3rd trimester, point-of-care, pocket ultrasound protocol by midwives to prevent maternal and perinatal mortality in rural Kenya, Ghana, Burundi, Haiti, and Peru

Organization: 
University of Toronto, Sunnybrook Research Institute
Organization Location: 
Toronto, Ontario, Canada

We aim to detect rural pregnancies at high-risk of maternal and perinatal mortality by training nurse-midwives to incorporate a simple, one-time, point-of-care, 3rd trimester ultrasound into their routine practice. Standard-of-care in most rural, resource-limited settings does not include prenatal ultrasound. Traditional barriers include limited training opportunities for non-physicians and lack of evidence around best practices for screening when presentation is delayed until 3rd trimester or onset of labor. The protocol parameters exclude conditions associated with significant maternal and/or fetal morbidity/mortality, and are technically easy to detect without extensive training. Any positive finding triggers obstetrical referral and termination of scanning: fetal demise, breech presentation, multiple gestation, and placenta previa. The curriculum is hands-on, using a portable simulation scan-trainer (Medaphor) to validate learner accuracy. Midwives will be provided with portable ultrasounds (VScan, GE). We will study the intervention with a multi-center, cluster-randomized controlled trial. The expected impact is significant mortality reduction. Portable ultrasound technology is a safe, inexpensive, and invaluable imaging tool on the verge of becoming ubiquitous. Our approach is innovative: current evidence-base for routine screening is in 2nd trimester pregnancy, with studies conducted in high-income, urban settings. Our simple, cost-effective intervention leapfrogs universal personnel shortages of trained technologists, radiologists, and obstetricians, and builds on existing rural healthcare infrastructure. Our proposal is cutting-edge in establishing the evidence-base for portable ultrasound use in communities where it is needed most.

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