No abstract

Background: Evidence on recent trends regarding the impact and cost-benefits of ultrasound in resource-constrained settings is limited. This study presents a systematic review to determine recent trends in the utility and applicability of ultrasound use in low and middle income countries (LMIC). The review includes characterizing and evaluating trends in (1) the geographic and specialty specific use of ultrasound in LMICs, (2) the innovative applications and the accompanying research findings, and (3) the development of associated educational and training programs. Methods: The electronic databases Medline OVID, EMBASE, and Cochrane were searched from 2010 to 2018 for studies available in English, French, and Spanish. Commentaries, opinion articles, reviews and book chapters were excluded. Two categories were created, one for reported applications of ultrasound use in LMICs and another for novel ultrasound studies. Results: A total of 6,276 articles were identified and screened, 4,563 studies were included for final review. 287 studies contained original or novel applications of ultrasound use in LMICs. Nearly 70% of studies involved ultrasound usage originating from Southeast Asia and sub-Saharan Africa, the latter being the region with the highest number of innovative ultrasound use. Educational studies, global collaborations, and funded studies were a substantial subset of overall ultrasound research. Our findings are limited by the lack of higher quality evidence and limited number of randomized clinical trials reported. Conclusion/Global Health Implications: Our systematic literature review of ultrasound use in LMICs demonstrates the growing utilization of this relatively low-cost, portable imaging technology in low resource settings. Key words: • Ultrasound • Ultrasono graph y • Echocardiogram • LMIC • Low resource • Global health • Systematic review   Copyright © 2020 Stewart et al. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited

Background/Purpose: The ex-utero intrapartum treatment (EXIT) procedure is used to secure effective gas exchange prior to postnatal life. We describe the obstetrical course and maternal outcomes of a series of patients who underwent EXIT.Methods: This is a review of all pregnancies in which fetuses were delivered by EXIT from January 2001 to April 2018. Outcome variables included estimated gestational age (EGA) at delivery, need for emergency EXIT, maternal estimated blood loss (EBL), need for maternal blood transfusion, and maternal postoperative length of hospital stay. Data were tested for normality and reported as median [range] and n (%). Results: A total of 45 patients were delivered by EXIT procedure. Sixteen (35.6%) of the EXIT procedures were performed emergently. Median maternal EBL was 800 (500-2000) mL; 6 (13.3%) patients received blood transfusion. Median maternal postoperative length of hospital stay was four [3-7] days. Conclusion: Our data highlight the complexity of the obstetrical management in the EXIT procedure as evidenced by an approximately 36% chance of emergency delivery. Despite having an experienced multidisciplinary team, 13.3% of our subjects underwent maternal blood transfusion. This information can be used in counseling EXIT candidates regarding the risks and benefits of this procedure.Parity, median [range] 1 [0-5] EGA at diagnosis of condition, weeks, median [range] 21 [16-36] EGA at presentation, weeks, median [range] 28 [20-37] EGA at diagnosis of polyhydramnios, weeks, median [range] 27 [18-36] EGA at delivery, median [range] 36 [28-39] Twin pregnancy, n (%) 0 (0) Male fetus, n (%) 24 (53.3) Polyhydramnios, n (%) 34 (75.6) Amnioreduction, n (%) 17 (37.8) Emergent EXIT, n (%) 16 (35.6) Preterm contractions, n (%) 12 (26.6) PPROM, n (%) 7 (15.6) Anterior placenta, n (%) 16 (35.6) Maternal estimated blood loss, mL, median [range] 800 [500-2000] Maternal blood transfusion, n (%) 6 (13.3) Duration of EXIT, min, median [range] 46 [15-133] Anesthesia duration, min, median [range] 130 [95-216] Maternal post-op length of hospital stay, days, median [range] 4 [3-7] Maternal surgical site infection, n (%) 2 (4.4)Note. Duration of EXIT was calculated as the time between skin incision and delivery of the baby.Values are presented as median [range] and n (%).Abbreviations: EGA, estimated gestational age; EXIT, ex-utero intrapartum treatment; PPROM, preterm-premature rupture of membranes.