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Could ultrasound midwifery training increase antenatal detection of congenital anomalies in Ghana?

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 fe...

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Autores principales: Abdul-Mumin, Alhassan, Rotkis, Lauren N., Gumanga, Solomon, Fay, Emily E., Denno, Donna M.
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Public Library of Science 2022
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9342792/
https://www.ncbi.nlm.nih.gov/pubmed/35913961
http://dx.doi.org/10.1371/journal.pone.0272250
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author Abdul-Mumin, Alhassan
Rotkis, Lauren N.
Gumanga, Solomon
Fay, Emily E.
Denno, Donna M.
author_facet Abdul-Mumin, Alhassan
Rotkis, Lauren N.
Gumanga, Solomon
Fay, Emily E.
Denno, Donna M.
author_sort Abdul-Mumin, Alhassan
collection PubMed
description 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.
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spelling pubmed-93427922022-08-02 Could ultrasound midwifery training increase antenatal detection of congenital anomalies in Ghana? Abdul-Mumin, Alhassan Rotkis, Lauren N. Gumanga, Solomon Fay, Emily E. Denno, Donna M. PLoS One Research Article 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. Public Library of Science 2022-08-01 /pmc/articles/PMC9342792/ /pubmed/35913961 http://dx.doi.org/10.1371/journal.pone.0272250 Text en © 2022 Abdul-Mumin et al https://creativecommons.org/licenses/by/4.0/This is an open access article distributed under the terms of the Creative Commons Attribution License (https://creativecommons.org/licenses/by/4.0/) , which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.
spellingShingle Research Article
Abdul-Mumin, Alhassan
Rotkis, Lauren N.
Gumanga, Solomon
Fay, Emily E.
Denno, Donna M.
Could ultrasound midwifery training increase antenatal detection of congenital anomalies in Ghana?
title Could ultrasound midwifery training increase antenatal detection of congenital anomalies in Ghana?
title_full Could ultrasound midwifery training increase antenatal detection of congenital anomalies in Ghana?
title_fullStr Could ultrasound midwifery training increase antenatal detection of congenital anomalies in Ghana?
title_full_unstemmed Could ultrasound midwifery training increase antenatal detection of congenital anomalies in Ghana?
title_short Could ultrasound midwifery training increase antenatal detection of congenital anomalies in Ghana?
title_sort could ultrasound midwifery training increase antenatal detection of congenital anomalies in ghana?
topic Research Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9342792/
https://www.ncbi.nlm.nih.gov/pubmed/35913961
http://dx.doi.org/10.1371/journal.pone.0272250
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