THE TRANSVAGINAL ULTRASOUND EXAM AT THE POINT OF CARE: FIRST TRIMESTER DATA 2011-2015

Intro: In 2006 a medical program combined the elements of obstetrics, ultrasound and family medicine. A one year fellowship for board certified super generalist was implemented. This fellowship emphasized quality improvement for prenatal care. Specifically , we developed a curriculum all phases of Point of Care ultrasound[POCUS]. This study describes the outcomes of transvaginal studies during the years 2011-2015. Methods: Using data from over 12 000 sequential ultrasound services in a private community health center combining high risk obstetrics and family medicine, frequencies were tabulated. In the study years 2011-2015, this community center proved total annual visit volumes of 40 000 and 500 deliveries.. Deliveries provided outcome data for quality of prenatal care. These data were used to assess blind spots in performance, document outcomes associated with transvaginal ultrasound. Condom sheaths and low grade cleaning with alcohol were used between examinations. Cases were followed delivery, completed miscarriage, or lost to follow-up. Documents for retention of data were saved in the computer. After 5 years of experience the curriculum was revised and simulators purchased to accelerate teaching of novices. Cervical length was added. Results: In comparison to previous studies, the utility and volume of point of care ultrasound has been underestimated. Quality was improved and risks were decreased. There are no previously published studies of this volume. The continuity of care and point of care service have not been previously described in the literature. Illustrative cases were collected for creation an improved curriculum within the surgical obstetrics fellowship with POCUS.