title: Introducing a Mobile-Connected Umbilical Doppler Device (UmbiFlow™) into a Primary Care Maternity Setting: Does This Reduce Unnecessary Referrals to Specialised Care? Results of a Pilot Study in Kraaifontein, South Africa.
abstract: OBJECTIVE
  UmbiFlow™ is a mobile-connected Doppler device that utilises a continuous waveform to measure resistance in the umbilical artery. The main aim of this pilot study was to determine whether the use of UmbiFlow™ for umbilical artery Doppler in patients with a suspected decreased symphysis fundal (SF) growth could safely lead to a decreased number of patients requiring referral to a more specialised level of care. A secondary aim of the study was to evaluate the effectiveness of UmbiFlow™ Doppler as a screening tool for concealed placental insufficiency in late bookers by using a single screening cut-off value that will be abnormal for any gestation >28 weeks.
  
  
  METHODS
  The cohort comprised two groups of patients: The first group included all follow-up patients with suspected intra-uterine growth restriction (a decreased symphysis-fundus measurement based on serial assessment) who underwent on-site UmbiFlow™Doppler testing performed by the midwife directly after the clinical examination. The second group included late bookers, where gestation was uncertain; but estimated >28 weeks based on clinical grounds. This group was comprised of unselected patients who report to antenatal care late for the first time and received an UmbiFlow™Doppler test for concealed placental insufficiency.
  
  
  RESULTS
  UmbiFlow™Doppler could reduce the number of false referrals to hospital by 55%. A single UmbiFlow™Doppler test in late bookers appeared to identify a group of women at moderate risk of lower birth weight babies.
authors.affiliation: Department of Obstetrics and Gynaecology, Stellenbosch University and Tygerberg Hospital, Cape Town, South Africa.
authors.forename: Josef
authors.initials: J
authors.lastname: Mufenda
authors.affiliation: Department of Obstetrics and Gynaecology, Stellenbosch University and Tygerberg Hospital, Cape Town, South Africa.
authors.forename: Stefan
authors.initials: S
authors.lastname: Gebhardt
authors.affiliation: mHealth Inc., 12525 El Camino Real B, San Diego, California, 92130, United States of America.
authors.forename: Rita
authors.initials: R
authors.lastname: van Rooyen
authors.affiliation: Department of Obstetrics and Gynaecology, Stellenbosch University and Tygerberg Hospital, Cape Town, South Africa.
authors.forename: Gerhard
authors.initials: G
authors.lastname: Theron
mesh_terms: D000293:Adolescent; D000328:Adult; D000465:Algorithms; D040421:Cell Phone; D015331:Cohort Studies; D005260:Female; D005317:Fetal Growth Retardation / Q000000981:diagnostic imaging; D006801:Humans; D007091:Image Processing, Computer-Assisted; D008952:Mobile Health Units; D010865:Pilot Projects; D011247:Pregnancy; D011295:Prenatal Care / Q000379:methods*; D011320:Primary Health Care / Q000379:methods*; D012017:Referral and Consultation; D012984:Software; D013019:South Africa; D018608:Ultrasonography, Doppler / Q000295:instrumentation* / Q000379:methods; D016216:Ultrasonography, Prenatal / Q000295:instrumentation* / Q000379:methods; D014469:Umbilical Arteries / Q000000981:diagnostic imaging*; D055815:Young Adult