Limited Obstetrics Ultrasound in Primary Healthcare Delivery; Outputs for Strategic Considerations: A Review of Pilot Study in Gauteng Province, South Africa

Abstract

In South Africa, midwives in primary healthcare setting are first responders to majority of the expectant mothers in the community. These pregnant mothers should benefit from at least one ultrasound in their pregnancy according to the WHO recommendation. However, these midwifes are not equipped to provide such limited obstetrics ultrasound services essential to accurately date the pregnancy, identify normal pregnancy and refer unsuspecting mothers in a timely manner following abnormality detected on ultrasound. The Advanced Midwifes could accurately diagnose morbidity related complications (for which ultrasound is perceived as the gold standard), they were trained to identify - placenta previa, breech presentation, intrauterine foetal demise and miscarriages, abnormal amniotic fluid levels, cervical incompetence, ectopic pregnancy, abnormal foetal growth and selected gross foetal anomalies. The Advanced Midwifes were accurately able to date the pregnancy on women who access the service did not know their last menstrual period (LMP) and on those who could recall their LMP had a significant disparity between gestational age by LMP and by composite ultrasound age (CUA). Limited obstetric ultrasound gestational age determination by advanced midwives was useful in not only assessing gestational age but also in identifying abnormalities associated with the pregnancies.