Limited sonography in collaborative midwifery practice

In 1996, the American College of Nurse Midwives published guidelines for midwives who wish to incorporate limited third trimester sonography into their practices. First, however, certain didactic and clinical content needs to be disseminated through basic and continuing midwifery education. To assist the busy practitioner, information is offered related to recommended methods of obtaining learning validation and continuing competency in limited sonography. This article discusses various clinical situations in which the assessment and management of a patient's condition might be improved by having ultrasonographic information immediately available. In addition, selected data obtained by limited sonography that may necessitate physician collaboration are described through clinical case presentations. The pitfalls of limited sonography are also discussed by use of case descriptions detailing some of the risks inherent in performing a limited ultrasonogram. The recommendation of performing a complete uterine survey with each limited ultrasonogram is emphasized. Finally, some of the controversies surrounding routine sonography in pregnancy and sonograms for entertainment are addressed.