Ultrasonography in Low-Resource Settings: Utility and Demand
This post is the first in a two-part series on issues related to the use of ultrasound to improve maternal health in low-resource settings.
Since its introduction to clinical practice in the 1960s, ultrasonography has created new opportunities for obstetric care providers to establish and investigate pregnancies. Ultrasound machines have become a regularly used diagnostic tool to improve the availability and quality of critical information related to maternal, fetal and newborn health.
It is typically recommended that women receive a minimum of two ultrasound scans to:
- Confirm the existence of a pregnancy or pregnancies
- Establish whether the pregnancy is intrauterine or ectopic
- Determine an accurate gestational age
- Monitor fetal growth
- Track the baby’s positioning
- Rule out occurrence of placenta previa
- Identify high-risk pregnancies and abnormalities
Having this information is critical to determining care plans and clinical interventions. For example, knowing the gestational age of the baby with greater certainty than a woman’s recollection of her Last Menstrual Period (LMP) will factor into an assessment of how the baby is growing and establishes the expected time of labor and delivery.
Many also believe the use of ultrasound has psychological benefits for parents—seeing the fetus is a “pull factor” for visiting a facility and may encourage early antenatal attendance. The capacity of ultrasound machines to attract men to antenatal care visits has also been noted.
These benefits could be especially impactful in settings where perinatal mortality and morbidity are highest. Ultrasound machines are most commonly used to assist with diagnosing obstetrical conditions in low- and middle-income countries, as opposed to investigating tropical infectious and non-communicable diseases. Preliminary data from Daktari Diagnostics demonstrate that the potential market size for ultrasonography in low- and middle-income countries is approximately 782 million tests per year during pregnancy. When factoring in access barriers to prenatal care provided by WHO and UNICEF, the accessible market size shrinks to approximately 500 million tests per year. However, upward trends in access to care and machines being produced at lower costs than ever before, this market size is projected to re-inflate over time.
A combination of ultrasound’s clinical and psychological benefits and these demand patterns may indicate that ultrasound machines are an obstetric care solution in low- and middle-income countries. However, the drawbacks of ultrasounds are also well-known. Machine and maintenance cost have been a major barrier to their use in low- and middle-income countries. In addition, training on the machines is required for use and interpretation of results; otherwise there is potential for misdiagnosis. A misdiagnosis of growth restriction from poor ultrasound measurements, for example, could lead to unnecessarily delivering the baby preterm, potentially causing great harm to the baby.
The next post in our two-part series will explore approaches to implementing ultrasound in low-resource settings. Do you have an opinion on the feasibility of ultrasound in low-resource settings? Please contact for more information on being a guest blogger for the MHTF.