What is the current status of availability and impact of antenatal point of care ultrasound services (PoCUS) in rural and remote communities globally? A review


      There are global disparities in the provision of maternal health care, with women from rural communities and under resourced countries expecting poorer access to health care services1-4. This potentially compounds the existing higher burden of maternal and neonatal morbidity within these populations4,5. In this setting point of care ultrasound (PoCUS) has the potential to improve patient outcomes4-7. The portability of the technology mitigates some of the barriers and challenges associated with the introduction of medical imaging services in rural and remote settings6-7.


      To explore the availability and impact of PoCUS use for antenatal care (ANC) in rural and under resourced settings globally.


      Medline, Embase and Scopus were searched with no year limit. Studies were included if the participants were pregnant women undergoing ANC in a rural setting or developing country and if the intervention was PoCUS use or training for PoCUS use.


      3863 unique articles were identified, with 17 meeting the inclusion criteria. Studies originated from Africa, Asia, Central America and Australia. All studies reported that PoCUS use for ANC produced positive outcomes. ANC utilisation, training and maternal and neonatal outcomes were the three primary outcomes identified in the literature. Methods and measures of outcomes varied between studies. PoCUS introduction into routine ANC resulted in a statistically significant increase in pregnant women attending and utilising ANC services8-11. PoCUS use was demonstrated to directly influence the identification, diagnosis and treatment of conditions associated with maternal and neonatal morbidity12-14. It was feasible to provide local health care workers in under-resourced communities with limited training to perform quality scanning and reporting in their clinics14-23.


      PoCUS for ANC is utilised in under resourced countries and in rural settings. Integration of PoCUS into ANC in these settings offer benefits particularly in the reduction of maternal and neonatal morbidity rates. It was demonstrated that with minimal PoCUS training, local health care workers were able to accurately determine gestational age, the number of gestations and identify fetal anomalies. This may facilitate improved clinical management in this setting.
      • 1.
        Sippel S, Muruganandan K, Levine A, Shah S. Review article: Use of ultrasound in the developing world. Int J Emerg Med 2011; 4: 72.
      • 2.
        Rijken MJ, Lee SJ, Boel ME, Papageorghiou AT, Visser GH, Dwell SL, et al. Obstetric ultrasound scanning by local health workers in a refugee camp on the Thai-Burmese border. Ultrasound Obstet Gynecol 2009; 34: 395-403.
      • 3.
        Finlayson K, Downe S. Why Do Women Not Use Antenatal Services in Low- and Middle-Income Countries? A Meta-Synthesis of Qualitative Studies. PLoS Med 2013; 10: e1001373.
      • 4.
        Wanyonyi SZ, Mariara CM, Vinayak S, Stones W. Opportunities and Challenges in Realizing Universal Access to Obstetric Ultrasound in Sub-Saharan Africa. Ultrasound Int Open 2017; 3: E52-E59.
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        World Health Organisation. WHO recommendations on antenatal care for a positive pregnancy experience. Luxembourg: WHO Press; 2016.
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        Harris RD, Marks WM. Compact ultrasound for improving maternal and perinatal care in low-resource settings: review of the potential benefits, implementation challenges, and public health issues. J Ultrasound Med 2009; 28: 1067-76.
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        Becker DM, Tafoya CA, Becker SL, Kruger GH, Tafoya MJ, Becker TK. The use of portable ultrasound devices in low- and middle-income countries: a systematic review of the literature. Trop Med Int Health 2016; 21: 294-311.
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        Mbuyita S, Tillya R, Godfrey R, Kinyonge I, Shaban J, Mbaruku G. Effects of introducing routinely ultrasound scanning during Ante Natal Care (ANC) clinics on number of visits of ANC and facility delivery: a cohort study. Arch Public Health 2015; 73: 36.
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        Ross AB, DeStigter KK, Coutinho A, Souza S, Mwatha A, Matovu A, et al. Ancillary benefits of antenatal ultrasound: an association between the introduction of a low-cost ultrasound program and an increase in the numbers of women receiving recommended antenatal
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        Cherniak W, Anguyo G, Meaney C, Kong LY, Malhame I, Pace R, et al. Effectiveness of advertising availability of prenatal ultrasound on uptake of antenatal care in rural Uganda: a cluster randomized trial. PLoS ONE 2017; 12: e0175440.
      • 11.
        Amoah B, Anto EA, Osei PK, Pieterson K, Crimi A. Boosting antenatal care attendance and number of hospital deliveries among pregnant women in rural communities: a community initiative in Ghana based on mobile phones applications and portable ultrasound scans. BMC Pregnancy Childbirth 2016; 16: 141.
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        Crispin Milart PH, Diaz Molina CA, Prieto-Egido I, Martinez-Fernandez A. Use of a portable system with ultrasound and blood tests to improve prenatal
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        Rulisa S, Rurangwa T, Lewis K, Small M. Point of care ultrasound use for emergency obstetric and gynecological conditions in a tertiary care hospital in Rwanda. Ultrasound Obstet Gynecol 2016; 48: 262–3.
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        Dalmacion GV, Reyles RT, Habana AE, Cruz LMV, Chua MC, Ngo AT, et al. Handheld ultrasound to avert maternal and neonatal deaths in 2 regions of the Philippines: an iBuntis(R) intervention study. BMC Pregnancy Childbirth 2018; 18: 32.
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        Greenwold N, Wallace S, Prost A, Jauniaux E. Implementing an obstetric ultrasound training program in rural Africa. Int J Gynaecol Obstet 2014; 124: 274–7.
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        Kimberly HH, Murray A, Mennicke M, Liteplo A, Lew J, Bohan JS, et al. Focused maternal ultrasound by midwives in rural Zambia. Ultrasound Med Biol 2010; 36: 1267–72.
      • 17.
        Bentley S, Hexom B, Nelson BP. Evaluation of an obstetric ultrasound curriculum for midwives in Liberia. J Ultrasound Med 2015; 34: 1563–8.
      • 18.
        Kinnevey C, Kawooya M, Tumwesigye T, Douglas D, Sams S. Addressing obstetrical challenges at 12 rural Ugandan health facilities: findings from an international ultrasound and skills development training for midwives in Uganda. IJMA 2016; 5: 46–52.
      • 19.
        Vinayak S, Sande J, Nisenbaum H, Nolsoe CP. Training midwives to perform basic obstetric point-of-care ultrasound in rural areas using a tablet platform and mobile phone transmission technology- a WFUMB COE project. Ultrasound Med Biol 2017; 43: 2125– 32.
      • 20.
        Swanson D, Lokangaka A, Bauserman M, Swanson J, Nathan RO, Tshefu A, et al. Challenges of implementing antenatal ultrasound screening in a rural study site- a case study from the Democratic Republic of the Congo. GHSP 2017; 5: 315–24.
      • 21.
        Kozuki N, Mullany LC, Khatry SK, Ghimire RK, Paudel S, Blakemore K, et al. Accuracy of home-based ultrasonographic diagnosis of obstetric risk factors by primary-level health care workers in rural Nepal. Obstet Gynecol 2016; 128: 604–12.
      • 22.
        Neufeld LM, Wagatsuma Y, Hussain R, Begum M, Frongillo EA. Measurement error for ultrasound fetal biometry performed by paramedics in rural Bangladesh. Ultrasound Obstet Gynecol 2009; 34: 387–94.
      • 23.
        Glazebrook R, Manahan D, Chater AB. Evaluation of an ultrasound program (intermediate obstetric and emergency medicine) for Australian rural and remote doctors. Aust J Rural Health 2005; 13: 295–9.