Perinatal Ultrasound Examination 

Pregnancy and perinatal care are integral to many family physicians' scope of practice and an important component of family medicine residency training.

Perinatal ultrasound examination appropriately enhances the diagnostic and therapeutic capabilities of family physicians. Applications in family medicine can be divided into the following general areas:

• First trimester diagnostic pregnancy care
• Second or third trimester diagnostic pregnancy care
• Ultrasound-guided procedures (e.g., amniocentesis)
• Emergency care of acutely ill patients in labor and delivery, in the emergency department, and in the office

Every family physician who delivers infants can make use of ultrasound examinations for applications that often arise suddenly and can have significant impact on patient care. These applications—which include assessment of fetal life, fetal number, fetal presentation, quantity of amniotic fluid, and placental location—are readily learned by family physicians. Family physicians can acquire skills for performing obstetric ultrasound examination during their family medicine residency training or a post-residency fellowship.

The American Academy of Family Physicians (AAFP) recommends that family physicians document all significant training and experience so that this information can be reported in an organized fashion, if necessary. Documentation should demonstrate the physician’s understanding of the technology, ability to perform the ultrasound examination, and ability to interpret findings. Any family physician who intends to perform perinatal ultrasound examinations is advised to keep a record of the following:

• Courses taken, including the number of hours of formal learning involved
• Number of directly supervised examinations performed
• Total number of examinations performed
• Types of examinations performed (e.g., standard examinations, labor and delivery scans, emergency department scans, ultrasound-guided procedures)

In addition, the AAFP acknowledges that documentation of outcomes is important to demonstrate proficiency and support credentialing. In the case of perinatal ultrasound examination, specific outcomes that are most likely to be scrutinized include the following:

• Accuracy of gestational age assessment by correlation of eventual delivery date and gestational age at birth
• Accuracy of fetal anatomic survey by follow-up of infants suspected of having fetal anomalies or those in whom fetal anomalies were missed

The AAFP advocates that ultrasound privileges should be granted on the basis of individual physician’s training, experience and demonstrated current competence, not by specialty designation alone. These criteria apply to performing perinatal ultrasound examinations in the family medicine practice, emergency department, and other settings. 

(2002) (October 2023 COD)