PREGO Protocol: Point-of-Care Ultrasound for Evaluating Third-Trimester Pregnancy in the Emergency Department

Knowledge about a third-trimester pregnancy is essential for guiding management of a pregnant patient presenting to the emergency department (ED) in labor or with an acute obstetrical complaint. Unfortunately, patients in their third trimester may present without prenatal obstetric care or with a condition (e.g., ill, altered, or trauma) in which information about the pregnancy is not immediately available. Moreover, many rural and community hospitals do not have an obstetrician available during all hours of the day. Our proposed point-of-care ultrasound (POCUS) PREGO protocol provides emergency physicians a bedside diagnostic framework to inform timely clinical decision-making.

This manuscript presents the PREGO protocol consisting of 5 transabdominal POCUS parameters for evaluating a third-trimester pregnancy in the ED. First, we describe the rationale and clinical implications for each parameter. Next, we provide the associated evidence for each parameter. Finally, we discuss common pitfalls and use high-quality media to provide step-by-step tutorials and advanced pearls for use at the bedside.

The 5 POCUS parameters of the PREGO protocol are: 1) Placental location; 2) fetal heart Rate; 3) Estimated amniotic fluid volume; 4) estimated Gestational age; and 5) fetal Orientation.

The order and priority in which each parameter is obtained depends on the patient's clinical presentation. Use of this framework can aid in formulating a management plan, streamline communication with obstetricians, guide early mobilization of operative resources, inform neonatal resuscitation preparations, and determine the need for transfer to an outside hospital when indicated.