Routine antenatal ultrasound in low- and middle-income countries: first look – a cluster randomised trial
Goldenberg, RL; Nathan, RO; Swanson, D; Saleem, S; Mirza, W; Esamai, F; Muyodi, D; AL 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; Hambidge, K Michael; Carlo, WA; Kanaiza, N; Naqvi, F; Pineda, IS; Lopez-Gomez, W; Hamsumonde, D; Harrison, MS; Koso-Thomas, M; Miodovnik, M; Wallace, DD; McClure, EM
Date:
2018-06-16
Abstract:
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.
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