The impact of performing a standardized, focused, basic ultrasound examination on admission to a large maternity ward in Tanzania. A prospective observational study

Abstract

Objective: To assess whether a basic ultrasound examination following the ordinary clinical examination on admission to a maternity ward, had any impact for improved diagnostics and the clinical management of labor. Methods: This is an observational study, which was carried out at the largest hospital in Tanzania. A four-­step basic ultrasound examination was performed after the clinical examination by the local midwife, on women admitted in labor. We assessed the fetal presentation, fetal cardiac activity, number of fetuses and the placental location. Outcome information was collected from the birth protocol. Results: A total of 63 women were recruited into the study and were examined with ultrasound on admission to the maternity ward. 21% of the women had received suboptimal primary pregnancy healthcare. Ten women had not been examined with ultrasound, while five women had received 4-­5 ultrasound examinations each. The median pregnancy length at delivery was 265 days, and the cesarean section rate in the study population was 35%. Conclusion: The local midwives proved to be very skilled at clinical examinations, and the ultrasound examinations were thus of limited value, and did not crucially alter the decision-­making, diagnosis nor management of labor in this small study sample.