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Routine antenatal ultrasound in low‐ and middle‐income countries: first look – a cluster randomised trial
Author(s) -
Goldenberg RL,
Nathan RO,
Swanson D,
Saleem S,
Mirza W,
Esamai F,
Muyodi D,
Garces AL,
Figueroa L,
Chomba E,
Chiwala M,
Mwenechanya M,
Tshefu A,
Lokangako A,
Bolamba VL,
Moore JL,
Franklin H,
Swanson J,
Liechty EA,
Bose CL,
Krebs NF,
Michael Hambidge K,
Carlo WA,
Kanaiza N,
Naqvi F,
Pineda IS,
LópezGomez W,
Hamsumonde D,
Harrison MS,
KosoThomas M,
Miodovnik M,
Wallace DD,
McClure EM
Publication year - 2018
Publication title -
bjog: an international journal of obstetrics and gynaecology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 2.157
H-Index - 164
eISSN - 1471-0528
pISSN - 1470-0328
DOI - 10.1111/1471-0528.15287
Subject(s) - medicine , referral , placenta previa , cluster randomised controlled trial , randomized controlled trial , obstructed labour , obstetrics , cluster (spacecraft) , pregnancy , intervention (counseling) , pediatrics , emergency medicine , caesarean section , family medicine , nursing , surgery , fetus , placenta , programming language , biology , computer science , genetics
Objective Ultrasound is widely regarded as an important adjunct to antenatal care ( ANC ) to guide practice and reduce perinatal mortality. We assessed the impact of ANC ultrasound use at health centres in resource‐limited countries. Design Cluster randomised trial. Setting Clusters within five countries (Democratic Republic of Congo, Guatemala, Kenya, Pakistan, and Zambia) Methods Clusters were randomised to standard ANC or standard care plus two ultrasounds and referral for complications. The study trained providers in intervention clusters to perform basic obstetric ultrasounds. Main outcome measures The primary outcome was a composite of maternal mortality, maternal near‐miss mortality, stillbirth, and neonatal mortality. Results During the 24‐month trial, 28 intervention and 28 control clusters had 24 263 and 23 160 births, respectively; 78% in the intervention clusters received at least one study ultrasound; 60% received two. The prevalence of conditions noted including twins, placenta previa, and abnormal lie was within expected ranges. 9% were referred for an ultrasound‐diagnosed condition, and 71% attended the referral. The ANC ( RR 1.0 95% CI 1.00, 1.01) and hospital delivery rates for complicated pregnancies ( RR 1.03 95% CI 0.89, 1.20) did not differ between intervention and control clusters nor did the composite outcome ( RR 1.09 95% CI 0.97, 1.23) or its individual components. Conclusions Despite availability of ultrasound at ANC in the intervention clusters, neither ANC nor hospital delivery for complicated pregnancies increased. The composite outcome and the individual components were not reduced. Tweetable abstract Antenatal care ultrasound did not improve a composite outcome that included maternal, fetal, and neonatal mortality.