First look: A cluster-randomized trial of ultrasound to improve pregnancy outcomes in low income country settings

Elizabeth M. McClure, Robert O. Nathan, Sarah Saleem, Fabian Esamai, Ana Garces, Elwyn Chomba, Antoinette Tshefu, David Swanson, Hillary Mabeya, Lester Figuero, Waseem Mirza, David Muyodi, Holly Franklin, Adrien Lokangaka, Dieudonne Bidashimwa, Omrana Pasha, Musaku Mwenechanya, Carl L. Bose, Waldemar A. Carlo, K. M. HambidgeEdward A. Liechty, Nancy Krebs, Dennis D. Wallace, Jonathan Swanson, Marion Koso-Thomas, Rexford Widmer, Robert L. Goldenberg

Research output: Contribution to journalArticle

37 Citations (Scopus)

Abstract

Background: In high-resource settings, obstetric ultrasound is a standard component of prenatal care used to identify pregnancy complications and to establish an accurate gestational age in order to improve obstetric care. Whether or not ultrasound use will improve care and ultimately pregnancy outcomes in low-resource settings is unknown.Methods/Design: This multi-country cluster randomized trial will assess the impact of antenatal ultrasound screening performed by health care staff on a composite outcome consisting of maternal mortality and maternal near-miss, stillbirth and neonatal mortality in low-resource community settings. The trial will utilize an existing research infrastructure, the Global Network for Women's and Children's Health Research with sites in Pakistan, Kenya, Zambia, Democratic Republic of Congo and Guatemala. A maternal and newborn health registry in defined geographic areas which documents all pregnancies and their outcomes to 6 weeks post-delivery will provide population-based rates of maternal mortality and morbidity, stillbirth, neonatal mortality and morbidity, and health care utilization for study clusters. A total of 58 study clusters each with a health center and about 500 births per year will be randomized (29 intervention and 29 control). The intervention includes training of health workers (e.g., nurses, midwives, clinical officers) to perform ultrasound examinations during antenatal care, generally at 18-22 and at 32-36 weeks for each subject. Women who are identified as having a complication of pregnancy will be referred to a hospital for appropriate care. Finally, the intervention includes community sensitization activities to inform women and their families of the availability of ultrasound at the antenatal care clinic and training in emergency obstetric and neonatal care at referral facilities.Discussion: In summary, our trial will evaluate whether introduction of ultrasound during antenatal care improves pregnancy outcomes in rural, low-resource settings. The intervention includes training for ultrasound-naïve providers in basic obstetric ultrasonography and then enabling these trainees to use ultrasound to screen for pregnancy complications in primary antenatal care clinics and to refer appropriately. Trial registration: Clinicaltrials.gov (NCT # 01990625).

Original languageEnglish
Article number73
JournalBMC Pregnancy and Childbirth
Volume14
Issue number1
DOIs
StatePublished - Feb 17 2014

Fingerprint

Prenatal Care
Pregnancy Outcome
Obstetrics
Pregnancy Complications
Stillbirth
Maternal Mortality
Infant Mortality
Patient Acceptance of Health Care
Guatemala
Morbidity
Nurse Midwives
Zambia
Democratic Republic of the Congo
Kenya
Pakistan
Health
Women's Health
Prenatal Diagnosis
Research
Gestational Age

Keywords

  • Low-income countries
  • Maternal mortality
  • Maternal near miss
  • Obstetric ultrasound
  • Perinatal mortality

ASJC Scopus subject areas

  • Obstetrics and Gynecology

Cite this

McClure, E. M., Nathan, R. O., Saleem, S., Esamai, F., Garces, A., Chomba, E., ... Goldenberg, R. L. (2014). First look: A cluster-randomized trial of ultrasound to improve pregnancy outcomes in low income country settings. BMC Pregnancy and Childbirth, 14(1), [73]. https://doi.org/10.1186/1471-2393-14-73

First look : A cluster-randomized trial of ultrasound to improve pregnancy outcomes in low income country settings. / McClure, Elizabeth M.; Nathan, Robert O.; Saleem, Sarah; Esamai, Fabian; Garces, Ana; Chomba, Elwyn; Tshefu, Antoinette; Swanson, David; Mabeya, Hillary; Figuero, Lester; Mirza, Waseem; Muyodi, David; Franklin, Holly; Lokangaka, Adrien; Bidashimwa, Dieudonne; Pasha, Omrana; Mwenechanya, Musaku; Bose, Carl L.; Carlo, Waldemar A.; Hambidge, K. M.; Liechty, Edward A.; Krebs, Nancy; Wallace, Dennis D.; Swanson, Jonathan; Koso-Thomas, Marion; Widmer, Rexford; Goldenberg, Robert L.

In: BMC Pregnancy and Childbirth, Vol. 14, No. 1, 73, 17.02.2014.

Research output: Contribution to journalArticle

McClure, EM, Nathan, RO, Saleem, S, Esamai, F, Garces, A, Chomba, E, Tshefu, A, Swanson, D, Mabeya, H, Figuero, L, Mirza, W, Muyodi, D, Franklin, H, Lokangaka, A, Bidashimwa, D, Pasha, O, Mwenechanya, M, Bose, CL, Carlo, WA, Hambidge, KM, Liechty, EA, Krebs, N, Wallace, DD, Swanson, J, Koso-Thomas, M, Widmer, R & Goldenberg, RL 2014, 'First look: A cluster-randomized trial of ultrasound to improve pregnancy outcomes in low income country settings', BMC Pregnancy and Childbirth, vol. 14, no. 1, 73. https://doi.org/10.1186/1471-2393-14-73
McClure, Elizabeth M. ; Nathan, Robert O. ; Saleem, Sarah ; Esamai, Fabian ; Garces, Ana ; Chomba, Elwyn ; Tshefu, Antoinette ; Swanson, David ; Mabeya, Hillary ; Figuero, Lester ; Mirza, Waseem ; Muyodi, David ; Franklin, Holly ; Lokangaka, Adrien ; Bidashimwa, Dieudonne ; Pasha, Omrana ; Mwenechanya, Musaku ; Bose, Carl L. ; Carlo, Waldemar A. ; Hambidge, K. M. ; Liechty, Edward A. ; Krebs, Nancy ; Wallace, Dennis D. ; Swanson, Jonathan ; Koso-Thomas, Marion ; Widmer, Rexford ; Goldenberg, Robert L. / First look : A cluster-randomized trial of ultrasound to improve pregnancy outcomes in low income country settings. In: BMC Pregnancy and Childbirth. 2014 ; Vol. 14, No. 1.
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AU - Garces, Ana

AU - Chomba, Elwyn

AU - Tshefu, Antoinette

AU - Swanson, David

AU - Mabeya, Hillary

AU - Figuero, Lester

AU - Mirza, Waseem

AU - Muyodi, David

AU - Franklin, Holly

AU - Lokangaka, Adrien

AU - Bidashimwa, Dieudonne

AU - Pasha, Omrana

AU - Mwenechanya, Musaku

AU - Bose, Carl L.

AU - Carlo, Waldemar A.

AU - Hambidge, K. M.

AU - Liechty, Edward A.

AU - Krebs, Nancy

AU - Wallace, Dennis D.

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AU - Goldenberg, Robert L.

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KW - Perinatal mortality

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