Experiences of midwives on Vscan limited obstetric ultrasound use: a qualitative exploratory study.

BACKGROUND: Ethiopia is a low-income country located in the horn of Africa's sub-Saharan region, with very high incidences of maternal and neonatal mortality. Quality antenatal care improves perinatal health outcomes. The USAID funded Transform: Primary Health Care Activity in collaboration with the Ministry of Health and GE Healthcare introduced Vscan limited obstetric ultrasound services in 120 health centers in Ethiopia. So far, the experiences and opinions of midwives on their use have not been explored and described within the local context. This study therefore aims to explore and describe the experiences and opinions of midwives on Vscan limited obstetric ultrasound services at health centers within Ethiopia. METHODS: An exploratory and descriptive qualitative study was conducted in Amhara, Oromia, and Southern Nations, Nationalities and Peoples' (SNNP) regions of Ethiopia. Twenty-four participants were selected through a purposeful sampling technique. In-depth individual interviews with trained midwives with practical hands-on limited obstetric ultrasound service provision experience were conducted. The thematic analysis was conducted manually. RESULTS: The qualitative data analysis on the experiences and opinions of midwives revealed three themes, namely: individual perception of self-efficacy, facilitators, and barriers of limited obstetric ultrasound services. The basic ultrasound training, which was unique in its organization and arrangement, prepared and built the self-efficacy of trainees in executing their expected competencies. Support of health systems and health managers in dedicating space, availing essential supplies, and assigning human resources emerged as facilitators of the initiated limited obstetric ultrasound services, whereas high workload on one or two ultrasound trained midwives, interruption of essential supplies like paper towels, gel, and alternative power sources were identified as barriers for limited ultrasound services. CONCLUSION: This study explored the experiences and opinions of midwives who were trained on the provision of limited obstetric ultrasound services and served the community in health centers in rural parts of Ethiopia. The results of this study revealed the positive impacts of the intervention on the perceived self-efficacy, facilitation, and breaking-down of barriers to obstetric ultrasound services. Before scaling-up limited obstetric ultrasound interventions, health managers should ensure and commit to availing essential supplies (e.g., paper towels, ultrasound gel, and large memory hard discs), arranging private rooms, and training other mid-level health professionals. In addition, improving pregnant women's literacy on the national schedule for ultrasound scanning services is recommended.

Ecografía cutánea en el sarcoma de Kaposi / Skin Ultrasound in Kaposi Sarcoma

Recientemente ha aumentado el uso de la ecografía cutánea en múltiples enfermedades dermatológicas. Se trata de una técnica no invasiva, que nos proporciona más detalles acerca de la estructura y vascularización de las lesiones cutáneas. El sarcoma de Kaposi es un tumor vascular, que se localiza principalmente en la piel y las mucosas, pudiendo afectar los ganglios linfáticos y los órganos internos. Presentamos 3 pacientes con diagnóstico de sarcoma de Kaposi, sospechado clínicamente, y confirmado histológicamente, a los cuales realizamos exploración ecográfica en modo B y modo Doppler color. Encontramos diferencias en el patrón ecográfico, tanto en modo B como en modo Doppler color, entre las lesiones que clínicamente correspondían a nódulos frente a las que eran placas. Consideramos que la ecografía cutánea podría ser útil como prueba complementaria, en el estudio de las lesiones cutáneas del sarcoma de Kaposi, proporcionándonos más información acerca de sus características estructurales y vasculares

The use of ultrasound imaging has recently been increasing in numerous dermatologic diseases. This noninvasive technique provides additional details on the structure and vascularization of skin lesions. Kaposi sarcoma is a vascular tumor that typically arises in the skin and mucosas. It can spread to lymph nodes and internal organs. We performed B-mode and color Doppler ultrasound studies in 3 patients with a clinical diagnosis of Kaposi sarcoma confirmed by histological examination. We found differences in the ultrasound pattern between nodular and plaque lesions, in both B-mode and color Doppler. We believe that skin ultrasound imaging could be a useful technique for studying cutaneous Kaposi sarcoma, providing additional information on the structural and vascular characteristics of the lesion

Verification of fetal brain responses by coregistration of fetal ultrasound and fetal magnetoencephalography data.

Fetal magnetoencephalography (fMEG) is used to study neurological functions of the developing fetus by measuring magnetic signals generated by electrical sources within the fetal brain. For this aim either auditory or visual stimuli are presented and evoked brain activity or spontaneous activity is measured at the sensor level. However a limiting factor of this approach is the low signal to noise ratio (SNR) of recorded signals. To overcome this limitation, advanced signal processing techniques such as spatial filters (e.g., beamformer) can be used to increase SNR. One crucial aspect of this technique is the forward model and, in general, a simple spherical head model is used. This head model is an integral part of a model search approach to analyze the data due to the lack of exact knowledge about the location of the fetal head. In the present report we overcome this limitation by a coregistration of volumetric ultrasound images with fMEG data. In a first step we validated the ultrasound to fMEG coregistration with a phantom and were able to show that the coregistration error is below 2 cm. In the second step we compared the results gained by the model search approach to the exact location of the fetal head determined on pregnant mothers by ultrasound. The results of this study clearly show that the results of the model search approach are in accordance with the location of the fetal head.

Life and death before birth: 4D ultrasound and the shifting frontiers of the abortion debate.

The development of 4D ultrasound technology has democratised fetal imagery by offering direct visual access to realistic images of the fetus in utero. These images, which purport to show a responsive being capable of complex behaviour, have renewed debate about the personhood of the fetus and the adequacy of current abortion regulation. This article considers recent abortion law reform initiatives in the United Kingdom and the United States and observes two shifts in the frontiers of these debates. The first concerns a shift from viability to sentience as a criterion of legal significance. The second concerns a shift toward constructing abortion in terms of feticide as distinct from the termination of pregnancy. Both strategies seek to deploy morphological similarities between the sentient fetus and newborn baby as a basis for extending law's dominion over the fetus.

Characteristics of the audio sound generated by ultrasound imaging systems.

Medical ultrasound scanners use high-energy pulses to probe the human body. The radiation force resulting from the impact of such pulses on an object can vibrate the object, producing a localized high-intensity sound in the audible range. Here, a theoretical model for the audio sound generated by ultrasound scanners is presented. This model describes the temporal and spectral characteristics of the sound. It has been shown that the sound has rich frequency components at the pulse repetition frequency and its harmonics. Experiments have been conducted in a water tank to measure the sound generated by a clinical ultrasound scanner in various operational modes. Results are in general agreement with the theory. It is shown that a typical ultrasound scanner with a typical spatial-peak pulse-average intensity value at 2 MHz may generate a localized sound-pressure level close to 100 dB relative to 20 microPa in the audible (< 20 kHz) range under laboratory conditions. These findings suggest that fetuses may become exposed to a high-intensity audio sound during maternal ultrasound examinations. Therefore, contrary to common beliefs, ultrasound may not be considered a passive tool in fetal imaging.

[Methods, value and limits of prenatal hearing diagnosis]. / Methode, Aussagefähigkeit und Grenzen pränataler Hördiagnostik.

An intrauterine sound test was developed for monitoring prenatal hearing disorders and evaluated concerning its efficacy and practical feasibility. The procedure is based on the fetesto capacity react upon exogenous sound stimulation. An acoustic stimulation was achieved by a noise generator placed directly on the maternal abdomen in the proximity of the fetal ear. Successful stimulation was monitored by sonographic means expressed as fetal child movements in 447 pregnant women at the end of the 26th to the 37th week of gestation. The most favourable time for an intrauterine hearing test is between the 30th and 32nd week of gestation. The quantity of amniotic liquor, placental location and pathological pregnancies influences the test results. Efficiency and limits of prenatal hearing diagnostics are discussed.