The diagnostic impact of limited, screening obstetric ultrasound when performed by midwives in rural Uganda

Objective:to evaluate the diagnostic impact of limited obstetric ultrasound (us) in identifying high-risk pregnancies when used as a screening tool by midwives in rural uganda.study design:this was an institutional review board-approved prospective study of expecting mothers in rural uganda who underwent clinical and us exams as part of their standard antenatal care visit in a local health center in the isingiro district of uganda. the midwives documented clinical impressions before performing a limited obstetric us on the same patient. the clinical findings were then compared with the subsequent us findings to determine the diagnostic impact. the midwives were us-naive before participating in the 6-week training course for limited obstetric us.result:midwife-performed screening obstetric us altered the clinical diagnosis in up to 12% clinical encounters. this diagnostic impact is less (6.7 to 7.4%) if the early third trimester diagnosis of malpresentation is excluded. the quality assurance review of midwives’ imaging demonstrated 100% sensitivity and specificity in the diagnosing gestational number, and 90% sensitivity and 96% specificity in the diagnosis of fetal presentation.conclusion:limited, screening obstetric us performed by midwives with focused, obstetric us training demonstrates the diagnostic impact for identifying conditions associated with high-risk pregnancies in 6.7 to 12% of patients screened. the limited obstetric us improved diagnosis of early pregnancy complication as well as later gestation twins and malpresentation. midwives who have undergone focused 6-week limited obstetric us training proved capable of diagnosing twins and fetal presentation with high sensitivity and specificity.