Format

Send to

Choose Destination
Semin Perinatol. 2019 Aug;43(5):273-281. doi: 10.1053/j.semperi.2019.03.017. Epub 2019 Mar 16.

Including ultrasound scans in antenatal care in low-resource settings: Considering the complementarity of obstetric ultrasound screening and maternity waiting homes in strengthening referral systems in low-resource, rural settings.

Author information

1
University of Washington, Seattle, WA, United States. Electronic address: dladleyswanson@gmail.com.
2
RTI International, Research Triangle Park, NC, United States. Electronic address: hfranklin@rti.org.
3
University of Washington, Seattle, WA, United States. Electronic address: swanson5@u.washington.edu.
4
Columbia University, New York, NY, United States. Electronic address: rlg88@columbia.edu.
5
RTI International, Research Triangle Park, NC, United States. Electronic address: mcclure@rti.org.
6
Aga Khan University, Karachi, Pakistan. Electronic address: waseem.mirza@aku.edu.
7
Moi University, Eldoret, Kenya.
8
INCAP, Guatemala City, Guatemala. Electronic address: lfigueroa@incap.int.
9
University of Washington, Seattle, WA, United States.
10
Aga Khan University, Karachi, Pakistan. Electronic address: farnaz.naqvi@aku.edu.
11
INCAP, Guatemala City, Guatemala. Electronic address: spineda@fancap.org.
12
INCAP, Guatemala City, Guatemala. Electronic address: wlopez@fancap.org.
13
University of Zambia, Lusaka, Zambia.
14
Kinshasa School of Public Health, Kinshasa, Democratic Republic of the Congo. Electronic address: vlokomba@yahoo.fr.
15
RTI International, Research Triangle Park, NC, United States. Electronic address: newman@rti.org.
16
RTI International, Research Triangle Park, NC, United States. Electronic address: efogleman@rti.org.
17
Aga Khan University, Karachi, Pakistan. Electronic address: sarah.saleem@aku.edu.
18
Indiana University, Indianapolis, IN, United States. Electronic address: shbucher@iupui.edu.
19
Indiana University, Indianapolis, IN, United States. Electronic address: eliecht@iupui.edu.
20
INCAP, Guatemala City, Guatemala. Electronic address: agarces@incap.int.
21
University of Colorado, Denver, CO, United States. Electronic address: nancy.krebs@ucdenver.edu.
22
University of Colorado, Denver, CO, United States. Electronic address: michael.hambidge@ucdenver.edu.
23
University of Zambia, Lusaka, Zambia. Electronic address: echomba@zamnet.zm.
24
University of North Carolina at Chapel Hill, Chapel Hill, NC, United States. Electronic address: melissa_bauserman@med.unc.edu.
25
University of Alabama at Birmingham, Birmingham, AL, United States. Electronic address: wcarlo@peds.uab.edu.
26
Kinshasa School of Public Health, Kinshasa, Democratic Republic of the Congo.
27
University of North Carolina at Chapel Hill, Chapel Hill, NC, United States. Electronic address: carl_bose@med.unc.edu.
28
University of Washington, Seattle, WA, United States. Electronic address: ronathan@uw.edu.

Abstract

Recent World Health Organization (WHO) antenatal care recommendations include an ultrasound scan as a part of routine antenatal care. The First Look Study, referenced in the WHO recommendation, subsequently shows that the routine use of ultrasound during antenatal care in rural, low-income settings did not improve maternal, fetal or neonatal mortality, nor did it increase women's use of antenatal care or the rate of hospital births. This article reviews the First Look Study, reconsidering the assumptions upon which it was built in light of these results, a supplemental descriptive study of interviews with patients and sonographers that participated in the First Look study intervention, and a review of the literature. Two themes surface from this review. The first is that focused emphasis on building the pregnancy risk screening skills of rural primary health care personnel may not lead to adaptations in referral hospital processes that could benefit the patient accordingly. The second is that agency to improve the quality of patient reception at referral hospitals may need to be manufactured for obstetric ultrasound screening, or remote pregnancy risk screening more generally, to have the desired impact. Stemming from the literature, this article goes on to examine the potential for complementarity between obstetric ultrasound screening and another approach encouraged by the WHO, the maternity waiting home. Each approach may address existing shortcomings in how the other is currently understood. This paper concludes by proposing a path toward developing and testing such a hybrid approach.

KEYWORDS:

Continuum of care; Maternity waiting home; Midwifery; Pregnancy risk screening; Referral systems; Task shifting

Supplemental Content

Full text links

Icon for Elsevier Science Icon for PubMed Central
Loading ...
Support Center