Butterfly iQ+ in Obstetric Anesthesia

The case for advanced ultrasound applications at the bedside in a specialty with increasingly diverse procedural demands.
A Case Study by
Original Research by
Antonio Gonzalez, MD.
“From guided neuraxial analgesia to peripheral and arterial cannulation, the value of simultaneous viewing of live-orthogonal planes supports the demand for versatility in anesthesiology today.”


The complexity of cases in obstetric anesthesia is increasing. We are experiencing an increase in maternal obesity, cardiac anomalies, as well as other comorbidities specifically related to the obstetric population (e.g., preeclampsia).1,2  This has necessitated the expansion of skills and tools to enable comprehensive obstetric care. This real-life account chronicles a recent example of use of Butterfly iQ+ to help support and streamline obstetrical care in a single morning of clinical practice.

Case History  

10am Labor and Delivery

I have just finished placing an epidural for a patient with a BMI of 60. With ultrasound guidance, we were able to identify the epidural space at 10cm from the skin with a single pass, and now the patient is comfortable. I place my Butterfly iQ+ in my back pocket when I get a call to help with a preeclamptic patient's blood pressure management in the triage area. 

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10:45am Obstetric Triage

I arrive in triage and find the patient will need an A-line insertion for continuous blood pressure monitoring. Shortly after that, the obstetric COVID unit called for support. 

11:30am Obstetric COVID Unit

I arrive in the COVID unit and discover that a morbidly obese maternal patient has lost her IV access. Carrying only my PPE and Butterfly iQ+ in my pocket, we mobilize the team to the unit and restore IV access in moments, with the support of Biplane Imaging™ at the bedside. 

What Does This Teach Us?

During a single morning of clinical practice, the ability to carry the power of ultrasound technology in my pocket helped facilitate care in three challenging cases: epidural guidance, challenging A-line insertion and technically difficult PIV placement. Given our patients’ increasing level of complexity, I see pocket ultrasound, and the advanced applications that it affords such as Biplane Imaging, as becoming increasingly synonymous with best practices of patient care.


1 Bamgbade OA, Khalaf WM, Ajai O, et al. Obstetric anaesthesia outcome in obese and non-obese parturients undergoing caesarean delivery: an observational study. Int J Obstet Anesth 2009;18(3):221 225. Doi: 10.1016/j.ijoa.2008.07.013.

2 Arendt KW, Lindley KJ. Obstetric anesthesia management of the patient with cardiac disease. Int J Obstet Anesth 2019;37(European Heart Journal 32 2011):73 85. Doi: 10.1016/j.ijoa.2018.09.011.

Image 1. Normal Side. Pediatric Lung setting, demonstrates clear pleural line with sliding and z lines (aka comet tails). No indication of B lines; normal appearing lung

Image 2. Abnormal side. Additional air bronchograms further identifying the consolidated lung region. With respiration consolidated lung is partially obscured by B lines. Consolidated lung with dynamic air bronchograms

Image 3. Abnormal Side. On left of image: few B lines indicating presence of fluid in lung, irregularly appearing pleural line with sub pleural consolidation (~ 2 cm in depth). Consolidated lung area looks like liver hence the term, lung hepatization. Echogenic dots are air bronchograms; these collections move with respiration therefore they are called dynamic air bronchograms. (Note: dynamic air bronchograms = pneumonia; static air bronchogram - no movement with respiration = atelectasis)

Antonio Gonzalez, MD.

Assistant Professor of Anesthesiology and Director of the Obstetrics Anesthesia Fellowship at Yale New Haven Hospital.