Association between antenatal ultrasound findings and neonatal outcomes in rural Uganda: a secondary analysis

Abstract

Background Although the use of prenatal ultrasound services has increased in low- income and lower middle-income countries, there has not been a concurrent improvement in perinatal mortality. It remains unknown whether individual ultrasound findings in this setting are associated with neonatal death or the need for resuscitation at delivery. If associations are identified by ultrasound, they could be used to inform the birth attendant and counsel the family regarding risk, potentially altering delivery preparedness in order to reduce neonatal mortality. Methods This was a secondary analysis of data collected from a prospective cohort. Data was gathered at Nawanyago Health Centre III in Kamuli District, Uganda. Participants included pregnant women who received second and third trimester prenatal ultrasound scans and delivered at that center between July 2010 and August 2018. All ultrasounds were performed at Nawanyago and deliveries were attended solely by midwives or nurses. Predictor variables included the following ultrasound findings: fetal number, fetal presentation, and amniotic fluid volume. The primary outcome was bag-mask ventilation (BMV) of the neonate at delivery. The secondary outcome was stillbirth or neonatal death in the delivery room. Results Primary outcome data was available for 1105 infants and secondary outcome data was available for 1098 infants. A total of 33 infants received BMV at delivery. The odds of receiving BMV at delivery was significantly increased if amniotic fluid volume was abnormal (OR 4.2, CI 1.2-14.9) and there were increased odds for multiple gestation (OR 1.9, CI 0.7-5.4) and for non-vertex fetal presentation (OR 1.4, CI 0.6-3.2) that were not statistically significant. Stillbirth or neonatal death in the delivery room was diagnosed for 20 infants. Multiple gestation (OR 4.7, CI 1.6-14.2) and abnormal amniotic fluid volume (OR 4.8, CI 1.0-22.1) increased the odds of stillbirth or neonatal death in the delivery room, though only multiple gestation was statistically significant. Conclusion Common findings that are easily identifiable on ultrasound in low- and lower middle-income countries are associated with adverse perinatal outcomes. Education could lead to improved delivery preparedness, with the potential to reduce perinatal mortality. This was a preliminary study; larger prospective studies are needed to confirm these findings.

Effects of tracking linkage self-management mode on the compliance of prenatal examinations and delivery modes in primiparas

“…[18,19] The tracking and linkage self-management model can not only improve the obstetric inspection compliance of pregnant women, but also give pregnant women and their families correct prenatal guidance in a timely manner, so that pregnant women can avoid risk factors that lead to adverse pregnancy outcomes as much as possible, and significantly reduce the incidence of adverse neonatal outcomes. [20] This study still has some limitations: the sample size of this study is too small; since we did not observe the effect of this nursing mode on female patients after delivery in this study, we will continue to extend the follow-up time to observe the effect on postpartum. We plan to conduct a multicenter study with extended follow-up to observe long-term outcomes in women.…”

“…[18,19] The tracking and linkage self-management model can not only improve the obstetric inspection compliance of pregnant women, but also give pregnant women and their families correct prenatal guidance in a timely manner, so that pregnant women can avoid risk factors that lead to adverse pregnancy outcomes as much as possible, and significantly reduce the incidence of adverse neonatal outcomes. [20]…”

“…Pregnant women in both groups followed a routine obstetric checkup cycle at 12,16,20,24,28,30,32,34,36,37,38,39, and 40 weeks of pregnancy Take a pregnancy test. The control group adopted the routine management mode to popularize the concept and importance of prenatal examinations to the mothers and their families, to inform them about the knowledge of physiological hygiene, life and nutrition during pregnancy, and to inform them of the problems that should be paid attention to before and after childbirth and the common sense of normal childbirth.…”

Impact of Technologic Innovation and COVID-19 Pandemic on Pediatric Cardiology Telehealth

“…A recent publication from Uganda described the clinical characteristics, technical implementation, patient/parent satisfaction, and cost of a telecardiology program. Patients received an electrocardiogram and echocardiogram (Philips Lumify) performed by a local nurse in Gulu (northern Uganda) which were stored and transmitted using a cloud-storage/PAC solution (Imaging the World [ 80 ]) to the Uganda Heart Institute in the capital of Kampala (6-h drive from Gulu) for remote consultation by a cardiologist. Results were relayed to patients/families following cardiologist interpretation.…”