Introduction: Ultrasound is an essential component of antenatal care. Midwives provide most of the antenatal care but they do not perform ultrasound as it has been beyond their scope of practice. This leaves many women in Low and Middle-Income Countries without access to ultrasound scanning. The aim of this study was to identify competencies in ultrasound scanning in midwifery education. Methods: A desk review and needs assessment were conducted between July and October 2023. Articles and curricula on the internet, Google scholar and PubMed were searched for content on ultrasound scanning competencies. A Google form consisting of 20 questions was administered via email and WhatsApp to 135 participants. Descriptive statistics were used to analyse data. Results:The desk review showed that it is feasible to train midwives in ultrasound scanning. The training programs for midwives in obstetric ultrasound were conducted for 1 week to 3 months with most of them running for 4 weeks. Content included introduction to general principles of ultrasound, physics, basic knowledge in embryology, obstetrics, anatomy, measuring foetal biometry, estimating amniotic fluid and gestational age. Experts like sonographers trained midwives. Theory and hands on were the teaching methods used. Written and practical assessments were conducted. Needs assessment revealed that majority of participants 71 (53%) knew about basic ultrasound training for midwives. All participants (100%) said it is necessary to train midwives in basic ultrasound scan in Zambia. Some content should include, anatomy, measuring foetal biometry, assessing amniotic fluid level, and gestational age determination. Most participants 91 (67%) suggested that the appropriate duration of training is 4 - 6 weeks. Conclusion:Empowering every midwife with ultrasound scanning skills will enable early detection of any abnormality among pregnant women and prompt intervention to save lives.
References
[1]
Abramowicz, J.S. (2021) Obstetric Ultrasound: Where Are We and Where Are We Going? Ultrasonography, 40, 57-74. https://doi.org/10.14366/usg.20088
[2]
Ulrich, C.C. and Dewald, O. (2022) Pregnancy Ultrasound Evaluation. StatPearls, Treasure Island.
[3]
Wulff, C.B., Rode, L., Rosthøj, S., Hoseth, E., Petersen, O. and Tabor, A. (2018) Transvaginal Sonographic Cervical Length in First and Second Trimesters in A Low-Risk Population: A Prospective Study. Ultrasound in Obstetrics & Gynecology, 51, 604-613. https://doi.org/10.1002/uog.17556
[4]
Zieleskiewicz, L., Bouvet, L., Einav, S., Duclos, G. & Leone, M. (2018) Diagnostic Point-Of-Care Ultrasound: Applications in Obstetric Anaesthetic Management. Anaesthesia, 73, 1265-1279. https://doi.org/10.1111/anae.14354
[5]
Kimberly, H.H., Murray, A., Mennicke, M., Liteplo, A., Lew, J., Bohan, J.S., Tyer-Viola, L., Ahn, R., Burke, T. and Noble, V.E. (2010) Focused Maternal Ultrasound by Midwives in Rural Zambia. Ultrasound in Medicine and Biology, 36, 1267-1272. https://doi.org/10.1016/j.ultrasmedbio.2010.05.017
[6]
World Health Organization. (2022) WHO Antenatal Care Recommendations for a Positive Pregnancy Experience: Maternal and Fetal Assessment Update: Imaging Ultrasound before 24 Weeks of Pregnancy. Geneva.
[7]
Vinayak, S., Sande, J., Nisenbaum, H. and Nolsøe, C. P. (2017) Training Midwives to Perform Basic Obstetric Point-Of-Care Ultrasound in Rural Areas Using a Tablet Platform and Mobile Phone Transmission Technology—A WFUMB COE Project. Ultrasound in Medicine & Biology, 43, 2125-2132. https://doi.org/10.1016/j.ultrasmedbio.2017.05.024
[8]
Fullerton, J., Butler, M., Aman, C. and Reid, T. (2019) Global Competencies for Midwives: External Cephalic Version; Ultrasonography, and Tobacco Cessation Intervention. Women Birth, 32, e413-e420. https://doi.org/10.1016/j.wombi.2018.08.166
[9]
Kim, J., Shakya, P.R., Choi, S., Park, J.S., Tamrakar, S.R., Heo, J. and Kim, W.H. (2021) An Evaluation of Obstetric Ultrasound Education Program in Nepal Using the RE-AIM Framework. BMC Medical Education, 21, Article No. 57. https://doi.org/10.1186/s12909-021-02484-3
[10]
Shah, S., Santos, N., Kisa, R., Mike Maxwell, O., Mulowooza, J., Walker, D. and Muruganandan, K.M. (2020) Efficacy of an Ultrasound Training Program for Nurse Midwives to Assess High-Risk Conditions at Labor Triage in Rural Uganda. PLOS ONE, 15, e0235269. https://doi.org/10.1371/journal.pone.0235269
[11]
Dornhofer, K., Farhat, A., Guan, K., Parker, E., Kong, C., Kim, D., Nguyen, T., Mogi, J., Lahham, S. and Fox, J.C. (2020) Evaluation of a Point-Of-Care Ultrasound Curriculum Taught by Medical Students for Physicians, Nurses, and Midwives in Rural Indonesia. Journal of Clinical Ultrasound, 48, 145-151. https://doi.org/10.1002/jcu.22809
[12]
Kern-Goldberger, A.R., Haeri, S., Lindsley, W. and Srinivas, S.K. (2021) Examining Ultrasound Diagnostic Performance Improvement with Utilization of Maternal-Fetal Medicine Tele-Interpretation. American Journal of Obstetrics & Gynecology MFM, 3, Article ID: 100389. https://doi.org/10.1016/j.ajogmf.2021.100389
[13]
Chen, Z., Liu, Z., Du, M. and Wang, Z. (2021) Artificial Intelligence in Obstetric Ultrasound: An Update and Future Applications. Frontiers in Medicine, 8, Article 733468. https://doi.org/10.3389/fmed.2021.733468
[14]
Vinayak, S., Temmerman, M., Villeirs, G. and Brownie, S.M. (2021) A Curriculum Model for Multidisciplinary Training of Midwife Sonographers in a Low Resource Setting. Journal of Multidisciplinary Healthcare, 14, 2833-2844. https://doi.org/10.2147/JMDH.S331371
[15]
Wilkinson, M., Usman, S., Barton, H. and Lees, C.C. (2019) The Views of Pregnant Women, Midwives, and a Women’s Panel on Intrapartum Ultrasound Research: A Pilot Study. Australasian Journal of Ultrasound in Medicine, 22, 186-190. https://doi.org/10.1002/ajum.12162
[16]
Argaw, M.D., Abawollo, H.S., Tsegaye, Z.T., Beshir, I.A., Damte, H.D., Mengesha, B.T., Gebremedhin, Z.K., Heyi, A.F., Guteta, A.A. and Mamo, T.T. (2022) Experiences of Midwives on Vscan Limited Obstetric Ultrasound Use: A Qualitative Exploratory Study. BMC Pregnancy and Childbirth, 22, Article No. 196. https://doi.org/10.1186/s12884-022-04523-3
[17]
Shaw-Battista, J., Young-Lin, N., Bearman, S., Dau, K. and Vargas, J. (2015) Interprofessional Obstetric Ultrasound Education: Successful Development of Online Learning Modules; Case-Based Seminars; and Skills Labs for Registered and Advanced Practice Nurses, Midwives, Physicians, and Trainees. Journal of Midwifery & Women’s Health, 60, 727-734. https://doi.org/10.1111/jmwh.12395
[18]
Kinnevey, C., Kawooya, M., Tumwesigye, T., Douglas, D. and Sams, S. (2016) Addressing Obstetrical Challenges at 12 Rural Ugandan Health Facilities: Findings from an International Ultrasound and Skills Development Training for Midwives in Uganda. International Journal of Maternal and Child Health and AIDS, 5, 46-52. https://doi.org/10.21106/ijma.106
[19]
Holmlund, S., Ntaganira, J., Edvardsson, K., Lan, P.T., Semasaka Sengoma, J.P., Åhman, A., Small, R. and Mogren, I. (2017) Improved Maternity Care If Midwives Learn to Perform Ultrasound: A Qualitative Study of Rwandan Midwives’ Experiences and Views of Obstetric Ultrasound. Global Health Action, 10, Article ID: 1350451. https://doi.org/10.1080/16549716.2017.1350451
[20]
Barnfield, L., Bamfo, J. and Norman, L. (2019) Should Midwives Learn to Scan for Presentation? Findings from a Large Survey of Midwives in the UK. British Journal of Midwifery, 27, 305-311. https://doi.org/10.12968/bjom.2019.27.5.305
[21]
Boamah, E.A., Asante, K., Ae-Ngibise, K., Kinney, P.L., Jack, D.W., Manu, G., Azindow, I.T., Owusu-Agyei, S. and Wylie, B.J. (2014) Gestational Age Assessment in the Ghana Randomized Air Pollution and Health Study (GRAPHS): Ultrasound Capacity Building, Fetal Biometry Protocol Development, and Ongoing Quality Control. JMIR Research Protocols, 3, e77. https://doi.org/10.2196/resprot.3797
[22]
Casmod, Y. and Armstrong, S.J. (2023) Obstetric Ultrasound Training Programmes for Midwives: A Scoping Review. Health SA Gesondheid, 28, a2163. https://doi.org/10.4102/hsag.v28i0.2163
[23]
Hall, E.A., Matilsky, D., Zang, R., Hase, N., Habibu Ali, A., Henwood, P.C. and Dean, A.J. (2021) Analysis of an Obstetrics Point-Of-Care Ultrasound Training Program for Healthcare Practitioners in Zanzibar, Tanzania. The Ultrasound Journal, 13, Article No. 18. https://doi.org/10.1186/s13089-021-00220-y
[24]
Damewood, S.C., Leo, M., Bailitz, J. and Gottlieb, M. (2020) Tools for Measuring Clinical Ultrasound Competency: Recommendations from the Ultrasound Competency Work Group. AEM Education and Training, 4, S106-S112. https://doi.org/10.1002/aet2.10368
[25]
Lukhele, S., Mulaudzi, F.M., Sepeng, N., Netshisaulu, K., Ngunyulu, R.N., Musie, M. and Anokwuru, R. (2023) The Training of Midwives to Perform Obstetric Ultrasound Scan in Africa for Task Shifting and Extension of Scope of Practice: A Scoping Review. BMC Medical Education, 23, Article No. 764. https://doi.org/10.1186/s12909-023-04647-w
[26]
Viner, A.C., Membe-Gadama, G., Whyte, S., Kayambo, D., Masamba, M., Makwakwa, E., Lissauer, D., Stock, S. J., Norman, J.E., Reynolds, R.M., Magowan, B., Freyne, B. and Gadama, L. (2022) Training in Ultrasound to Determine Gestational Age (TUDA): Evaluation of A Novel Education Package to Teach Ultrasound-Naive Midwives Basic Obstetric Ultrasound in Malawi. Frontiers in Global Women’s Health, 3, Article 880615. https://doi.org/10.3389/fgwh.2022.880615
[27]
Mubuuke, A.G., Erem, G., Nassanga, R. and Kiguli-Malwadde, E. (2023) Point of Care Obstetric Ultrasound Training for Midwives and Nurses: Implementation and Experiences of Trainees at a Rural Based Hospital in Sub-Saharan Africa: A Qualitative Study. BMC Research Notes, 16, Article No. 287. https://doi.org/10.1186/s13104-023-06569-8
[28]
David, S., Adrien, L., Melissa, B., Jonathan, S., Robert, O.N., Antoinette, T., Elizabeth, M.M., Carl, L.B., Ana, G., Sarah, S., Elwyn, C., Fabian, E. and Robert, L.G. (2017) Challenges of Implementing Antenatal Ultrasound Screening in a Rural Study Site: A Case Study from the Democratic Republic of the Congo. Global Health: Science and Practice, 5, 315-324. https://doi.org/10.9745/GHSP-D-16-00191
[29]
Mashamba, T., Eyo, A., Masilela, S., Busakwe, A. and Towobola, O. (2022) Limited Obstetrics Ultrasound in Primary Healthcare Delivery; Outputs for Strategic Considerations: A Review of Pilot Study in Gauteng Province, South Africa. Journal of Gynecology and Obstetrics, 10, 52-59. https://doi.org/10.11648/j.jgo.20221002.11
[30]
Wanyonyi, S.Z., Mariara, C.M., Vinayak, S. and Stones, W. (2017) Opportunities and Challenges in Realizing Universal Access to Obstetric Ultrasound in Sub-Saharan Africa. Ultrasound International Open, 3, E52-E59. https://doi.org/10.1055/s-0043-103948
[31]
Aliyu, L.D., Kurjak, A., Wataganara, T., De Sá, R.A.M., Pooh, R., Sen, C., Ebrashy, A., Adra, A. and Stanojevic, M. (2016) Ultrasound in Africa: What Can Really Be Done? Journal of Perinatal Medicine, 44, 119-123. https://doi.org/10.1515/jpm-2015-0224
[32]
Viner, A.C., Malata, M.P., Mtende, M., Membe-Gadama, G., Masamba, M., Makwakwa, E., Bamuya, C., Lissauer, D., Stock, S.J., Norman, J.E., Reynolds, R.M., Magowan, B., Freyne, B., Gadama, L., Cunningham-Burley, S., Nyondo-Mipando, L. and Chipeta, E. (2023) Implementation of a Novel Ultrasound Training Programme for Midwives in Malawi: A Mixed Methods Evaluation Using the RE-AIM Framework. Frontiers in Health Services, 2, Article 953677. https://doi.org/10.3389/frhs.2022.953677
[33]
Holmlund, S., Lan, P.T., Edvardsson, K., Phuc, H.D., Ntaganira, J., Small, R., Kidanto, H., Ngarina, M. and Mogren, I. (2019) Health Professionals’ Experiences and Views on Obstetric Ultrasound in Vietnam: A Regional, Cross-Sectional Study. BMJ Open, 9, e031761. https://doi.org/10.1136/bmjopen-2019-031761
