Ultrasound by midwives in the postpartum period: feasibility, reproducibility and midwives' perspectives

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.