Association between antenatal ultrasound findings and neonatal outcomes in rural Uganda: a secondary analysis

Delia Horn,Renny Ssembatya,Kristen Destigter,Anne Dougherty,Erika Edwards,Danielle Ehret

doi:10.1186/s12884-021-04204-7

Delia Horn, Renny Ssembatya + Show 4 more

Open Access

https://doi.org/10.1186/s12884-021-04204-7

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Abstract

BackgroundAlthough the use of prenatal ultrasound services has increased in low- income and lower middle-income countries, there has not been a concurrent improvement in perinatal mortality. It remains unknown whether individual ultrasound findings in this setting are associated with neonatal death or the need for resuscitation at delivery. If associations are identified by ultrasound, they could be used to inform the birth attendant and counsel the family regarding risk, potentially altering delivery preparedness in order to reduce neonatal mortality.MethodsThis was a secondary analysis of data collected from a prospective cohort. Data was gathered at Nawanyago Health Centre III in Kamuli District, Uganda. Participants included pregnant women who received second and third trimester prenatal ultrasound scans and delivered at that center between July 2010 and August 2018. All ultrasounds were performed at Nawanyago and deliveries were attended solely by midwives or nurses. Predictor variables included the following ultrasound findings: fetal number, fetal presentation, and amniotic fluid volume. The primary outcome was bag-mask ventilation (BMV) of the neonate at delivery. The secondary outcome was stillbirth or neonatal death in the delivery room.ResultsPrimary outcome data was available for 1105 infants and secondary outcome data was available for 1098 infants. A total of 33 infants received BMV at delivery. The odds of receiving BMV at delivery was significantly increased if amniotic fluid volume was abnormal (OR 4.2, CI 1.2-14.9) and there were increased odds for multiple gestation (OR 1.9, CI 0.7-5.4) and for non-vertex fetal presentation (OR 1.4, CI 0.6-3.2) that were not statistically significant. Stillbirth or neonatal death in the delivery room was diagnosed for 20 infants. Multiple gestation (OR 4.7, CI 1.6-14.2) and abnormal amniotic fluid volume (OR 4.8, CI 1.0-22.1) increased the odds of stillbirth or neonatal death in the delivery room, though only multiple gestation was statistically significant.ConclusionCommon findings that are easily identifiable on ultrasound in low- and lower middle-income countries are associated with adverse perinatal outcomes. Education could lead to improved delivery preparedness, with the potential to reduce perinatal mortality. This was a preliminary study; larger prospective studies are needed to confirm these findings.

Highlights

The use of prenatal ultrasound services has increased in low- income and lower middleincome countries, there has not been a concurrent improvement in perinatal mortality
98% of stillbirths occur in Low and middle income country (LMIC), with an incidence of 28.7/1000 in Sub-Saharan Africa compared with the global average of 18.4/1000 [3]
All predictor variable data was available for the 33 infants who received bag-mask ventilation (BMV) and for infants diagnosed with the composite secondary outcome of stillbirth or neonatal death in the delivery room; there was missing data related to each predictor variable for infants who did not have the primary or secondary outcome of interest

Summary

Introduction

The use of prenatal ultrasound services has increased in low- income and lower middleincome countries, there has not been a concurrent improvement in perinatal mortality. It remains unknown whether individual ultrasound findings in this setting are associated with neonatal death or the need for resuscitation at delivery. Neonatal mortality remains high in low-income and lower middle-income countries (LMICs). In high income countries, detailed US scans reviewed by specialty trained radiologists and obstetricians are routinely used to guide prenatal care and delivery planning. Potentially more cost effective and suitable for low resource areas, available machines (often hand-held portable) may be less sophisticated for obstetric assessment; task-shifting is common due to the lack of skilled workforce, and the staff performing the scans often have limited training with the ability to capture only basic obstetric findings; the images are regularly interpreted by these same providers at the point-of-care [5,6,7,8,9,10,11,12]

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