A health clinic in St. Paul, Minnesota, is touting results from an Early Pregnancy Dating and Risk Assessment (EPD-RA) program utilizing point-of-care ultrasound (POCUS) to enhance first trimester obstetrical care.

Launched in September 2022, the bimonthly clinic at M Health Fairview Bethesda Family Medicine Clinic has improved access to timely care and provided enhanced support to first trimester patients through a program focused on early pregnancy dating, risk assessment, and timely management of complications. At the clinic, POCUS is part of a multidisciplinary visit to confirm viable intrauterine pregnancies, estimate gestational age, and address potential first trimester complications.

Notably, POCUS has expedited the diagnosis of high-risk conditions like ectopic and molar pregnancies.

For patients experiencing miscarriage, the average time from initial concern to diagnosis dropped significantly from 5.8 days to 1.7 days after the clinic’s implementation. For those without miscarriage, first trimester emergency department visits, urgent clinic appointments, and telephone calls decreased by 81%.

The initiative primarily serves a diverse patient population, including many non-English-speaking refugees, with nearly all patients covered by Medicaid. The clinic, which typically handles 55 to 80 prenatal cases at a time, operates in collaboration with the Woodwinds Family Medicine Residency program, involving 24 residents and 10 core faculty, two of whom are fellowship-trained in family medicine obstetrics (FMOBs).

The clinic visits include detailed history-taking, risk assessment, and patient education. The clinic assigns due dates, initiates medical management, and provides counseling on miscarriage management and first trimester concerns such as vaginal bleeding and nausea.

The model of care at M Health aligns with American Academy of Pediatrics and American College of Obstetricians and Gynecologists (AAP/ACOG) guidelines but optimizes workflow by consolidating multiple steps into a single visit.

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