothers who are concerned they may have been exposed toed COVID-19 and safely monitoring those with the virus.
"We believe that extensive and rapid training of healthcare providers on the application of ultrasound in the detection of characteristic pulmonary signs of COVID-19, in addition to proper care and handling of their ultrasound machines, is feasible and may be critical to provide appropriate management especially to the obstetrical patients in the coming period.”
Lung Ultrasound Provides Convenience and Safety for Pregnant Patients
The protocol was developed by the team after working together in an ad hoc team at Sant’Orsola Malpighi University Hospital that had been quickly assembled to help combat the overwhelming number of COVID-19 cases in one of Italy's highly affected regions.
“We had been using lung ultrasound on patients in the ICU and as a practicing OBGYN I thought to myself, ‘We should be incorporating this into exams with pregnant patients during the pandemic being we’re already conducting ultrasounds routinely with them’,” said Dr. Youssef.
Dr. Aly Youssef performs a lung ultrasound on a pregnant patient using GE Healthcare's Voluson technology
Ultrasound has quickly emerged as an integral technology for clinicians treating COVID-19 patients due to its portability, fast imaging, and ability to be easily cleaned. Lung ultrasound in particular has been shown effective in quickly detecting signs of COVID-19 such as increased B-Lines and thickened pleura.
Additional benefits of using ultrasound for lung examinations on pregnant women include no radiation, compared to imaging technologies like CT or X-Ray, and bedside accessibility which can help reduce the patient’s risk of exposure to the virus during hospital visits.
“With many obstetricians and gynecologists already using ultrasound regularly for their patients, their familiarity with the technology makes them well suited for using the system on the lungs and has allowed them to adopt this technique to their existing obstetrical protocols in today’s environment,” said Dr. Youssef.
Using GE Healthcare’s Voluson Women’s Health Ultrasound technology, the team developed the protocol that involves checking for normal lung ultrasound findings which include a regular pleural line visible and sliding, and A-lines, regularly spaced horizontal lines under the pleural line.
COVID-19 and Pregnancy Forge New Scientific Turf
During the height of the pandemic, the Northern region of Italy faced over 300,000 confirmed cases of COVID-19. However, the team found that in their experience pregnant women were not more susceptible to the virus or at higher risk if they do contract the virus.
“We only saw a few pregnant women who contracted the virus, and in most cases, they were asymptomatic,” said Dr. Pilu. “For example, we had an expecting mother who came to the emergency room with mild chest pain and dyspnea, but no fever and normal oxygen saturation. Her obstetrical ultrasound was normal, but an ultrasound of both lungs showed pleural thickening and diffuse coalescent B-lines. She tested positive for COVID-19. The team could then monitor both her lung health and her obstetrical health using ultrasound. When both exams showed good health, we were able to discharge the mother with more confidence.”
Ongoing studies are reviewing if COVID-19 can be passed from mother to baby across the placenta, but while this work continues, Dr. Pilu shared a piece of advice:
“While there is still some unknown, we feel the best approach for expecting mothers is to practice the recommended precautions to prevent getting the virus. This is the best prevention for all.”
Click here to access the full poster on the lung ultrasound protocol developed for pregnant patients.