There are certain risk factors that can be detected prior to the start of delivery so families can prepare for a facility-based delivery. Many women in low-resource settings give birth without a skilled attendant and therefore risk intrapartum complications and potentially a fresh stillbirth.
This project seeks to assess the feasibility and accuracy of using portable ultrasound during home visits in the third trimester by training community-based health workers and auxiliary nurse midwives (who are high school graduates with 18 months of midwifery training) to detect three risk factors of intrapartum-related neonatal, fetal, and maternal death: non-cephalic presentation (the fetus presenting with a body part other than its head first, e.g. breech), multiple gestation (e.g. twins), and placenta previa (when the placenta is positioned low on the uterus, thus partially or fully covering the cervix, often leading to hemorrhage). These risk factors are expected to be associated with adverse outcomes during the intrapartum period, and are thought to only be identified in a high-level facility setting, due to the need for ultrasound exams for valid diagnosis. With the advent of portable ultrasound and the ensuing reduction in costs, the use of such technology in a community-based or low-level facility setting is possible.
The diagnosis of each health worker will be compared with a gold standard sonographer reading the same sonograms and estimate sensitivity and specificity of each community-based worker as well as inter-observer agreement between workers to measure reliability of their assessments.