The Global Health Challenge of Ensuring Healthy Pregnancy and Birth
A number of maternal and fetal conditions can put a healthy pregnancy at risk. Ultrasound imaging is a safe and effective means to provide healthcare workers with real-time information that they can use to make evidence-based clinical decisions and early interventions, including referral to higher levels of care. Ultrasound-based accurate estimation of fetal gestational age is particularly useful to guide time-sensitive decisions around pregnancy complications like preeclampsia and preterm birth. Obstetric ultrasound imaging also improves the efficiency of care delivery, helping relieve the burden on health workers, and it helps mothers plan for their antenatal care.
Obstetric ultrasound is routinely available in high-income countries and recommended by the WHO. It is not routinely available in LMICs, however, particularly at the PHC level. This is because of its high cost and requirement for specialized training. Technology innovation could overcome these bottlenecks, yielding a low-cost, AI-enabled, point-of-care ultrasound (POCUS) tool as a core part of antenatal care.
GH Labs supports the development of AI-based models for POCUS devices that make them usable by non-medical personnel without extensive ultrasound training, overcoming a common gap in health care in LMICs. These models are directly shared with multiple partners who are creating ultrasound products for the market. (Please note that this repository has fixed categories for organizing the information, including Etiology, Disease Burden, and Disease Context, and we acknowledge that for the Obstetric Ultrasound topic, what is being discussed is the set of associated maternal and child health conditions.)
Etiology
Ultrasound Imaging Identifies Risks to Healthy Pregnancy and Birth
Ultrasound imaging provides key information on fetal and maternal factors during pregnancy. The WHO recommends one ultrasound scan before 24 weeks of gestation to confirm that the pregnancy is intrauterine; to assess fetal number, gestational age, size, anatomy, and cardiac activity; and to evaluate details in the case of multiple fetuses. Ultrasound estimation of fetal age is particularly useful, either to confirm the gestational age predicted by last menstrual period or to provide a new estimate.
Disease Burden
Ultrasound Imaging Improves Pregnancy Management
92% of all maternal deaths occur in LMICs (2023), and the maternal mortality ratio in low-income countries was 346 per 100,000 live births versus 10 in high-income countries. Similarly, the neonatal mortality rate in low-income countries was 48 deaths per 1,000 live births (2022) versus 4 in high-income countries. In LMICs, low birth weight is associated with 80% of neonatal deaths, and pregnancy complications, such as preeclampsia and preterm birth, are major causes of maternal and perinatal morbidity and mortality. Obstetric ultrasound imaging in LMICs can improve not only patient diagnosis and management, but also the efficiency of care delivery. Uncertainties remain, however, around the degree to which it improves morbidity and mortality outcomes in LMICs as well as in high-income countries. In LMICs, there are multiple factors challenging a healthy pregnancy and birth, and the full clinical benefits of ultrasound can be revealed as antenatal care improves more broadly.
Accessible Ultrasound Imaging is a Key Part of Pregnancy Care
An ultrasound screening device is on the list of essential equipment for PHC clinics in most LMICs. It is not routinely available, however, because of its high cost, and even when available, there is a shortage of personnel with the specialized training needed to perform the scans and interpret the results. Ready access to ultrasound technology can also be constrained by regulations to limit its use for fetal sex determination. Health workers at PHC facilities typically rely on palpation-based exams to monitor the fetus and the course of pregnancy, which are less accurate and more time-consuming than ultrasound imaging. This limits opportunities for early, evidence-based interventions and adds to the burden on health workers.
Patient Experience
Obstetric Ultrasound Guides Clinical Decisions
Learn more about the patient experience across antenatal care wellness exams
Technology Solutions
New Technologies are Needed for Accessible Obstetric Ultrasound
Learn more about how GH Labs and others are addressing the key technical gaps in PHC ultrasound