Could ultrasound midwifery training increase antenatal detection of congenital anomalies in Ghana?
PLoS One
; 17(8): e0272250, 2022.
Article
em En
| MEDLINE
| ID: mdl-35913961
ABSTRACT
BACKGROUND:
As part of World Health Organization (WHO) 2016 updated antenatal care (ANC) guidelines routine ultrasonography is recommended, including to detect congenital anomalies. The Ghana Health Service (GHS) developed an in-service midwifery ultrasound training course in 2017, which includes fetal anomaly detection. Training rollout has been very limited. We sought to determine proportions of anomalies among neonates presenting to Tamale Teaching Hospital (TTH) that should be prenatally detectable by course-trained midwives in order to determine training program potential utility.METHODS:
We analyzed data from a registry of neonates admitted to TTH with congenital anomaly diagnoses in 2016. We classified ultrasonographic detectability of anomalies at ≤13 and 14-23 weeks gestation, based on GHS course content and literature review. Secondary analysis included 2011-2015 retrospective chart review data.RESULTS:
Eighty-five neonates with congenital anomalies were admitted to TTH in 2016. Seventy-three (86%) mothers received ≥1 ANC visit; 47 (55%) had at least one prenatal ultrasound, but only three (6%) were interpreted as abnormal. Sixteen (19%) and 26 (31%) of the anomalies should be readily detectable by course-trained midwives at ≤13 and 14-23 weeks gestation, respectively. When the 161 anomalies from 2011-2015 were also analyzed, 52 (21%) and 105 (43%) should be readily detectable at ≤13 and 14-23 weeks gestation, respectively. "Optimal conditions" (state-of-the-art equipment by ultrasonography-trained physicians) should readily identify 53 (22%) and 115 (47%) of the anomalies at ≤13 and 14-23 weeks gestation, respectively.CONCLUSION:
Training Ghanaian midwives could substantially increase second trimester anomaly detection, potentially at proportions nearing highly resourced settings. Our data also highlight the need for refinement of the WHO antenatal ultrasonography recommendation for a scan before 24 weeks gestation for multiple purposes. Gestational dating accuracy requires first trimester scanning while fetal anomaly detection is more accurate during second trimester. Further specification will enhance guideline utility.
Texto completo:
1
Coleções:
01-internacional
Base de dados:
MEDLINE
Assunto principal:
Anormalidades Congênitas
/
Tocologia
Tipo de estudo:
Diagnostic_studies
/
Guideline
/
Observational_studies
Limite:
Female
/
Humans
/
Newborn
/
Pregnancy
País/Região como assunto:
Africa
Idioma:
En
Revista:
PLoS One
Assunto da revista:
CIENCIA
/
MEDICINA
Ano de publicação:
2022
Tipo de documento:
Article
País de afiliação:
Gana