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

David L. Swanson, Holly L. Franklin, Jonathan O. Swanson, Robert L. Goldenberg, Elizabeth M. McClure, Waseem Mirza, David Muyodi, Lester Figueroa, Nicole Goldsmith, Nancy Kanaiza, Farnaz Naqvi, Irma Sayury Pineda, Walter López-Gomez, Dorothy Hamsumonde, Victor Lokomba Bolamba, Jamie E. Newman, Elizabeth V. Fogleman, Sarah Saleem, Fabian Esamai, Sherri BucherEdward A. Liechty, Ana L. Garces, Nancy F. Krebs, K. Michael Hambidge, Elwyn Chomba, Melissa Bauserman, Musaku Mwenechanya, Waldemar A. Carlo, Antoinette Tshefu, Adrien Lokangaka, Carl L. Bose, Robert O. Nathan

Research output: Contribution to journalReview article

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.

Original languageEnglish (US)
Pages (from-to)273-281
Number of pages9
JournalSeminars in Perinatology
Volume43
Issue number5
DOIs
StatePublished - Aug 2019

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Keywords

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

ASJC Scopus subject areas

  • Pediatrics, Perinatology, and Child Health
  • Obstetrics and Gynecology

Cite this

Swanson, D. L., Franklin, H. L., Swanson, J. O., Goldenberg, R. L., McClure, E. M., Mirza, W., Muyodi, D., Figueroa, L., Goldsmith, N., Kanaiza, N., Naqvi, F., Pineda, I. S., López-Gomez, W., Hamsumonde, D., Bolamba, V. L., Newman, J. E., Fogleman, E. V., Saleem, S., Esamai, F., ... Nathan, R. O. (2019). 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. Seminars in Perinatology, 43(5), 273-281. https://doi.org/10.1053/j.semperi.2019.03.017