Volume 125, Issue 12 p. 1591-1599
General obstetrics

Routine antenatal ultrasound in low- and middle-income countries: first look – a cluster randomised trial

RL Goldenberg

RL Goldenberg

Columbia University, New York, NY, USA

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RO Nathan

RO Nathan

University of Washington, Seattle, WA, USA

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D Swanson

D Swanson

University of Washington, Seattle, WA, USA

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S Saleem

S Saleem

Aga Khan University, Karachi, Pakistan

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W Mirza

W Mirza

Aga Khan University, Karachi, Pakistan

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F Esamai

F Esamai

Moi University, Eldoret, Kenya

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D Muyodi

D Muyodi

Moi University, Eldoret, Kenya

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AL Garces

AL Garces

INCAP, Guatemala City, Guatemala

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L Figueroa

L Figueroa

INCAP, Guatemala City, Guatemala

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E Chomba

E Chomba

University of Zambia, Lusaka, Zambia

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M Chiwala

M Chiwala

University of Zambia, Lusaka, Zambia

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M Mwenechanya

M Mwenechanya

University of Zambia, Lusaka, Zambia

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A Tshefu

A Tshefu

Kinshasa School of Public Health, Kinshasa, DRC

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A Lokangako

A Lokangako

Kinshasa School of Public Health, Kinshasa, DRC

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VL Bolamba

VL Bolamba

Kinshasa School of Public Health, Kinshasa, DRC

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JL Moore

JL Moore

RTI International, Durham, NC, USA

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H Franklin

H Franklin

RTI International, Durham, NC, USA

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J Swanson

J Swanson

University of Washington, Seattle, WA, USA

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EA Liechty

EA Liechty

Indiana University, Indianapolis, IN, USA

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CL Bose

CL Bose

University of North Carolina at Chapel Hill, Chapel Hill, NC, USA

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NF Krebs

NF Krebs

University of Colorado, Denver, CO, USA

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K Michael Hambidge

K Michael Hambidge

University of Colorado, Denver, CO, USA

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WA Carlo

WA Carlo

University of Alabama at Birmingham, Birmingham, AL, USA

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N Kanaiza

N Kanaiza

Moi University, Eldoret, Kenya

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F Naqvi

F Naqvi

Aga Khan University, Karachi, Pakistan

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IS Pineda

IS Pineda

San Carlos University, Guatemala City, Guatemala

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W López-Gomez

W López-Gomez

NICHD, Bethesda, MD, USA

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D Hamsumonde

D Hamsumonde

University of Zambia, Lusaka, Zambia

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MS Harrison

MS Harrison

Columbia University, New York, NY, USA

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M Koso-Thomas

M Koso-Thomas

NICHD, Bethesda, MD, USA

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M Miodovnik

M Miodovnik

NICHD, Bethesda, MD, USA

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DD Wallace

DD Wallace

RTI International, Durham, NC, USA

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EM McClure

Corresponding Author

EM McClure

RTI International, Durham, NC, USA

Correspondence: EM McClure, RTI International, Durham, NC, USA. Email: [email protected]Search for more papers by this author
First published: 21 May 2018
Citations: 50
Trial Registration: Clinicaltrials.gov NCT01990625
This article has been contributed to by US Government employees and their work is in the public domain in the USA.
Linked article This article is commented on by BD Einerson, p. 1600 in this issue. To view this mini commentary visit https://doi.org/10.1111/1471-0528.15402.

Abstract

Objective

Ultrasound is widely regarded as an important adjunct to antenatal care (ANC) to guide practice and reduce perinatal mortality. We assessed the impact of ANC ultrasound use at health centres in resource-limited countries.

Design

Cluster randomised trial.

Setting

Clusters within five countries (Democratic Republic of Congo, Guatemala, Kenya, Pakistan, and Zambia)

Methods

Clusters were randomised to standard ANC or standard care plus two ultrasounds and referral for complications. The study trained providers in intervention clusters to perform basic obstetric ultrasounds.

Main outcome measures

The primary outcome was a composite of maternal mortality, maternal near-miss mortality, stillbirth, and neonatal mortality.

Results

During the 24-month trial, 28 intervention and 28 control clusters had 24 263 and 23 160 births, respectively; 78% in the intervention clusters received at least one study ultrasound; 60% received two. The prevalence of conditions noted including twins, placenta previa, and abnormal lie was within expected ranges. 9% were referred for an ultrasound-diagnosed condition, and 71% attended the referral. The ANC (RR 1.0 95% CI 1.00, 1.01) and hospital delivery rates for complicated pregnancies (RR 1.03 95% CI 0.89, 1.20) did not differ between intervention and control clusters nor did the composite outcome (RR 1.09 95% CI 0.97, 1.23) or its individual components.

Conclusions

Despite availability of ultrasound at ANC in the intervention clusters, neither ANC nor hospital delivery for complicated pregnancies increased. The composite outcome and the individual components were not reduced.

Tweetable abstract

Antenatal care ultrasound did not improve a composite outcome that included maternal, fetal, and neonatal mortality.