Book Description

Specialization has driven medical practice over the last century. Expanding knowledge has increased the physician workforce but has decreased the proportion of general family doctors, leaving rural areas with critical physician shortages. In 1978 almost half of family physicians delivered babies. By 2005 this number decreased to 23 percent. Although many recognize the broad medical and surgical skills required in remote Africa, few recognize the need for similar skills among doctors in rural America. These physicians blend family and emergency medicine with specific skills from obstetrics, gynecology, and general surgery. Many family doctors provide extensive women’s health services, including cancer screening, prenatal care, and cesarean delivery. This work is written for these physicians. In rural areas, most women cannot leave their communities to have children. Extensive travel for prenatal care and delivery has detrimental economic and social consequences. Although rural counties provide quality care, they cannot afford an array of technicians, nurses, and physicians trained in obstetrics, gynecology, surgery, neonatology, and critical care. Drawing from my mentors’ and family’s experiences in Texas and Tennessee, I realized that there was no formal ultrasound curriculum for family doctors providing rural obstetrical care. The majority of texts have been written for ultrasound technicians performing examinations and subspecialists interpreting the acquired images. Historically, family physicians have played a prominent role in obstetrical patient safety and care, as seen through the continued success of the Advanced Life Support in Obstetrics (ALSO) curriculum. Although the ALSO course provides valuable training, I argue that a formal program for physician performed obstetrical ultrasound is equally, if not more, important. Ultrasound is the basis for obstetrical risk stratification. Without basic skills, physicians may inadvertently put mothers and children at risk. For example, a physician in west Texas should not trend beta hCG levels over two days when evaluating a suspected ectopic pregnancy. Any suspected threat to pregnancy should be investigated immediately at the point of care to avoid unnecessary delays that may lead to maternal or fetal death. This text serves as a rational but not exhaustive introduction to obstetrical ultrasound for the physician providing women’s health services in remote or resource-poor settings. This text distills volumes of information found in advanced obstetrical textbooks as well as recent American and European literature. The referenced articles come from a variety of journals and represent many specialties. Ultimately, we desire to promote patient safety and improve care and welcome any suggestions or ideas that help achieve this goal. Thank you for selecting this text; we hope it serves you and your patients well.