UNASSIGNED: Obstetric ultrasound is considered important for determining gestational age, identifying single or multiple pregnancies, locating the placenta and fetal anomalies and monitoring fetal growth and pregnancy-related complications in order to improve patient management.
UNASSIGNED: To explore health professionals\' perspectives on different aspects of obstetric ultrasound in Tanzania regarding self-reported skills in performing ultrasound examinations and what could improve access to and utilization of obstetric ultrasound in the clinical setting.
UNASSIGNED: Cross-sectional study.
UNASSIGNED: Data was collected between November and December 2017 using a questionnaire based on previous qualitative research results from the CROss Country UltraSound Study (CROCUS Study). Seventeen healthcare facilities in 5 urban and semiurban municipalities in the Dar-es-Salaam region were included, with 636 health professionals participating (physicians, n = 307 and midwives/nurses, n = 329).
UNASSIGNED: Most health professionals (82% physicians, 81% midwives/nurses) believed that obstetric ultrasound was decisive in the clinical management of pregnancy. Results indicate proficiency gaps across disciplines: 51% of physicians and 48.8% of midwives/nurses reported no or low-level skills in assessing cervical length. Similarly, deficiencies were observed in evaluating the four-chamber view of the fetal heart (physicians: 51%, midwives/nurses: 61%), aorta, pulmonary artery (physicians: 60.5%, midwives/nurses: 65%) and Doppler assessments (umbilical artery: physicians 60.6%, midwives/nurses 56.1%). Compared to midwives/nurses, physicians were significantly more likely to agree or strongly agree that utilization would improve with more ultrasound machines (odds ratio (OR) 2.13; 95% confidence intervals (CI) 1.26-3.61), better quality of ultrasound machines (OR 2.27; 95% CI 1.10-4.69), more training for health professionals currently performing ultrasound (OR 2.11; 95% CI 1.08-4.17) and more physicians trained in ultrasound (OR 2.51; 95% CI 1.30-4.87).
UNASSIGNED: Improving the provision of obstetric ultrasound examinations in Tanzania requires more and better-quality ultrasound machines, enhanced training for health professionals and an increased number of physicians trained in ultrasound use. To further increase the accessibility and utilization of obstetric ultrasound in maternity care in Tanzania, it is essential to provide training for midwives in basic obstetric ultrasound techniques.
A study reporting on health professionals’ insights and skills regarding pregnancy scans in TanzaniaThis study, conducted in Tanzania, explores health professionals’ perspectives on obstetric ultrasound, an important component believed to increase antenatal care attendance in low-income countries. The research was carried out through a cross-sectional study involving 636 health professionals, primarily physicians and midwives/nurses, to assess their self-reported skills in performing obstetric ultrasound examinations and identify factors that could enhance access to and utilization of obstetric ultrasound in clinical settings. The findings highlight that most health professionals view obstetric ultrasound as crucial in managing pregnancy. However, there is a notable discrepancy in the perceived skills between physicians and midwives/nurses, especially in basic obstetric ultrasound examinations. A majority of health professionals reported either no skills or low-level skills in assessing various aspects like cervical length, fetal heart (four-chamber views), aorta, pulmonary artery and Doppler (umbilical artery). The study suggests that improving access and utilization of obstetric ultrasound could be achieved through increased availability of quality ultrasound machines and enhanced training. Physicians expressed a stronger belief in the positive impact of more ultrasound machines, better machine quality, additional training for current ultrasound examiners and more physicians trained in ultrasound. The data underscores the potential for enhancing obstetric ultrasound provision in Tanzania by investing in better technology, providing more training for healthcare professionals and increasing the number of physicians skilled in ultrasound use. Furthermore, the study recommends targeted training for midwives to enhance their proficiency in basic obstetric ultrasound, ultimately contributing to improved accessibility and utilization of obstetric ultrasound in maternity care in Tanzania.

Background and objective Severe preeclampsia may be managed expectantly before 34 weeks gestation with close surveillance. Utilized in fetal growth restriction (FGR), evidence supports umbilical artery (UA) Doppler preventing neonatal morbidity from hypertensive disease and predicting adverse outcomes in preeclampsia. We evaluated the association of abnormal UA Doppler waveforms with early delivery (before 34 weeks gestation) and adverse maternal-fetal outcomes in patients with early severe preeclampsia without FGR. Methodology This is a retrospective cohort study of singleton pregnancies with International Classification of Diseases (ICD) Ninth or Tenth Revision, defined severe preeclampsia diagnosed before 34 weeks gestation without FGR from January 1, 2018, through January 27, 2023, at a large tertiary care center where S/D ratios were calculated from UA Doppler interrogation of a free loop of cord at least once weekly. This study was approved by the IRB (ID:00002216) and granted a full Health Insurance Portability and Accountability Act (HIPAA) waiver of consent. Exclusion criteria were major congenital anomalies, congenital infection, aneuploidy, leaving against medical advice >24 hours, and patient instability on admission defined as condition(s) precluding expectant management by the American College of Obstetrics and Gynecology. The primary outcome was delivery before 34 weeks gestation. Secondary outcomes were the mode of delivery and maternal/fetal complications. Patient characteristics and outcomes for normal versus abnormal UA Doppler groups were compared with chi-square, t-tests, and Fisher\'s exact test. Odds ratios and relative risks were calculated to compare outcomes. Results Of 194 patients with severe preeclampsia, 107 met inclusion criteria. Thirty-four patients had abnormal UA Doppler studies. There were no differences in demographic and clinical data between patients with normal and abnormal UA Doppler studies. Patients with abnormal UA Doppler studies were more likely to deliver before 34 weeks (OR=3.91; 95% CI 1.24-12.33) for worsening severe features (OR=3.85; 95% CI 1.42-10.41), and were less likely to deliver vaginally (OR=0.12; 95% CI 0.03-0.54). Abnormal UA Doppler studies were associated with an increased risk of neonatal complications (OR=6.46; 95% CI 1.42-29.42) and respiratory distress syndrome (RDS) (OR=4.75; 95% CI 1.32-17.16). Abnormal UA Doppler subgroups were divided into patients with elevated S/D >95% Acharya (N=22) and absent end-diastolic flow (EDF) (N=10). The elevated S/D group tended to deliver before 34 weeks gestation for worsening severe features (OR=3.71, 95% CI 1.144-12.050) and had a higher risk of neonatal complications (RR 1.404; 95% CI 1.213-1.624). The absent EDF subgroup was more likely to deliver before 34 weeks (RR=1.52; 95% CI 1.29-1.79) for abnormal fetal testing (OR=6.92; 95% CI 1.71-28.08) and undergo primary cesarean delivery (OR=7.23; 95% CI 1.43-36.61). Conclusion Pregnancies with severe preeclampsia without FGR displayed a high incidence of abnormal UA Doppler waveforms associated with loss of clinical stability and adverse fetal outcomes. The groups with more impedance to umbilical artery flow tended to deliver earlier, and as the Doppler shifted from elevated S/D to absent end-diastolic flow, the mode of delivery shifted to cesarean delivery with increased risk of abnormal fetal testing. These results support the utility of UA Doppler surveillance in severe preeclampsia.

Benign uterine tumors, known as leiomyomas or uterine fibroids, can result in severe pain, bleeding, and infertility. They impact a woman\'s overall well-being, ability to conceive, and the course of her pregnancy. Fibroids are associated with increasing maternal age. When a patient with fibroids is considering pregnancy, ultrasonography and a detailed pelvic examination should be performed to determine the size and location of any fibroids. This case study details a 30-year-old female patient who had fibroids during her pregnancy and responded well to treatment.

OBJECTIVE: To evaluate the accuracy of two portable ultrasound machines (PUM) in assessing fetal biometry and estimated gestational age (EGA).
METHODS: This was a secondary analysis of data from the Fetal Age Machine Learning Initiative, an observational study of pregnant women in the USA and Zambia. Each participant underwent ultrasound assessment by an experienced sonographer using both a high-specification ultrasound machine (HSUM) and a PUM (Butterfly iQ or Clarius C3) to measure fetal biometry and calculate EGA at each visit. By comparing paired PUM and HSUM scans, we estimated agreement between individual biometry measurements and aggregate gestational age estimates by reporting mean difference, intraclass correlation coefficient (ICC) and Bland-Altman plots, adjusting for trend.
RESULTS: Between April and December 2021, 818 participants contributed 1386 paired PUM-HSUM ultrasound investigations, of which 991 PUM scans were obtained using the Butterfly iQ device and 395 using the Clarius C3 device. Gestational age at scan ranged from 7 to 38 weeks. Compared with HSUM, the Butterfly iQ PUM had a mean difference of -0.20 (95% CI, -0.60 to 0.20) days in the first trimester and -0.68 (95% CI, -0.93 to -0.44) days in the second/third trimesters. Compared with HSUM, the Clarius C3 PUM had a mean difference of -0.47 (95% CI, -1.11 to 0.18) days in the first trimester and -1.67 (95% CI, -2.10 to -1.25) days in the second/third trimesters. ICCs were 0.989 or greater throughout. Increasing gestational age was associated with increasing error and absolute error in EGA and fetal biometry. Both PUM devices demonstrated a modest trend toward underestimation of EGA with advancing gestational age in second/third-trimester scans, compared with HSUM.
CONCLUSIONS: The Butterfly iQ and Clarius C3 PUM devices were highly accurate in performing fetal biometry in a diverse population from the USA and Zambia. © 2023 International Society of Ultrasound in Obstetrics and Gynecology.

Fetal intestinal volvulus is a rare condition that can lead to hemorrhage, bowel necrosis, and urgent surgical treatment after birth. Thus, prompt diagnosis and treatment are essential to avoiding fetal or neonatal demise. Prenatal ultrasound is a keystone tool in the diagnostic course. However, sonographic findings tend to be non-specific, with limited understanding of the pathophysiology behind their atypical presentation. With a literature review and a case series, we aim to optimize the antenatal diagnosis and management of this rare but life-threatening condition. Six cases from our institution were retrospectively analyzed over 12 years. A literature review was conducted until December 2022. A total of 300 articles matched the keyword \"Fetal volvulus\", and 52 studies were eligible for the review. Our 6 cases are added to the 107 cases reported in the literature of fetal intestinal volvulus with antenatal ultrasound assessment and without associated gastroschisis or omphalocele. Several prenatal symptoms and ultrasound markers, even if not specific, were more frequently reported. Different experiences of management were described regarding follow-up, the timing of delivery, the mode of delivery, and surgery outcomes. This paper highlights the importance of suspecting and assessing fetal volvulus at routine ultrasound scans, describing the most frequent antenatal presentations and management in order to improve fetal and neonatal outcomes.

BACKGROUND: Obstetric ultrasound is a non-invasive imaging modality that uses sound waves to provide a real-time image of the foetus. Women\'s knowledge of and attitudes toward ultrasound are suggested to influence their responses, and a variety of barriers also influence their practices.
OBJECTIVE: This study aimed to assess the knowledge, attitude, barriers, and associated factors of obstetric ultrasound among pregnant women in public hospitals in Addis Ababa.
METHODS: An institution-based cross-sectional study was conducted on 422 pregnant women from July to August 2021 using systematic random sampling. A structured questionnaire was employed, entered into Epi Info 7.2, and analysed in SPSS 23. Bivariate and multivariate logistic regression was used to identify associated factors.
RESULTS: The proportion with good knowledge of obstetric ultrasound was 51.4%, and that with positive attitudes was 70.1%. Women with a degree and above (AOR 2.70; 95% CI 0.21-35.23), government employment (AOR 3.901; 95% CI 1.92-7.90), and previous ultrasound exposure (AOR 1.966; 95% CI 1.24-3.12) were significantly associated with knowledge. Government-employed women (AOR 6.83; 95% CI 2.43-19.18), women with 1000-5000birr in household income (AOR 5.31; 95% CI 2.01-14.03), and women with a history of births with congenital anomalies (AOR 21.07; 95% CI 2.09-21.21) were significantly associated with the attitude toward obstetric ultrasound. Participants in the study expressed a variety of barriers that influenced their practices; long waiting time was the most common (77.3%).
CONCLUSIONS: Pregnant women\'s levels of knowledge and attitudes towards obstetric ultrasound were moderately good. However, there were a variety of barriers, including patient privacy, waiting time, handling, and side effects, that influenced the utilisation of ultrasound.

UNASSIGNED: Antenatal care is essential for all expectant mothers and assists in reducing maternal mortality rates thus addressing the Sustainable Development Goal 3. Obstetric ultrasound complements antenatal care and is used in pregnancy to identify and monitor high-risk pregnancies. However, disparities exist and in low- and middle-income countries, ultrasound services are not readily available. This contributes to maternal and neonatal morbidity and mortality within these populations. Short ultrasound training programmes for midwives can be beneficial in alleviating some of the challenges experienced.
UNASSIGNED: The aim of this scoping review was to identify global ultrasound education programmes for midwives.
UNASSIGNED: Articles containing suitable keywords were retrieved from databases suitable to nursing, education and ultrasound. Themes were developed based on the articles included in the review.
UNASSIGNED: A total of 238 articles were identified, and after the duplicates and irrelevant studies were removed, 22 articles were included. Articles were analysed and discussed under the identified themes and categories.
UNASSIGNED: It is essential that sufficient training is provided to medical professionals performing obstetric ultrasound so that adequate and safe care is offered to expectant mothers. With the introduction of ultrasound in low-resource settings, the knowledge of safety and competencies required to operate the equipment necessitate adequate training. Developed programmes have been found to meet the demands of the ever-changing workforce and allow for midwives to perform focused obstetric ultrasound examinations.
UNASSIGNED: This scoping review highlighted ultrasound training programmes for midwives and provided guidance on the development of future midwifery ultrasound training programmes.

UNASSIGNED: The aim of this systematic review is to critically assess the efficacy of the cerebroplacental ratio performed in the third trimester at predicting adverse perinatal outcomes and reducing stillbirth rates.
UNASSIGNED: The literature search was performed using CINAHL, EMBASE, EMCARE, MEDLINE and PubMed including systematic reviews, retrospective and prospective studies from inception until July 2020 utilising the PRISMA checklist and flowchart. Data displaying sensitivities, specificity and odds ratios (OR) to include 95% confidence interval (CI) were extracted and synthesised.
UNASSIGNED: Initially, 1226 studies were identified, and nine studies met the inclusion criteria. Sample sizes ranged from 491 to 9772 pregnancies. The cerebroplacental ratio had the strongest diagnostic accuracy of all of the independent variables for detecting fetal demise (mean sensitivity and specificity; 79% and 78%). The cerebroplacental ratio, however, did not perform as favourably at predicting operative delivery (mean sensitivity and specificity; 59% and 82%) or anticipating admission to the neonatal intensive care unit (mean sensitivity and specificity; 55% and 74%).
UNASSIGNED: The results from this study showed that the cerebroplacental ratio within third trimester pregnancies has been proven to have moderate to high diagnostic value when detecting adverse perinatal outcomes, in particular fetal demise.
UNASSIGNED: Cerebroplacental ratio has the potential as a diagnostic tool to reduce adverse perinatal outcomes, in particular fetal demise and help reduce stillbirth rates. The main study limitation involved heterogeneity within the included studies, in particular with a regard to blinding.

UNASSIGNED: This study aimed to measure the Cobb angle of the fetal spine using three-dimensional ultrasound (3D-US) and to assess the relationship between the Cobb angle and the prognosis of congenital scoliosis.
UNASSIGNED: From March 2015 to June 2019, 77 pregnant women whose fetuses had suspected spinal skeletal dysplasia consented to undergo 3D-US examinations, and 54 fetuses were selected for the analysis group. The study protocol was approved by the review board of the Institutional Ethics Committee for Fetal Medicine. 3D-US was used to show the structure of the fetal spine in 3 planes, and the Cobb angle was measured on the coronal plane. The diagnostic efficacy of 3D-US was compared to that of X-ray for 33 fetuses.
UNASSIGNED: In the diagnosis of congenital scoliosis, the sensitivity, specificity, accuracy, positive predictive value (PPV), and negative predictive value (NPV) of 3D-US were 91.7%, 90.0%, 90.7%, 88.0%, and 93.1%, respectively. The area under the receiver operating characteristic (ROC) curve with 3D-US was 0.908. The Spearman correlation coefficient between the Cobb angle measurement on an X-ray image and on the coronal plane image acquired by 3D-US was 0.84, which showed a significant correlation (P<0.05).
UNASSIGNED: 3D-US was successful in the diagnosis of congenital scoliosis. It is feasible to measure the Cobb angle on the coronal plane of the fetal spine by using 3D-US. The Cobb angle has the potential to become an auxiliary index for evaluating the prognosis of congenital scoliosis.

UNASSIGNED: Ultrasound scanning is an integral part of antenatal care worldwide. However, little is known about the utilization of obstetric ultrasound in Ethiopia. This study aimed to assess prenatal ultrasound utilization and its associated factors among pregnant women attending antenatal care in Jimma town public health care facilities.
UNASSIGNED: An institutional-based cross-sectional study was conducted on 303 pregnant women attending antenatal care (ANC) from July to August 2021 in Jimma town public health care facilities. A systematic sampling technique was used to select study participants who attended the ANC service during the data collection period. Logistic regression analysis was performed to determine the association between the explanatory and response variables. The strength of association of dependent and independent variables was presented as crude and adjusted odds ratio (AOR) at a 95% confidence interval. The level of significance was declared at a P-value of less than .05 in multivariable logistic regression. Narratives, figures, and tables were used to obtain the results.
UNASSIGNED: The proportion of prenatal ultrasound utilization in this study was 60.7% [(95% CI); (55.4%-66%)]. Residency AOR = 6.09 (95%CI: 2.35-15.78), household monthly income less than 1000 AOR = 0.159(0.035-0.73), mother\'s history of at least one abortion AOR = 5.78 (95% CI: 1.89- 17.64), and knowledge towards prenatal ultrasound AOR = 15.77 (95% CI: 6.39-38.92) were found statistically significant association with prenatal ultrasound utilization.
UNASSIGNED: In the current study, the proportion of prenatal ultrasound utilization during pregnancy was lower than the world health organization (WHO) recommendation. Therefore, the author recommended that educating mothers on the purposes of obstetric ultrasound and/ or including a prenatal ultrasound screening as part of antenatal care is needed.