The major causes of maternal and neonatal mortality in the Philippines are hemorrhages and obstructed labor due to placental implantation abnormalities (PIAs), twin pregnancies and fetal malpresentations. All of which are all easily detected by ultrasound. However, women in rural areas and low-income groups do not have access to ultrasound during their prenatal care. We aimed to provide additional evidence on the benefits of handheld ultrasound (HU) for screening pregnancy related abnormalities in order to avert maternal and neonatal deaths.
Using a HU, we trained community healthcare workers (CHWs) to identify 5 obstetrical conditions: fetal viability and number, placental localization, amniotic fluid volume (AFV) and fetal presentation. Women, between 20th and 24th weeks age of gestation from 2 regions of the Philippines, were scanned using the HU and the GE Logic 5 Premium ultrasound machine for validation. Maternal and neonatal deaths averted were estimated as health outcome measures of the study.
Four hundred sixty women were scanned of which 146 (31.7%) showed abnormal ultrasound readings consisting of 17 PIAs, 123 fetal malpresentation, 3 twins and 3 AFV abnormalities. The use of HU could have possibly averted 29 (6.3%) maternal deaths and 14.6% neonatal deaths at the time of delivery. Thirty-two out of the 460 women (~7%) delivered at home and 93% in hospitals or birthing facilities/lying–in centers. We observed approximately 95% agreement between the ultrasound readings of the trainees and the trainers, and 99% agreement between the readings made from the HU with the validation machine.
CHWs could be trained in the use of HU for scanning 5 obstetrical parameters. Early detection of abnormalities in these 5 obstetrical parameters can lead to early referral to facilities that are better equipped to manage obstetrical emergencies. Prenatal ultrasound can be an excellent point of care test for screening pregnant women at risk for possible complications and even death during labor and delivery.
Thai Clinical Trial Registry identification number TCTR20171128004, retrospectively registered November 28, 2017.
Maternal and newborn health country profiles: Philippines. UNICEF. https://www.unicef.org/philippines/MNH_Philippines_Country_Profile.pdf.
Philippines Maternal Mortality Rate. 2015. https://www.indexmundi.com/philippines/maternal_mortality_rate.html.
Filippi V, Chou Ronsmans C, et.al, Level and causes of maternal mortality and morbidity.In: Black RE,Laxminarayan R, Temmerman M. et al.,editors. Reproductive, maternal, newborn and child health: diseases control priorities, Third Edition (Volume 2). Washington (DC): The International Bank for Reconstruction and Development/The World Bank; 2016 Apr 5. Chapter 3. Available from https://www.ncbi,nih.gov/books/NBK361917/. doi: https://doi.org/10.1596/978-1-4648-0348-2_ch3.
World Data Atlas. Philippines neonatal mortality rate (deaths per/1000 livebirths). Retrieved January 15, 2018. https://knoema.com/atlas/Philippines/Neonatal-mortality-rate?compareTo=ID.
Mortality rate, neonatal (per 1,000 live births). The World Bank. https://data.worldbank.org/indicator/SH.DYN.NMRT.
Vahanian SA. Vintzelios. Placental implantation abnormaties: a modern approach. Curr Opin Obstet Gynecol. 2016;28(6):477–84. https://doi.org/10.1097/GCO.00000000000000319. CrossRefPubMed
Stanton K,Mwanri L.”Global maternal and child health outcomes: the role of obstetric Ultrasosund in low resource settings.” world J Prev Med2013, 1(3): 22-29.
Wiafe YA, Odoi AT, Dassah ET. The role of obstetric ultrasound in reducing maternal and perinatal mortality, Ultrasound Imaging - Medical Applications, Minin IV and Minin OV (Ed.), ISBN: 978-953-307-279-1, INTECH, https://doi.org/10.5772/22847. https://www.intechopen.com/books/ultrasound-imaging-medical-applications/the-role-of-obstetric-ultrasound-in-reducing-maternal-and-perinatal-mortality.
Bussman H, Koen E, Arhin- Tenkorang D, Munyadzwe G, Troeger J. Feasibility of an ultrasound service on district health care level in Botswana. Tropical Med Int Health. 2001;6(12):1023–31. CrossRef
SOGC clinical practice guideline: diagnosis and Management of Placenta Previa no. 189 ( 2007). Principal Author; lawrence Oppenheimer.Maternal Fetal medicine Committee. http://sogc.org/wp-content/uploads/2013/01/189E-CPG-March2007.pdf
Philippine Statistics Authority. Philippine Live Births: 2015 retrieved Dec 27,2017. https://psa.gov.ph/content/philippine-live-births-2015.
Brunette W., Hicks M., Hope A., Ruddy G., Anderson R., Kolko B. Reducing maternal mortality: an ultrasound system for village midwives. http://ieeexplore.ieee.org/xpl/login.jsp?tp=&arnumber=6103613&url=http%3A%2F%2Fieee
Padilla CD, Paz C-d, Cavan B, Abarquez C, Sur A, Sales R, Posecion W, Orbillo L, Basilio J. Establishment of the Philippines birth defect surveillance. Acta Medica Philippina. 2011;40(4):12–9.
- Handheld ultrasound to avert maternal and neonatal deaths in 2 regions of the Philippines: an iBuntis® intervention study
Godofreda V. Dalmacion
Ramon T. Reyles
Antonia E. Habana
Lalaine Mae V. Cruz
Maricelle C. Chua
Analyn T. Ngo
Milagros J. Tia-Jocson
Emmanuel S. Baja
- BioMed Central
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