背景:虽然成长,关于影响的证据,access,实用程序,有效性,在资源受限的环境中,产科超声的成本效益仍然有限。因此,在低收入和中等收入国家(LMICs)实施和扩大产科超声技术之前,必须仔细审查有关目的和预期益处以及各个领域潜在挑战的问题。
方法:这篇叙述性综述为那些试图在LMIC中实施或扩大超声技术的人讨论了这些问题。本次审查涉及的问题包括卫生人员能力,维护,成本,过度使用和误用超声波,提供者和患者之间的误解,患者诊断和护理管理,健康结果,患者对胎儿性别决定的看法和担忧。
结论:随着产科超声的费用在LMICs中变得更实惠,评估收益至关重要,权衡和大规模实施的潜在弊端。此外,需要更清楚地识别超声的能力和局限性,特别是在提供者培训有限的情况下,以确保超声波的目的实际上是可行的。我们发现产科使用超声改善患者管理的证据。然而,有证据表明,使用超声波与减少孕产妇无关,围产期或新生儿死亡率。据报道,各种研究中的患者对超声有积极和消极的看法和经验,最后,非法使用超声波来确定胎儿性别是一个令人担忧的问题。
BACKGROUND: Although growing, evidence on the impact, access, utility, effectiveness, and cost-benefit of obstetric ultrasound in resource-constrained settings is still somewhat limited. Hence, questions around the purpose and the intended benefit as well as potential challenges across various domains must be carefully reviewed prior to implementation and scale-up of obstetric ultrasound technology in low-and middle-income countries (LMICs).
METHODS: This narrative
review discusses these issues for those trying to implement or scale-up ultrasound technology in LMICs. Issues addressed in this
review include health personnel capacity, maintenance, cost, overuse and misuse of ultrasound, miscommunication between the providers and patients, patient diagnosis and care management, health outcomes, patient perceptions and concerns about fetal sex determination.
CONCLUSIONS: As cost of obstetric ultrasound becomes more affordable in LMICs, it is essential to assess the benefits, trade-offs and potential drawbacks of large-scale implementation. Additionally, there is a need to more clearly identify the capabilities and the limitations of ultrasound, particularly within the context of limited training of providers, to ensure that the purpose for which an ultrasound is intended is actually feasible. We found evidence of obstetric uses of ultrasound improving patient management. However, there was evidence that ultrasound use is not associated with reducing maternal, perinatal or neonatal mortality. Patients in various studies reported to have both positive and negative perceptions and experiences related to ultrasound and lastly, illegal use of ultrasound for determining fetal sex was raised as a concern.