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The diagnostic impact of limited, screening obstetric ultrasound when performed by midwives in rural Uganda

Journal of Perinatology volume 34, pages 508–512 (2014)Cite this article

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Abstract

Objective:

To evaluate the diagnostic impact of limited obstetric ultrasound (US) in identifying high-risk pregnancies when used as a screening tool by midwives in rural Uganda.

Study Design:

This was an institutional review board-approved prospective study of expecting mothers in rural Uganda who underwent clinical and US exams as part of their standard antenatal care visit in a local health center in the Isingiro district of Uganda. The midwives documented clinical impressions before performing a limited obstetric US on the same patient. The clinical findings were then compared with the subsequent US findings to determine the diagnostic impact. The midwives were US-naive before participating in the 6-week training course for limited obstetric US.

Result:

Midwife-performed screening obstetric US altered the clinical diagnosis in up to 12% clinical encounters. This diagnostic impact is less (6.7 to 7.4%) if the early third trimester diagnosis of malpresentation is excluded. The quality assurance review of midwives’ imaging demonstrated 100% sensitivity and specificity in the diagnosing gestational number, and 90% sensitivity and 96% specificity in the diagnosis of fetal presentation.

Conclusion:

Limited, screening obstetric US performed by midwives with focused, obstetric US training demonstrates the diagnostic impact for identifying conditions associated with high-risk pregnancies in 6.7 to 12% of patients screened. The limited obstetric US improved diagnosis of early pregnancy complication as well as later gestation twins and malpresentation. Midwives who have undergone focused 6-week limited obstetric US training proved capable of diagnosing twins and fetal presentation with high sensitivity and specificity.

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Acknowledgements

This study is supported through grants from the GE Foundation, the University of Washington Radiology Health Services Research Seed Grant Program and Seattle International Foundation. We also thank Millenium Village Project in Isingiro, Uganda for their generous inclusion and support of our work within their healthcare facilities.

Funding for this project provided by: GE Foundation University of Washington Radiology Health Services Research Seed Grant Program Seattle International Foundation.

Author information

Authors and Affiliations

  1. Department of Radiology, University of Washington, Seattle, WA, USA,

    J O Swanson, D L Swanson, D S Hippe & R Nathan

  2. Ernest Cook Ultrasound Research and Education Institute, Mengo Hospital, Kampala, Uganda,

    M G Kawooya & P Dungu-Matovu

Authors
  1. J O Swanson
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  2. M G Kawooya
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  3. D L Swanson
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  4. D S Hippe
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  5. P Dungu-Matovu
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  6. R Nathan
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Corresponding author

Correspondence to J O Swanson.

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The authors declare no conflict of interest.

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Swanson, J., Kawooya, M., Swanson, D. et al. The diagnostic impact of limited, screening obstetric ultrasound when performed by midwives in rural Uganda. J Perinatol 34, 508–512 (2014). https://doi.org/10.1038/jp.2014.54

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