In South Africa advanced midwifes are expected to independently provide comprehensive midwifery care from prenatal to postnatal stage. The integration of obstetric ultrasound diagnostics capability into routine pregnancy care delivery by the first healthcare responders will augment clinical decision making and appropriate case management action. The current PHC service delivery has not integrated basic ultrasound capability into routine pregnancy care service. Advanced midwifes were trained on basic obstetric ultrasound and make a care management decision based on ultrasound findings performed. Midwifes could accurately diagnose morbidity related complications. We conclude that advance midwifes care management plan is augmented when competence and provision of limited obstetrics ultrasound is integrated as a routine pregnancy care service in a maternity outpatient unit and community health centre. Because close to fifty percent of women from the community who attend these clinics could not accurately recall their last menstrual period, it is appropriate, and should become an expectation for these first responders to utilise ultrasound to offset potential morbidity induced by uncertainty of gestational age and weight estimation. These should be an integral component where this program is transferred or reproduced.

In South Africa, midwives in primary healthcare setting are first responders to majority of the expectant mothers in the community. These pregnant mothers should benefit from at least one ultrasound in their pregnancy according to the WHO recommendation. However, these midwifes are not equipped to provide such limited obstetrics ultrasound services essential to accurately date the pregnancy, identify normal pregnancy and refer unsuspecting mothers in a timely manner following abnormality detected on ultrasound. The Advanced Midwifes could accurately diagnose morbidity related complications (for which ultrasound is perceived as the gold standard), they were trained to identify -placenta previa, breech presentation, intrauterine foetal demise and miscarriages, abnormal amniotic fluid levels, cervical incompetence, ectopic pregnancy, abnormal foetal growth and selected gross foetal anomalies. The Advanced Midwifes were accurately able to date the pregnancy on women who access the service did not know their last menstrual period (LMP) and on those who could recall their LMP had a significant disparity between gestational age by LMP and by composite ultrasound age (CUA). Limited obstetric ultrasound gestational age determination by advanced midwives was useful in not only assessing gestational age but also in identifying abnormalities associated with the pregnancies.