Routine antenatal ultrasound in low- andmiddle-income countries: first look–a clusterrandomised trial

Abstract

ObjectiveUltrasound is widely regarded as an important adjunctto antenatal care (ANC) to guide practice and reduce perinatalmortality. We assessed the impact of ANC ultrasound use athealth centres in resource-limited countries.DesignCluster randomised trial.SettingClusters within five countries (Democratic Republic ofCongo, Guatemala, Kenya, Pakistan, and Zambia)MethodsClusters were randomised to standard ANC or standardcare plus two ultrasounds and referral for complications. Thestudy trained providers in intervention clusters to perform basicobstetric ultrasounds.Main outcome measuresThe primary outcome was a compositeof maternal mortality, maternal near-miss mortality, stillbirth, andneonatal mortality.ResultsDuring the 24-month trial, 28 intervention and 28 controlclusters had 24 263 and 23 160 births, respectively; 78% in theintervention 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) andhospital delivery rates for complicated pregnancies (RR 1.03 95%CI 0.89, 1.20) did not differ between intervention and controlclusters nor did the composite outcome (RR 1.09 95% CI 0.97,1.23) or its individual components.ConclusionsDespite availability of ultrasound at ANC in theintervention clusters, neither ANC nor hospital delivery forcomplicated pregnancies increased. The composite outcome andthe individual components were not reduced.