What is the current status of availability and impact of antenatal point of care ultrasound services (PoCUS) in rural and remote communities globally? A review

Abstract

Background There are global disparities in the provision of maternal health care, with women from rural communities and under resourced countries expecting poorer access to health care services1-4. This potentially compounds the existing higher burden of maternal and neonatal morbidity within these populations4,5. In this setting point of care ultrasound (PoCUS) has the potential to improve patient outcomes4-7. The portability of the technology mitigates some of the barriers and challenges associated with the introduction of medical imaging services in rural and remote settings6-7. Objectives To explore the availability and impact of PoCUS use for antenatal care (ANC) in rural and under resourced settings globally. Methods Medline, Embase and Scopus were searched with no year limit. Studies were included if the participants were pregnant women undergoing ANC in a rural setting or developing country and if the intervention was PoCUS use or training for PoCUS use. Results 3863 unique articles were identified, with 17 meeting the inclusion criteria. Studies originated from Africa, Asia, Central America and Australia. All studies reported that PoCUS use for ANC produced positive outcomes. ANC utilisation, training and maternal and neonatal outcomes were the three primary outcomes identified in the literature. Methods and measures of outcomes varied between studies. PoCUS introduction into routine ANC resulted in a statistically significant increase in pregnant women attending and utilising ANC services8-11. PoCUS use was demonstrated to directly influence the identification, diagnosis and treatment of conditions associated with maternal and neonatal morbidity12-14. It was feasible to provide local health care workers in under-resourced communities with limited training to perform quality scanning and reporting in their clinics14-23. Conclusion PoCUS for ANC is utilised in under resourced countries and in rural settings. Integration of PoCUS into ANC in these settings offer benefits particularly in the reduction of maternal and neonatal morbidity rates. It was demonstrated that with minimal PoCUS training, local health care workers were able to accurately determine gestational age, the number of gestations and identify fetal anomalies. This may facilitate improved clinical management in this setting.