Exploring the prevalence of high-risk obstetric conditions diagnosed by point-of-care ultrasound evaluation in a rural Ugandan population: a cohort study

Objective: The aim of this study was to determine the prevalence of high-risk obstetric conditions identified by point-of-care ultrasound in a rural Ugandan community and compare them with known rates in high-income settings. Methods: Pregnant women in a rural Ugandan clinic were offered a screening obstetric ultrasound at a late second or third trimester antenatal visit (Clearvue 350). Appropriate follow-up was determined by a preset algorithm. Placental abnormalities, multiple gestations, and fetal malpresentation were recorded. Descriptive statistics were used for analysis. Results: Fetal malpresentation in the third trimester was found in 15% [confidence interval (CI), 11.7–18.6] of pregnancies. Rates of multiple gestations and placental location abnormalities were 4% (CI, 2.7–5.2) and 1.7% (CI, 0.8–2.5), respectively. Overall, prevalence of abnormal placentation was comparable to published rates, although persistent fetal malpresentation was higher than in the United States. The rate of multiple gestations is on par with United States data despite lack of access to artificial reproductive technology. Conclusions: Given that placental abnormalities, multiple gestations, and fetal malpresentation in a rural Ugandan population are at least as common as in high-income countries, and emergency obstetric care is more difficult to access in Uganda, the contribution of these conditions to maternal mortality is likely higher in rural Uganda. Ultrasound can be used to identify and refer patients to higher-level facilities for safe delivery.