Implementation of the INTERGROWTH-21 ^st gestational dating and fetal and newborn growth standards in Nairobi, Kenya: women’s experiences with ultrasound and newborn assessment

Abstract

Background: In order to make further gains in preventing newborn deaths, effective interventions are needed. Ultrasounds and newborn anthropometry are proven interventions to identify preterm birth complications, the leading cause of newborn deaths. The INTERGROWTH-21 st global gestational dating and fetal and newborn growth standards prescribe optimal growth in any population. Jacaranda Health in Kenya was the first lowresource health facility to implement the standards and evaluate their feasibility and acceptability. Objective: To capture patients' perceptions of ultrasound and newborn care before and during implementation of the INTERGROWTH-21 st standards. Methods: The study was conducted over two years before and during the introduction of the INTERGROWTH-21 st standards. Fifty pregnant and/or newly delivered women were selected for in-depth interviews and focus group discussions using convenience and purposive sampling. Interviews were conducted by research assistants using semi-structured guides once in the pre-implementation phase and twice in the implementation phase. Interviews were transcribed, double-coded by two independent researchers and thematically analyzed together. Demographic information was obtained from hospital records. Results: Patients reported being generally satisfied with ultrasound care when providers communicated effectively. Women reported a priority for ultrasound was that it allowed them to feel reassured. However, a clear need for better pre-screening information emerged consistently from patients. Women noted that factors facilitating their choosing to have an ultrasound included ensuring the well-being of the fetus and learning the sex. Barriers included wait times and financial constraints. Patients were generally satisfied with care using the newborn standards. Conclusions: As the INTERGROWTH-21 st standards are implemented worldwide, understanding ways to facilitate implementation is critical. Increased and standardized communication about ultrasound should be provided before the procedure to increase satisfaction and uptake. Considering patient perspectives when integrating new standards or guidelines into routine clinical care will inform effective strategies in care provision, thus improving maternal and newborn health and survival.

Reliability of last menstrual period recall, an early ultrasound and a Smartphone App in predicting date of delivery and classification of preterm and post-term births

“…A reliable expected date of delivery (EDD) is important for pregnant women in planning for a safe and uneventful delivery and critical for clinical management of obstetric emergencies [ 1 , 2 ]. In an implementation study of the Intergrowth-21 gestational dating in Kenya, all respondents interviewed reported that the EDD helped them to prepare for delivery financially and logistically [ 3 ]. According to the WHO guidelines pregnant women should have at least one ultrasound (US) before 24 weeks in pregnancy to determine the gestational age (GA), EDD and identify fetal anomalies and poor fetal growth [ 4 ].…”

“…According to the WHO guidelines pregnant women should have at least one ultrasound (US) before 24 weeks in pregnancy to determine the gestational age (GA), EDD and identify fetal anomalies and poor fetal growth [ 4 ]. In low and middle income countries (LMIC) the availability of an ultrasound machine and ultrasound expertise are often limited to secondary and tertiary level facilities [ 3 – 6 ] and pregnant women attending primary health care clinics are referred to hospitals and Midwifery Outpatient Units for an US. However, long waiting times and financial constraints together with late antenatal attendance often delay an ultrasound examination to after 24 weeks of pregnancy [ 6 ].…”

First and second trimester ultrasound in pregnancy: A systematic review and metasynthesis of the views and experiences of pregnant women, partners, and health workers

“…Finding out the fetal sex was important for respondents in a range of contexts, in terms of imaging their future baby, and practical planning [ 28 , 45 , 48 , 68 – 70 ]. However, in some circumstances, this knowledge had negative consequences [ 30 , 71 ].…”

“…The scan appointment was a source of great excitement, joy and relief for many couples, providing a chance to bond with their baby, whilst also instilling a sense of responsibility, particularly amongst fathers and other co-parents [ 19 , 21 , 32 , 41 , 45 , 68 , 77 , 83 ]. For some, it also offered the potential for choice and the opportunity to plan when complications were detected [ 22 , 68 , 84 , 85 ].…”

A pre-implementation study on the experience of ultrasound scanning in selected healthcare facilities of Lusaka, Zambia: the perspectives of pregnant women and male partners

“…Despite the [25] recommendations for reducing perinatal mortalities, Zambia faces a signi cant challenge in effectively preventing and managing preterm birth and stillbirths due to the lack of an accurate, consistently applied estimated date of delivery (EDD) for each pregnant woman, which is obtained through ultrasound scanning. Studies from LMICs show that USS interventions delivered by midwives are highly feasible and acceptable [29,36,37]. Despite these ndings, there are still no known studies describing how ultrasound scanning is used in Zambia to decrease preterm and stillbirths.…”