Handheld ultrasound to avert maternal and neonatal deaths in 2 regions of the Philippines: an iBuntis® intervention study

Abstract

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.

Exploring the availability and impact of antenatal point‐of‐care ultrasound services in rural and remote communities: A scoping review

“…The initial search yielded 3863 original results; however, 17 studies remained for inclusion after screening, as per the study protocol (see Figure ). Majority of the results were observational studies, with 7 prospective cohort studies, 3 cross‐sectional studies and 1 retrospective data analysis . Other study designs included a non‐blinded clustered randomised control trial, a pre‐post survey, a randomised control trial, a blinded investigational study, a field action report and a survey followed by a pilot project …”

“…Three of the included studies were from Asia, all reporting on the effectiveness of training health workers from rural communities in obstetric PoCUS . All studies used a comparison between the trainees’ reporting and the reviewers’ reporting; however, the methods used and outcomes varied …”

“…Dalmacion et al . used a cross‐sectional study to analyse the maternal and neonatal outcomes associated with training 20 community healthcare workers (six doctors, five nurses and nine midwives) in antenatal PoCUS at an urban and rural site in the Philippines.…”

“…used a cross‐sectional study to analyse the maternal and neonatal outcomes associated with training 20 community healthcare workers (six doctors, five nurses and nine midwives) in antenatal PoCUS at an urban and rural site in the Philippines. Pre‐post tests were used to assess the training; however, the only results reported from this testing was that training outcomes did not differ between the two locations . Four hundred and sixty women were scanned, with 31.7% showing abnormal findings (most commonly foetal malpresentation 124/146) .…”

Point‐of‐care ultrasound in obstetrics

“…There is much interest in the use of PoCUS in remote and poorly resourced areas, as a means of screening at‐risk patients for tertiary follow‐up . Many studies have looked at training of healthcare workers such as midwives in the use of PoCUS, which strongly support the practice .…”