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


METHODS
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.


RESULTS
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.


CONCLUSIONS
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.
University of Washington, Department of Radiology, Seattle, WA, USA.
J O
JO
Swanson
Ernest Cook Ultrasound Research and Education Institute, Mengo Hospital, Kampala, Uganda.
M G
MG
Kawooya
University of Washington, Department of Radiology, Seattle, WA, USA.
D L
DL
Swanson
University of Washington, Department of Radiology, Seattle, WA, USA.
D S
DS
Hippe
Ernest Cook Ultrasound Research and Education Institute, Mengo Hospital, Kampala, Uganda.
P
P
Dungu-Matovu
University of Washington, Department of Radiology, Seattle, WA, USA.
R
R
Nathan
D000293:Adolescent; D000328:Adult; D005260:Female; D006801:Humans; D008880:Midwifery / Q000193:education / Q000706:statistics & numerical data*; D009774:Obstetrics / Q000706:statistics & numerical data*; D011247:Pregnancy; D011248:Pregnancy Complications / Q000000981:diagnostic imaging*; D018566:Pregnancy, High-Risk; D011446:Prospective Studies; D012424:Rural Population; D012680:Sensitivity and Specificity; D014454:Uganda; D016216:Ultrasonography, Prenatal / Q000706:statistics & numerical data*; D055815:Young Adult