BackgroundThe major causes of maternal and neonatal mortality in the Philippines are hemorrhages and obstructed labor due to placental implantation abnormalities (PIAs), twin pregnancies and fetal malpresentations. All of which are all easily detected by ultrasound. However, women in rural areas and low-income groups do not have access to ultrasound during their prenatal care. We aimed to provide additional evidence on the benefits of handheld ultrasound (HU) for screening pregnancy related abnormalities in order to avert maternal and neonatal deaths.MethodsUsing a HU, we trained community healthcare workers (CHWs) to identify 5 obstetrical conditions: fetal viability and number, placental localization, amniotic fluid volume (AFV) and fetal presentation. Women, between 20th and 24th weeks age of gestation from 2 regions of the Philippines, were scanned using the HU and the GE Logic 5 Premium ultrasound machine for validation. Maternal and neonatal deaths averted were estimated as health outcome measures of the study.ResultsFour hundred sixty women were scanned of which 146 (31.7%) showed abnormal ultrasound readings consisting of 17 PIAs, 123 fetal malpresentation, 3 twins and 3 AFV abnormalities. The use of HU could have possibly averted 29 (6.3%) maternal deaths and 14.6% neonatal deaths at the time of delivery. Thirty-two out of the 460 women (~7%) delivered at home and 93% in hospitals or birthing facilities/lying–in centers. We observed approximately 95% agreement between the ultrasound readings of the trainees and the trainers, and 99% agreement between the readings made from the HU with the validation machine.ConclusionCHWs could be trained in the use of HU for scanning 5 obstetrical parameters. Early detection of abnormalities in these 5 obstetrical parameters can lead to early referral to facilities that are better equipped to manage obstetrical emergencies. Prenatal ultrasound can be an excellent point of care test for screening pregnant women at risk for possible complications and even death during labor and delivery.Trial registrationThai Clinical Trial Registry identification number TCTR20171128004, retrospectively registered November 28, 2017.

Fetal and pediatric cardiomyopathies are rare disorders with a yearly incident rate of 1.1-1.5 per 100, 000. Hypertrophic and dilated cardiomyopathy are two common forms of cardiomyopathy, characterised by thickened ventricular wall with diastolic dysfunction. The alpha kinase 3 (ALPK3) gene had recently been described to be associated with severe forms of pediatric cardiomyopathy, with phenotypic variations. We describe a case of fetal hydrops that presented on the 3rd trimester, due to severe cardiomyopathy with a ALPK3 gene mutation detected. A 40-year-old, G9P2, consanguineous relationship, with gestational diabetes and hypothyroidism, had a routine growth ultrasound at 32+3 showing fetal ascites. The ultrasound at the fetal medicine unit showed cardiomegaly and hydrops fetalis. Primary investigations for hydrops returned normal. Fetal Echocardiography confirmed cardiomegaly with biventricular hypertrophy and poor contractility, no apparent structural abnormality. Results from genetic testing (QF-PCR and MCA) were normal. The parents were counselled regarding further testing for definitive diagnosis. Interim, cardiac functioning was worsening along with hydrops fetalis needing imminent delivery by Caesarean section. At 33+1 weeks of gestation, a baby boy was born by Caesarean section. At birth weighed 2.2Kg and was transferred to NICU needing support due to impaired cardiac function. Aim of the treatment was to reach around 10Kg in order to have a heart transplant. Unfortunately, at three months of age the cardiac function deteriorated. Meanwhile a homozygous ''likely pathogenic'' variant in the ALPK3 gene was detected on whole-exome sequencing (WES), which have been associated with autosomal recessive cardiomyopathy. The parents were advised of the poor prognosis based on available literature. The decision was made to cease all life support. Parents were found to be carriers of the gene variation and were advised about the recurrence risk. VP22.18 Prenatal diagnosis of ostium secundum-type interatrial communication: a case report