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Clinical and Experimental Obstetrics & Gynecology  2020, Vol. 47 Issue (3): 348-354    DOI: 10.31083/j.ceog.2020.03.5307
Original Research Previous articles | Next articles
Ultrasound by midwives in the postpartum period: feasibility, reproducibility and midwives’ perspectives
S. Coremans1, J. Muys1, J. De Winter1, H. De Raedemaecker1, Y. Jacquemyn1, *()
1Department of Obstetrics and Gynaecology, Antwerp University Hospital UZA and Antwerp University UA, ASTARC and Global Health, Edegem, Belgium
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Abstract  

Objective: To describe feasibility, reproducibility, and acceptability of introducing ultrasound by midwives as a routine in postpartum care. Materials and Methods: A quantitative, monocentric cross-sectional study used questionnaires to evaluate the viewpoint of the midwife and the mother; repeat transabdominal ultrasound measurements were made of uterine length, width, height, and endometrial thickness by midwives, junior gynaecology trainees, and experienced gynaecologic ultrasonographers, 24 to 48 hours after delivery; Bland-Altman plotting assessed interand intra-observer variability. Results: Fifty-five percent of midwives considered implementation of ultrasound in postpartum care as feasible; time restrictions were seen as an obstacle by 60%, and 97% considered themselves after training as capable to perform postpartum ultrasound autonomously. Almost all mothers valued the ultrasound as non-disturbing and interesting. Inter-observer variability demonstrated a fixed bias between midwives and gynaecologists for total uterine length but not for other measurements. Intra-observer variability decreased with experience but was generally low and there was no fixed bias. Conclusion: Midwives saw postpartum ultrasound as feasible in daily practice, reproducibility was acceptable, and the mothers’ experience was positive. More study is needed to evaluate the eventual clinical value of routine postpartum ultrasound.

Key words:  Postpartum      Retained products of conception      Ultrasound      Midwifery     
Submitted:  07 June 2019      Accepted:  24 September 2019      Published:  15 June 2020     
*Corresponding Author(s):  YVES JACQUEMYN     E-mail:  Yves.Jacquemyn@uza.be

Cite this article: 

S. Coremans, J. Muys, J. De Winter, H. De Raedemaecker, Y. Jacquemyn. Ultrasound by midwives in the postpartum period: feasibility, reproducibility and midwives’ perspectives. Clinical and Experimental Obstetrics & Gynecology, 2020, 47(3): 348-354.

URL: 

https://ceog.imrpress.com/EN/10.31083/j.ceog.2020.03.5307     OR     https://ceog.imrpress.com/EN/Y2020/V47/I3/348

Figure 1.  — Standardized images and measurements as performed on day 2 after delivery by transabdominal ultrasound. a) Measurement of the maximal endometrial thickness. b) Measurement of uterine length. c) Measurement of uterine width. r) Example of retained products of conception.

Table 1  — Midwives’ responses regarding postpartum ultrasound, with variance and relative frequency (N = 30)
Table 2  — Opinions of recently delivered women, with variation and frequency (N = 56)
Figure 2.  — Bland-Altman plot for inter-observer variability; three different measured dimensions (endometrial thickness, uterine length, and uterine width) are presented in rows and in columns with comparisons between different operators (midwife versus junior sonographer, junior sonographer versus experienced sonographer, and midwife versus experienced sonographer). The green line represents the mean difference between measurements and the red lines represent 95% confidence interval for the difference between measurements, i.e. limits of agreement.

Table 3  — Inter-observerariability and testing for fixed and proportional biases
Midwife versus junior sonographer Junior versus experienced sonographer Midwife versus experienced sonographer
Endometrial thickness A
B
C
D
0.08
0.40
2.66
0.02
-0.07
0.38
2.23
0.16
0.02
0.81
2.22
0.36
Uterine length A
B
C
D
-0.51
0.11
8.72
0.06
-0.48
0.11
8.09
0.21
-1.04
0.001
8.15
0.73
Uterine width A
B
C
D
-0.56
0.14
10.28
0.17
0.01
0.98
7.19
0.72
-0.34
0.37
10.27
0.76
Figure 3.  — Bland-Altman plot for inter-observer variability; three different measured dimensions (endometrial thickness, uterine length, and uterine width) are presented in rows and in columns with comparisons between operators (midwife versus junior sonographer, junior sonographer versus experienced sonographer, and midwife versus experienced sonographer). The green line represents the mean difference between measurements and the red lines represent 95% confidence interval for the difference between measurements, i.e. limits of agreement.

Table 4  — Intra-observerariability and testing for fixed and proportional bias
Midwife versus junior sonographer Junior versus experienced sonographer Midwife versus experienced sonographer
Endometrial thickness A
B
C
D
-0.11
0.58
1.72
0.74
-0.05
0.56
1.00
0.05
0.07
0.36
0.80
0.56
Uterine length A
B
C
D
-0.34
0.34
3.10
0.43
-0.14
0.68
3.84
0.84
-0.01
0.97
2.21
0.10
Uterine width A
B
C
D
-0.66
0.56
10.13
0.08
-0.03
0.90
2.74
0.03
0.12
0.45
1.85
0.54
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