The final few weeks of the first trimester of pregnancy can be a time filled with worry. Women can have symptoms such a bleeding or cramping that may suggest an early pregnancy loss, but cannot know for sure without an ultrasound. In the final few weeks of a pregnancy, questions can arise about baby’s position, which necessitates an ultrasound to confirm the fetal position. Wait times for these ultrasounds can sometimes be several days at least, and in the interim, the family experiences tremendous anxiety and stress as they anticipate a diagnosis which may change their course of care.
Dr. Jennifer Tranmer and Dr. Alicia Power wanted to create the opportunity for outpatient ultrasounds during these two crucial periods at their clinic, Grow Health, which provides maternity care to 20% of Victoria’s population, rather than have to funnel these patients through Island Health’s busy ultrasound facilities. They sought a grant from the South Island Medical Staff Association to bring together key stakeholders to discuss existing barriers, brainstorm solutions, and develop protocols for improved care.
Drawing on expertise from Dr. Kim MacDonald, maternal fetal medicine specialist who works in the Antenatal Assessment Unit (AAU), the group convened a series of training sessions on basic ultrasound techniques, both for assessing fetal heart rate at 10-12 weeks and for fetal position at 36-40 weeks (Dr. MacDonald was compensated for his time while physician attendees attended without compensation). They then formed smaller working groups to develop protocols for how to manage a suspected fetal demise, how to manage a breech position, how to document these issues in the patient’s chart, and how to coordinate with the AAU to confirm diagnoses if necessary. They liaised closely with The Vancouver Island Woman’s Clinic which has been funded through Island Health to provide management of unplanned pregnancies and miscarriages.
All of these initiatives make it easier and less stressful for patients to resolve pregnancy loss without having to sit in the emergency room waiting for a spot to free up on the surgical slate. Likewise, for patients needing to confirm a breech position, they can do so without having to attend multiple appointments with various specialists and Island Ultrasound. If Dr. Power, Dr. Tranmer or their colleagues are able to confirm a breech position or detect a fetal heartbeat, they are able to save Island Health an ultrasound spot, and an unnecessary specialist appointment (in regards to breech).
In streamlining the process of administering perinatal ultrasounds in their clinic, the group estimates they have saved Island Health the cost and time associated with 5-10 ultrasounds per month. This has not only freed up time slots for ultrasounds needed for other patients, it has immeasurably improved the management of first trimester losses and term trimester queri breech management for patients. Speaking about the importance of providing this service for patients, Dr. Power stated, “By affording us the opportunity to train and provide this care for pregnant women in our clinic, not only are we improving their care and decreasing the tremendous anxiety in some women, but we are also decreasing unnecessary use of a valuable resource in our community. It also increases care providers skill and job satisfaction”.
Though there is currently no additional funding provided for performing these procedures, Dr. Power believes that she and her colleagues do it because it results in significantly better patient care. In the future, they would like to offer the use of the ultrasound machine and their designated space to other GPs and midwives keen to connect their patients with a more streamlined pathway for care. In the meantime, Dr. Power is liaising with Corilee Watters, Manager of Medical Imaging Quality and Operations for Geo 3 to provide insight into improving communication with patients experiencing first trimester pregnancy loss.
We thank this group for their hard work in improving access to prenatal ultrasound services and wish them all the best in the next steps of this project!