Based on a 2013 UNICEF Philippine Report, 13 mothers die every day in the country from pregnancy-related complications [
1]. It reported a high maternal death rate of 162 per 100,000 livebirths in 2000 escalating further to 221/100,000 livebirths in 2011 [
1]. Neverthleless, there was a dramatic decrease in June 2015 to 115/100,000 livebirths which was still short of the 2015 Millennium Development Goal (MDG) of 15 per 100,000 livebirths. In 2015, the Philippines ranked 74th among 184 countries for maternal mortality rate (MMR) [
2]. The major cause of maternal death in the country has been hemorrhage at 41% [
1]. The different causes of maternal deaths worldwide have been attributed to hemorrhage (27%) of which 17% occurred in the postpartum period, sepsis (10.7%), obstructed labor (2.8%), hypertensive disorders (14%), and complications of unsafe abortion (7.9%). Most of these disorders are preventable with early diagnosis and prompt interventions [
3]. Placental implantation abnormalities (PIAs) namely, placenta previa, marginal/low lying placenta, placenta accreta vasa previa and velamentous cord insertion account for both intrapartum and postpartum maternal hemorrhages [
4]. They are identified by ultrasound, which normally can be done anytime between 18 and 22 weeks [
4]. In contrast, the trend for neonatal mortality rate (NMR) of the Philippines or deaths in the newborn before they reach 28 days of life showed a downward trend from 20 per 1000 livebirths in 1990 to 12.6 per 1000 livebirths in 2015. This was comparable to Indonesia’s estimated 13.5 neonatal deaths per 1000 livebirths [
5]. The top three causes of newborn deaths in the Philippines are prematurity (31%) followed by asphyxia and birth trauma (23%) and congenital anomalies (19%), which are congruent with the worldwide statistics [
6]. Nevertheless, PIAs contributed substantially to preterm birth with prematurity rates ranging from 38 to 82% simply because premature termination of pregnancy in many instances may be the definitive management for PIAs [
7]. Several studies on maternal health traced the link between neonatal and maternal deaths to the lack of adequate health care during pregnancy [
3]. Poor access to obstetric ultrasound in rural areas of developing countries is known to be significantly detrimental to perinatal outcomes [
8]. A separate study in 2011 reported not only the under-ultilization of ultrasound imaging in many developing countries but also the lack of trained sonographers as a challenge in delivering quality maternal healthcare [
9].
In the Philippines, even the cheapest handheld types are not available in the government birthing facilities. In addition, ultrasound machines can only be found in government Tertiary Hospitals where most Obstetrician (OB)-Sonographers practice. In primary and secondary health facilities, the prenatal management is confined to measuring the vital signs of the pregnant patient, performing physical examination including the Leopold’s Maneuver and doing routine blood tests. A study in Botswana, involving 2309 patients, who attended an Ultrasound Service in a district hospital showed fetal demise, spontaneous abortion, low lying placenta and ectopic pregnancy as among the obstetrical pathologies. It found out that offering ultrasound services during the prenatal visits are cost effective and can improve patient care by 30% [
10].
Active surveillance of the pregnant patient with abnormal obstetrical images on ultasound can be initiated earlier, reducing the development of conditions to a more catastrophic event. Unnecessary internal examination, which can potentially result to undue vaginal bleeding, can also be avoided by the early identification of abnormal placental implantation. Lastly, adequate preparation such as improving the hemodynamic state of the parturient to withstand heavy blood loss during labor and delivery especially by cesarean section can be appropriately instituted avoiding possible blood transfusions during labor and delivery. A study of Oyelese and colleagues reported 97% (59/61) of infants prenatally diagnosed by ultrasound with vasa previa surviving compared with only 44% (41/94) survivors out of those undiagnosed [
11]. Finally, Harris and Marks in 2009 summarized the anecdotal experience of ultrasound in low resource setting. They observed improvement of public health care including maternal care with the deployment of donated ultrasound units. They particularly cited the experience of a Nicaraguan physician who reported a reduction of maternal mortality from 12 deaths per year to 5 per year in his practice. The study recommended doing field trials using ultrasound against a reference validation machine on a scale equal with public health interventions [
12].
The objectives of the study were: (1) to ascertain the benefits of early ultrasound imaging of pregnant women in their 20th to 24th weeks age of gestation in detecting PIAs, fetal conditions such as malpresentations and multiple pregnancies; (2) to estimate the agreement between the ultrasound readings of the trainees with their trainers; (3) to validate the readings from the handheld ultrasound (HU) with the reference ultrasound validation machine; (4) to determine the type of birth attendant and place of deliveries of our study population representing both rural and urban sites and (5) to estimate the maternal and neonatal deaths possibly averted from the use of a HU in their prenatal care.