Compact ultrasound for improving maternal and perinatal care in low-resource settings: review of the potential benefits, implementation challenges, and public health issues

Abstract

Objective: Ultrasound imaging, a front-line diagnostic tool for perinatal care, is rarely available in the developing world, where maternal and newborn mortality rates are starkly higher than elsewhere. The development of portable and inexpensive medical ultrasound machines (compact ultrasound) offers the possibility of broader use of ultrasound. Our objective was to assess the potential benefits and challenges of deploying compact ultrasound in developing countries for improving obstetric health.

Methods: Existing literature on perinatal care, compact ultrasound, and issues in the deployments of medical technology in low-resource settings was reviewed. Anecdotal evidence was assessed, and the authors' field experiences in Nicaragua and Mali were evaluated as a template for wider deployments.

Results: Few published studies directly concerned with compact ultrasound in low-resource settings were found. These, however, in combination with available anecdotal data, support the view that compact ultrasound in less-developed regions is feasible and would result in a relatively low-cost improvement in perinatal care.

Conclusions: The development of lightweight, portable, and relatively inexpensive ultrasound systems offers a great opportunity for reducing maternal and neonatal mortality in low-resource settings. Evidence-based analysis of compact ultrasound deployments as a public-health response to obstetric needs in less-developed countries has been hampered by limited data in 3 key areas: maternal and perinatal mortality and morbidity in these settings, evaluations of compact ultrasound systems as reliable alternatives to full-sized systems, and the lack of outcomes data based on actual deployments of compact ultrasound for this purpose. Field trials of compact ultrasound on a scale commensurate with public health interventions should be undertaken.