AIUM Practice Parameter for the Performance of Limited Obstetric Ultrasound Examinations by Advanced Clinical Providers

American Institute of Ultrasound in Medicine, National Association of Nurse Practitioners in Women's Health, Association of Physician Assistants in Obstetrics & Gynecology, American College of Nurse-Midwives, SMFM, ACOG, American College of Osteopathic Obstetricians and Gynecologists — 2018

The American Institute of Ultrasound in Medicine (AIUM) is a multidisciplinary association dedicated to advancing the safe and effective use of ultrasound in medicine through professional and public education, research, development of practice parameters, and accreditation. Practice parameters of the AIUM are intended to provide the medical ultrasound community with recommendations for the performance and recording of high-quality ultrasound examinations.

To promote this mission, the AIUM is pleased to publish, in conjunction with the National Association of Nurse Practitioners in Women's Health (NPWH), Association of Physician Assistants in Obstetrics and Gynecology (APAOG), American College of Nurse-Midwives (ACNM), American College of Obstetricians and Gynecologists (ACOG), American College of Osteopathic Obstetricians and Gynecologists (ACOOG), and Society for Maternal-Fetal Medicine (SMFM) the AIUM Practice Parameter for the Performance of Limited Obstetric Ultrasound Examinations by Advanced Clinical Providers. This practice parameter has been developed for use by women's health nurse practitioners (WHNPs), physician assistants in obstetrics and gynecology (PAOGs), and certified nurse-midwives (CNMs)/certified midwives (CMs) performing and interpreting limited obstetric ultrasound studies within their scopes of practice.1-3

Scope-of-practice laws and requirements that govern each health care provider's clinical activity vary by individual state, including requirements for physician consultation and supervision. Health care providers and interprofessional health care teams should understand their scopes of practice within the state where they are practicing.4

With respect to this AIUM Practice Parameter for the Performance of Limited Obstetric Ultrasound Examinations by Advanced Clinical Providers, when the imaging issue is outside of advanced clinical provider's education, experience, or scope of practice, or when a high-risk situation is identified, consultation should occur with a qualified physician who at minimum meets the AIUM Training Guidelines for Physicians Who Evaluate and Interpret Diagnostic Obstetric Ultrasound Examinations in accordance with state law.1-3, 5 A plan should be in place to address imaging concerns outside the advanced clinical provider's scope of practice.

This parameter reflects what the AIUM considers the minimum criteria for a limited obstetric ultrasound examination within the scopes of practice of advanced clinical providers in women's health. For the purpose of this document and the associated AIUM Training Guideline, “advanced clinical providers in women's health” refers specifically to WHNPs, PAOGs, and CNMs/CMs. It is not intended to establish a legal standard of care or to replace the performance of a clinically indicated standard diagnostic6, 7 or detailed8 obstetric ultrasound examination. If not previously performed during the index pregnancy, a standard diagnostic or detailed obstetric ultrasound examination should be performed as soon as reasonably possible after the limited ultrasound examination.

A limited obstetric ultrasound examination may be performed in an acute clinical situation when an immediate impact on management is anticipated: for example, evaluation of cardiac activity or fetal presentation in a laboring patient. A limited obstetric ultrasound examination may also be performed in patients requiring serial examinations in which a subsequent anatomic evaluation may be unnecessary or impractical.

When a patient undergoes a limited ultrasound examination, it is important that she understands why a limited scan is being done and that she has appropriate expectations regarding the information being sought.

Clinical judgment should be used to determine the proper type of ultrasound examination performed.