Abstract
The Focused Assessment with Sonography for Trauma (FAST) exam, is a point of care ultrasound evaluation used routinely in surgical and trauma evaluation of critically ill patients to assess intrabdominal free fluid. It is a cost effective, noninvasive approach with no radiation exposure, which allows for rapid decision making in surgical intervention. Although extensively evaluated in the trauma and critical care literature, this study has never been evaluated in an obstetric population. Our objective was to create an ultrasound training protocol and evaluate the feasibility of this study during pregnancy. This is a prospective, observational study completed in large academic center. Health care providers (sonographers and physicians) underwent an ultrasound training protocol involving a live webinar and on-site supervision to obtain the four standard FAST exam views (the right upper quadrant, left upper quadrant, subcostal cardiac, and pelvis). Patients were enrolled after their routine obstetric ultrasound evaluation and additional images for the FAST exam were completed. The images were then reviewed for quality by a blinded physician subspecialist in clinician performed ultrasound and critical care echocardiography. 64 ultrasound studies were completed each evaluating standard FAST exam views. 62/64 (96.8%) of exams had adequate visualization of all windows. Fisher exact test was completed and no significant differences in visualization across gestational age between early pregnancy (24 weeks) , or BMI were noted (P<0.05). The FAST exam is a feasible study among pregnant women, it is not affected by gestational age or BMI. Training of obstetric providers with a web-based ultrasound protocol and quality review of images demonstrates the ability of clinicians familiar with obstetric ultrasound the ability to complete the FAST exam successfully. This is a novel study, suggesting the FAST exam may serve as a useful clinical adjunct during assessment of critically ill obstetric patients.
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