First look: a cluster-randomized trial of ultrasound to improve pregnancy outcomes in low income country settings

dc.contributor.authorMcClure, Elizabeth M.
dc.contributor.authorNathan, Robert O.
dc.contributor.authorSaleem, Sarah
dc.contributor.authorEsamai, Fabian
dc.contributor.authorGarces, Ana
dc.contributor.authorChomba, Elwyn
dc.contributor.authorTshefu, Antoinette
dc.contributor.authorSwanson, David
dc.contributor.authorMabeya, Hillary
dc.contributor.authorFiguero, Lester
dc.contributor.authorMirza, Waseem
dc.contributor.authorMuyodi, David
dc.contributor.authorFranklin, Holly
dc.contributor.authorLokangaka, Adrien
dc.contributor.authorBidashimwa, Dieudonne
dc.contributor.authorPasha, Omrana
dc.contributor.authorMwenechanya, Musaku
dc.contributor.authorBose, Carl L.
dc.contributor.authorCarlo, Waldemar A.
dc.contributor.authorHambidge, K. Michael
dc.contributor.authorLiechty, Edward A.
dc.contributor.authorKrebs, Nancy
dc.contributor.authorWallace, Dennis D.
dc.contributor.authorSwanson, Jonathan
dc.contributor.authorKoso-Thomas, Marion
dc.contributor.authorWidmer, Rexford
dc.contributor.authorGoldenberg, Robert L.
dc.contributor.departmentPediatrics, School of Medicine
dc.date.accessioned2025-04-16T13:08:13Z
dc.date.available2025-04-16T13:08:13Z
dc.date.issued2014-02-17
dc.description.abstractBackground: In high-resource settings, obstetric ultrasound is a standard component of prenatal care used to identify pregnancy complications and to establish an accurate gestational age in order to improve obstetric care. Whether or not ultrasound use will improve care and ultimately pregnancy outcomes in low-resource settings is unknown. Methods/design: This multi-country cluster randomized trial will assess the impact of antenatal ultrasound screening performed by health care staff on a composite outcome consisting of maternal mortality and maternal near-miss, stillbirth and neonatal mortality in low-resource community settings. The trial will utilize an existing research infrastructure, the Global Network for Women's and Children's Health Research with sites in Pakistan, Kenya, Zambia, Democratic Republic of Congo and Guatemala. A maternal and newborn health registry in defined geographic areas which documents all pregnancies and their outcomes to 6 weeks post-delivery will provide population-based rates of maternal mortality and morbidity, stillbirth, neonatal mortality and morbidity, and health care utilization for study clusters. A total of 58 study clusters each with a health center and about 500 births per year will be randomized (29 intervention and 29 control). The intervention includes training of health workers (e.g., nurses, midwives, clinical officers) to perform ultrasound examinations during antenatal care, generally at 18-22 and at 32-36 weeks for each subject. Women who are identified as having a complication of pregnancy will be referred to a hospital for appropriate care. Finally, the intervention includes community sensitization activities to inform women and their families of the availability of ultrasound at the antenatal care clinic and training in emergency obstetric and neonatal care at referral facilities. Discussion: In summary, our trial will evaluate whether introduction of ultrasound during antenatal care improves pregnancy outcomes in rural, low-resource settings. The intervention includes training for ultrasound-naïve providers in basic obstetric ultrasonography and then enabling these trainees to use ultrasound to screen for pregnancy complications in primary antenatal care clinics and to refer appropriately.
dc.eprint.versionFinal published version
dc.identifier.citationMcClure EM, Nathan RO, Saleem S, et al. First look: a cluster-randomized trial of ultrasound to improve pregnancy outcomes in low income country settings. BMC Pregnancy Childbirth. 2014;14:73. Published 2014 Feb 17. doi:10.1186/1471-2393-14-73
dc.identifier.urihttps://hdl.handle.net/1805/47069
dc.language.isoen_US
dc.publisherSpringer Nature
dc.relation.isversionof10.1186/1471-2393-14-73
dc.relation.journalBMC Pregnancy and Childbirth
dc.rightsAttribution 4.0 Internationalen
dc.rights.urihttp://creativecommons.org/licenses/by/4.0/
dc.sourcePMC
dc.subjectMaternal mortality
dc.subjectMaternal near miss
dc.subjectPerinatal mortality
dc.subjectObstetric ultrasound
dc.subjectLow-income countries
dc.titleFirst look: a cluster-randomized trial of ultrasound to improve pregnancy outcomes in low income country settings
dc.typeArticle
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