Ultrasound in early Pregnancy by Village Midwives in Sudan

ABSTRACT Antenatal care services are provided by village midwives in rural communities in Sudan.Village midwives are well trained in the detection of pregnancy complications in late pregnancy. Ultrasound is an essential and safe tool in managing pregnancy in modern obstetric practice. However, in low-resource countries, the technique is not widely available. The aim of this pilot study was to systematically train village midwives to use ultrasound in the evaluation of early pregnancy. Midwives working in 20 villages were invited to participate in the study. Thirty-seven of them joined the study. They were enrolled in a two-weeks training programme. The training contained basic knobology, scanning techniques, sonographic anatomy and ultrasound appearances in early pregnancy using a portable machine. Patients with amenorrhea less than 12 weeks were included in the study population. Patients were first scanned by the principal investigators, midwives then scanned the patients and recorded their findings on a structured form. Patients mean age was 27 years +/ - 3.6, range 17- 41 years. Nine of the patients were not pregnant, and 4 women had twins. A variety of pregnancy problems were identified including 13 missed abortions, 8 threatened abortions, 4 incomplete abortions, 2 molar pregnancies and one ectopic pregnancy. There were 378 patients with a viable intrauterine singleton pregnancy. Menstrual dates were confirmed in 297 (78.6%) while in 81 (21.4%) the dates were changed. Midwives recognized normal maternal anatomy in 100 % of patients. The rates of true-positive for detection of presence of fetus and viability ranged between 81.9 to 100 % . Sensitivity for the diagnosis of molar pregnancy and ectopic pregnancy was 13.5 % and 2.7 % respectively. After a short training, village midwives could reliably confirm the presence/absence of pregnancy, viability and number of gestations. They could accurately measure and estimate gestational age in the first trimester, determine the location of the placenta and recognize when patients should be referred for specialist care. Keywords: obstetric ultrasound, midwives, maternal mortality, early pregnancy.