Achieving universal access to obstetric ultrasound in resource constrained settings: A narrative review

Luntsi, Geofery; Ugwu, AC; Nkubli, Flavious Bobuin; Emmanuel, R.; Ochie, Kalu; Nwobi, Chigozie

doi:10.1016/j.radi.2020.10.010

Cited by 11 publications

(16 citation statements)

References 54 publications

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“…Obstetric examinations were the focus of some recent reviews, which concluded that ultrasound has the potential to improve aspects of foetal, perinatal and maternal health. 15 , 16 While the potential was recognised, appropriate support and monitoring were recommended to ensure positive outcomes. In both reviews, limited training of providers and inappropriate use of ultrasound were raised as significant concerns related to the use of ultrasound to determine foetal sex, inadequate image quality and consequent misdiagnosis.…”

Section: Introductionmentioning

confidence: 99%

Potential for Use of Portable Ultrasound Devices in Rural and Remote Settings in Australia and Other Developed Countries: A Systematic Review

Shaddock¹,

Smith²

2022

JMDH

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Introduction Point of care ultrasound (POCUS) has become more common for rapid evaluation. Applications are limited by lack of training of users, difficulty maintaining ultrasound competencies, access to equipment for optimal imaging, and limitations in quality control. Such barriers exist in low-resource, underserved health care settings. Objective The aim was to explore the use of POCUS in under-resourced health care settings, such as rural and remote locations in Australia and other countries. Key variables include health outcomes, quality of care, service availability, examinations types performed, equipment used, who performs the examinations, and the ultrasound training received. Methods Literature was identified via CINAHL, Cochrane, Embase, Medline, PubMed, SCOPUS, and Web of Science, plus grey literature. Recommended guidelines were followed, and only research-based articles were included, with searches limited to English language and 2010–present. Results After screening, 23 articles were reviewed. No studies had low risk of bias and, overall, the quality was poor and only two studies used random sampling. The majority were from developing countries, with only one performed in Australia. Echocardiographic screening in schools was common. Others included emergency department (ED) patients, abdominal aorta screening, obstetric scans, and intensive care unit (ICU) management. Operators included ED doctors, medical students, nurses, community healthcare workers and general practitioners, who received limited training in protocol-driven scanning, often monitored by experts. In comparison to clinical assessment, standard ultrasound or other imaging, accuracy was of the order of 70–95%, depending on the condition, with high efficacy in improving patient care. Conclusion Lack of studies of POCUS in Australia and other developed countries suggests a need for further research. Current evidence supports use of limited ultrasound using portable machines in locations with limited access to diagnostic ultrasound performed by sonographers, which has the potential to improve health outcomes in under-resourced communities in Australia and elsewhere.

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Section: Introductionmentioning

confidence: 99%

Potential for Use of Portable Ultrasound Devices in Rural and Remote Settings in Australia and Other Developed Countries: A Systematic Review

Shaddock¹,

Smith²

2022

JMDH

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“…Increased access to the US technology has favored its use by other non-medical professionals, such as nurses. This has expanded the possibility of performing imaging exams in a variety of clinical settings, favoring care for the population in places where access to these resources has been limited 9 .…”

Section: /15mentioning

confidence: 99%

“…In this context, prenatal care is essential for the health of pregnant women and newborns alike, with a focus on preventing problems and promoting the health of the dyad, favoring a reduction in maternal, fetal and neonatal morbidity and mortality [4][5] . Obstetric ultrasound is fundamental for prenatal monitoring, as it allows for the quick and accurate identification of various aspects, such as anatomy and possible pathologies of the fetus, presence of multiple pregnancies, fetal viability, estimating weight and growth of the fetus, location of the placenta, fetal position, if there is an ectopic pregnancy, as well as detection of oligohydramnios, among other relevant factors [4][5][6][7][8][9] .…”

Section: Introductionmentioning

confidence: 99%

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Technological Advances in Obstetric Nursing Consultations Using Ultrasound

Borborema,

Alves,

Rodrigues

et al. 2024

Texto contexto - enferm.

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Objective: to understand how ultrasound tools are used in prenatal Nursing consultations from the perspective of obstetric nurses. Method: a descriptive and qualitative study carried out with ten obstetric nurses that use obstetric ultrasound in their Nursing consultations at a maternity hospital in Belo Horizonte, Minas Gerais, Brazil. Individual, semi-structured interviews were conducted between December 1st and 4th, 2021. The Atlas.ti software was employed to process the results using Bardin's thematic content analysis. Results: the obstetric nurses expanded comprehensive care for pregnant women by implementing the use of ultrasound technology during Obstetric Nursing consultations, thus innovating the practices in Brazil. However, they faced countless challenges, which they overcame thanks to the positive results of improving obstetric and fetal care. Conclusion: using ultrasound technology in Obstetric Nursing consultations represents an advance in the Nursing practice, as it enables access and qualification to timely care, free of charge and through the Unified Health System. The support and encouragement of the institutional management strengthened obstetric nurses' professional autonomy, mediating the implementation of innovation. The study focus is added to the technological development employed in the everyday work of Brazilian Nursing, increasing resoluteness of decision-making in health problems.

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“…15 Nonetheless, these methods are inaccessible in resource-limited settings. 15,16 Meanwhile, there was an association detected of FGR/SGA with a woman’s medical history. 17 Because a health insurance claim database abundantly records medical histories, this allows proactive screening for FGR/SGA, particularly in countries with universal health coverage.…”

Section: Introductionmentioning

confidence: 99%

Widely accessible prognostication using medical history for fetal growth restriction and small for gestational age in nationwide insured women

Sufriyana,

Amani,

Al Hajiri

et al. 2024

Preprint

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ObjectivesPrevention of fetal growth restriction/small for gestational age is adequate if screening is accurate. Ultrasound and biomarkers can achieve this goal; however, both are often inaccessible. This study aimed to develop, validate, and deploy a prognostic prediction model for screening fetal growth restriction/small for gestational age using only medical history.MethodsFrom a nationwide health insurance database (n=1,697,452), we retrospectively selected visits of 12-to-55-year-old females to 22,024 healthcare providers of primary, secondary, and tertiary care. This study used machine learning (including deep learning) to develop prediction models using 54 medical-history predictors. After evaluating model calibration, clinical utility, and explainability, we selected the best by discrimination ability. We also externally validated and compared the models with those from previous studies, which were rigorously selected by a systematic review of Pubmed, Scopus, and Web of Science.ResultsWe selected 169,746 subjects with 507,319 visits for predictive modeling. The best prediction model was a deep-insight visible neural network. It had an area under the receiver operating characteristics curve of 0.742 (95% confidence interval 0.734 to 0.750) and a sensitivity of 49.09% (95% confidence interval 47.60% to 50.58% using a threshold with 95% specificity). The model was competitive against the previous models in a systematic review of 30 eligible studies of 381 records, including those using either ultrasound or biomarker measurements. We deployed a web application to apply the model.ConclusionsOur model used only medical history to improve accessibility for fetal growth restriction/small for gestational age screening. However, future studies are warranted to evaluate if this model’s usage impacts patient outcomes.

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Achieving universal access to obstetric ultrasound in resource constrained settings: A narrative review

Cited by 11 publications

References 54 publications

Potential for Use of Portable Ultrasound Devices in Rural and Remote Settings in Australia and Other Developed Countries: A Systematic Review

Potential for Use of Portable Ultrasound Devices in Rural and Remote Settings in Australia and Other Developed Countries: A Systematic Review

Technological Advances in Obstetric Nursing Consultations Using Ultrasound

Widely accessible prognostication using medical history for fetal growth restriction and small for gestational age in nationwide insured women

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