Efficacy of an ultrasound training program for nurse midwives to assess high-risk conditions at labor triage in rural Uganda.

Many high-risk conditions of pregnancy are undetected until the time of delivery in low-income countries. We developed a point-of-care ultrasound training protocol for providers in rural Uganda to detect fetal distress or demise, malpresentation, multiple gestation, placenta previa, oligohydramnios and preterm delivery. This was a mixed-methods study to evaluate the 2-week training curriculum and trainees' ability to perform a standard scanning protocol and interpret ultrasound images. Surveys to assess provider confidence were administered pre-training, immediately after, and at 3-month follow up. Following lecture and practical demonstrations, each trainee conducted 25 proctored scans and were required to pass an observed structured clinical exam (OSCE). All images produced 8 weeks post course underwent blinded review by two ultrasound experts to assess image quality and to identify common errors. Key informant interviews further assessed perceptions of the training program and utility of point-of-care ultrasound. All interviews were audio recorded, transcribed, and reviewed by multiple readers using a content analysis approach. Twenty-three nurse/nurse midwives and two physicians from one district hospital and three health centers participated in the training curriculum. Confidence levels increased from an average of 1 point pre-course to over 6 points post-course for all measures (maximum of 7 points). Of 25 participants, 22 passed the OSCE on the first attempt (average score 89.4%). Image quality improved over time; the final error rate at week 8 was less than 5%, with an overall kappa of 0.8-1 for all measures between the two reviewers. Among the 12 key informant interviews conducted, key themes included a desire for more hands-on training and longer duration of training and challenges in balancing clinical duties with ability to attend training sessions. This study demonstrates that providers without previous ultrasound experience can detect high-risk conditions during labor with a high rate of quality and accuracy after training.

Incidental Fetal Ultrasound Findings: Interpretation and Management.

Ultrasonography is a common component of prenatal care worldwide and is often used in early pregnancy to determine gestational age, number of fetuses, fetal cardiac activity, and placental location. Patients and their families may also consider ultrasonography a social event, as it provides confirmation and reassurance of a normal pregnancy. Ultrasound screening is typically scheduled in the second trimester to visualize fetal anatomy and confirm gestational age. Most ultrasound examinations are reassuring, but some incidentally identify structural anomalies and soft markers for aneuploidy, making it necessary for health care providers to correctly interpret these findings. The health care provider's ability to prepare patients prior to the ultrasound and deliver the necessary information needed to make informed decisions regarding any follow-up screening or diagnostic testing is critical to reducing parental anxiety. Preparation for the anatomic survey should include counseling for normal and abnormal findings. The ethical concepts of patient autonomy and shared decision making are used as a guide in providing this critical information and enabling informed choices during follow-up for incidental ultrasound findings.

A routine tool with far-reaching influence: Australian midwives' views on the use of ultrasound during pregnancy.

BACKGROUND: Ultrasound is a tool of increasing importance in maternity care. Midwives have a central position in the care of pregnant women. However, studies regarding their experiences of the use of ultrasound in this context are limited. The purpose of this study was to explore Australian midwives' experiences and views of the role of obstetric ultrasound particularly in relation to clinical management of complicated pregnancy, and situations where maternal and fetal health interests conflict. METHODS: A qualitative study was undertaken in Victoria, Australia in 2012, based on six focus group discussions with midwives (n = 37) working in antenatal and intrapartum care, as part of the CROss-Country Ultrasound Study (CROCUS). Data were analysed using qualitative content analysis. RESULTS: One overarching theme emerged from the analysis: Obstetric ultrasound--a routine tool with far-reaching influence, and it was built on three categories. First, the category'Experiencing pros and cons of ultrasound' highlighted that ultrasound was seen as having many advantages; however, it was also seen as contributing to increased medicalisation of pregnancy, to complex and sometimes uncertain decision-making and to parental anxiety. Second, 'Viewing ultrasound as a normalised and unquestioned examination' illuminated how the use of ultrasound has become normalised and unquestioned in health care and in wider society. Midwives were concerned that this impacts negatively on informed consent processes, and at a societal level, to threaten acceptance of human variation and disability. Third, 'Reflecting on the fetus as a person in relation to the pregnant woman' described views on that ultrasound has led to increased 'personification' of the fetus, and that women often put fetal health interests ahead of their own. CONCLUSIONS: The results reflect the significant influence ultrasound has had in maternity care and highlights ethical and professional challenges that midwives face in their daily working lives concerning its use. Further discussion about the use of ultrasound is needed, both among health professionals and in the community, in order to protect women's rights to informed decision-making and autonomy in pregnancy and childbirth and to curb unnecessary medicalisation of pregnancy. Midwives' experiences and views play an essential role in such discussions.

Neonatal liver cell donation: a case report.

Traditional organ transplant options for newborns have been rare. There continues to be an increasing need for organs for transplant and a limited number of available organs, especially for small children. Liver cell transplantation is a promising alternative to orthotopic liver transplantation to treat liver-based inborn errors of metabolism.1 The procedure is minimally invasive and can be performed repeatedly. The safety of the procedure has been well established, and the clinical results are encouraging.1 The liver cell donation process is an option for families who experience the loss of a newborn and offers them a legacy for their child by providing life for others. The purpose of this article is to discuss the neonatal liver cell donation process and present a case report of an anencephalic infant whose parents chose to participate in this unique program.

Survey of second-trimester maternal serum screening in Japan.

AIM: Second-trimester maternal serum screening (MSS) is the predominant form of prenatal screening in Japan. We hypothesize that patient education and physician knowledge of Down syndrome (DS) screening are insufficient to provide adequate information regarding prenatal screening in Japan. MATERIAL AND METHODS: In-person or telephone interviews with medical personnel were conducted at 25 medical facilities utilizing Afp(4) (Esoterix Genetic Laboratories, LLC, a wholly-owned subsidiary of Laboratory Corporation of America Holdings) second trimester screening. We explored how medical facilities provided information about the MSS process to pregnant women. RESULTS: Before prenatal testing, 60% of medical facilities spent an average of less than 5 min per patient explaining the MSS process. The option of amniocentesis for chromosomal aneuploidy was explained at nearly all facilities, but only 60% explained the risk of amniocentesis. Ultrasound examination for open neural tube defects was explained only at half the facilities. Only five of 25 (20%) medical practitioners explained the possibility of having congenital disorders fetus. CONCLUSION: This study revealed that most obstetricians in Japan do not provide their patients with sufficient information about MSS.

[Malformation of the oral cavity of the foetus, what support is available for parents?]. / Malformation buccale du foetus, quel accompagnement pour les parents?

One of the many questions which parents ask with regard to the malformation of the oral cavity of their child at birth concerns feeding. By answering all the couple's questions, the antenatal consultation aims to prepare the baby's birth and its admission into its family and society.

Comparison of abdominal palpation, Johnson's technique and ultrasound in the estimation of fetal weight in Northern Iran.

OBJECTIVES: to assess the accuracy of abdominal palpation, Johnson's technique and ultrasound in the estimation of fetal weight (EFW). DESIGN, SETTING AND PARTICIPANTS: 174 pregnant women were recruited at random in a large teaching hospital in Iran. Fetal weight was estimated by palpation and Johnson's technique at the time of admission by one qualified midwife, and then estimated by ultrasound by one radiologist. After birth, all newborns were weighed using the same scale. FINDINGS: a significant correlation was found between EFW by ultrasound, palpation and Johnson's technique and actual birth weight. The differences between EFW by palpation, ultrasound and Johnson's technique and actual birth weight were significant for small-for-gestational-age fetuses (p<0.05, p<0.01 and p<0.001, respectively), but not for appropriate-for-gestational-age fetuses. These differences were significant for ultrasound (p<0.001) and palpation (p<0.05) in large-for-gestational-age fetuses. The sensitivity of ultrasound for EFW of low-birthweight fetuses (72.2%) and the sensitivity of Johnson's technique for EFW of normal-weight and macrosomic fetuses (97.3% and 75%, respectively) appeared to be higher than the sensitivities of the other methods. CONCLUSION: palpation and Johnson's technique can be used as alternatives to ultrasound for EFW, particularly if the measurements are taken by experienced, skilled personnel.

Fetal growth scans and amniotic fluid assessments in pregestational and gestational diabetes.

Fetal growth scans and amniotic fluid assessments are used to evaluate fetal well-being in women with pregestational and gestational diabetes. These measurements reflect placental function and guide clinicians in timing of delivery to decrease morbidity to mother and infant. Ultrasound assessments may be performed by nurses in the perinatal setting. Nurses who perform these examinations have a unique opportunity to provide teaching and support for women with diabetes while helping to improve perinatal outcomes.

Learner portfolios and hands-on workshop to facilitate and evaluate nurses' learning in obstetric ultrasound.

Over the past three decades, ultrasound has played an increasing role in perinatal nursing. In obstetric triage, many clients present with indications for ultrasound. In one institution's triage unit, restrictive policies, lack of opportunities for learning skills, and an unstructured method of verifying competence created barriers to nurses learning ultrasound. A revised approach using learner portfolios and a hands-on workshop resulted in improved acquisition of skills, learner confidence, and increased accessibility of ultrasound to clients.