$3,289 Raised
"As an obstetrician, I have seen the heartache and grief experienced by families when a baby is born too early and becomes sick or dies."
— Kristina Adams Waldorf, M.D.

Kristina Adams Waldorf

M.D.
UW Medicine
As an obstetrician, I have seen the heartache and grief experienced by families when a baby is born too early and becomes sick or dies. A baby has the best start in life when born near the due date. I am committed to research to prevent preterm birth and to give each baby the chance to develop to their full potential. Teaching ultrasound in the developing world enables large studies of preterm birth in countries with the greatest need. I research preterm birth and I am expanding my studies to include pregnant women in Western Kenya and Africa. Accurate pregnancy dating with early ultrasound is critical for the identification of preterm births in our studies and also serves the purpose of identifying pregnancy complications that may be fatal for the mother if she attempts a home birth.

Robert Nathan

M.D., M.P.H.
UW Medicine
In trips to sub-Saharan Africa, we saw the incredible challenges midwives faced practicing obstetrics in remote locations and we searched for a way to have a significant impact. Since then, our team at the University of Washington has placed low-cost ultrasound equipment in the hands of midwives in rural Uganda and has trained them to use it effectively. The videos will make these valuable ultrasound skills available to many midwives and other healthcare providers who would not otherwise have access to training. We believe that the use of ultrasound will dramatically improve maternal and newborn health in these challenging environments.

Summary

Women and children are the foundation of healthy communities, but nearly 500,000 women die in childbirth every year, most in Africa, India and Asia. Training local people to perform an ultrasound early in pregnancy would allow detection of life-threatening conditions (twins, ectopic pregnancy) and enable the woman to seek care in a hospital instead of attempting a home birth. An early ultrasound also provides an accurate due date for the pregnancy, which allows researchers to perform high-quality studies of pre-term birth and other pregnancy complications in low-income countries. Our team has trained about 45 midwives in Uganda to perform pregnancy ultrasound, and we believe that a video tutorial, in combination with hands-on training, would be an important educational tool to help new learners feel comfortable using the technology. We propose creating the first publicly available video tutorial, based on our seven-hour ultrasound curriculum, to be featured on YouTube. This video will teach principles of pregnancy ultrasound, how to date a pregnancy and how to identify certain serious complications. Once the video tutorial is created, we will pilot the series in Uganda and Western Kenya in combination with hands-on training. 

We believe that teaching pregnancy ultrasound is a first, critical step in reducing the deaths of pregnant women and their infants in the developing world. Older ultrasounds are now making their way to the developing world, but healthcare providers lack the training to use them. Our video tutorial could be viewed on a computer or a cell phone (nearly 60–90 percent of households across Kenya have access to a cell phone, and the majority of the Kenyan middle class has access to a smartphone.)  Contributing to this project has the potential to make an impact on maternal and neonatal mortality now and for decades to come as more healthcare providers around the world learn ultrasound.

Who will benefit?

The first population to benefit would be pregnant women in Western Kenya, where we will begin training midwives to perform ultrasound at three sites. We will also pilot the tutorial on our current users in Uganda. We would like to expand the use of this video to other places in the developing world — Mexico, for example — where we can leverage other grant support to offer hands-on ultrasound training after the video tutorial is created. 

Budget

The slides and curriculum have already been developed and pilot-tested with 40 midwives in Ghana. Funding would allow us to significantly improve this existing curriculum, then create the online video tutorial. We would pilot test the video tutorial in Ghana and Western Kenya.

Updates

Additional Project Details

In our projects in Uganda, referral facilities were identified prior to initiation of training. These referral facilities are staffed and equipped to deal with OB emergencies as well as routine deliveries and scheduled cesarean sections. The midwives who we trained to perform screening OB ultrasound are medical extenders, triaging patients for delivery of routine pregnancies at their health center or complicated pregnancies at the referral center. All high risk ultrasound diagnoses are confirmed at the referral center by a fully trained sonographer. In our planned studies in Western Kenya, referral facilities equipped to handle high-risk conditions identified by ultrasound are also well known. The purpose of our videos is to help train midwives or other health care providers to perform ultrasound screening on pregnant women who present to health centers for routine antenatal care (ANC). The ultrasound screening will be used specifically to identify multiple gestation, malpresentation, and placenta previa, conditions that are present in 6% to 7% of pregnancies. It will also be used to identify causes of 1st trimester bleeding. No reliable data are available on mortality from these conditions, but in a survey of seven Ugandan opinion makers from academic settings, private practice, government practice and the Ministry of Health, the average expected mortality of women with multiple gestation, malpresentation, and placenta previa respectively who deliver in the home with or without trained birth attendants is 50%, 70%, and 98% respectively. This mortality is drastically reduced by delivery in a referral facility with ability to perform Cesarean section. Knowing about a high-risk condition allows a woman time to plan for travel to the referral facility (often “too far to walk”) and time to save the money for the procedure fee. An ultrasound diagnosis gives the woman a chance to change her plan from delivering at home to delivering with doctors that can manage a high-risk condition. We also anticipate that availability of ultrasound at the health centers will have a "magnet effect," drawing women to antenatal care that might not otherwise present. Studies in both developed and developing countries have shown that ultrasound during pregnancy has provided excitement at seeing the fetus, reassurance of the health of the fetus, a sense of maternal bonding, and satisfaction at knowing the due date. Viewing the fetus during ultrasound may encourage the parents to provide better care for the mother and baby, including more frequent antenatal visits and better care during labor and delivery. The WHO recommends four antenatal care visits during a routine pregnancy and ministries of health in sub-Saharan Africa prioritize these four visits. Although they have been relatively ineffective in identifying potential birth complications, antenatal care visits do benefit the health of babies and mothers by providing interventions such as tetanus immunizations, iron/folate supplementation and other health promotion and disease prevention activities. Also, women who attend at least one antenatal care visit are far more likely to deliver in a health facility with skilled attendants than women who do not participate in antenatal care; in Uganda, women who attend four antenatal visits are four times more likely to deliver in such facilities. The performance of ultrasound on routine antenatal visits will add identification of high-risk ultrasound diagnoses to the other advantages of antenatal care. When multiple gestation, malpresentation, or placenta previa are identified, the midwives will discuss with the family the implications of these conditions, timing of delivery, and the logistics and importance of planning for the delivery in a facility equipped for comprehensive emergency obstetric care. If emergency conditions such as an ectopic pregnancy are identified, patients will be sent immediately to the referral facility. For those patients without these specific ultrasound diagnoses, the midwives will be instructed to discuss the advantages that accrue to the mother and the baby by delivering in a health center equipped to deliver basic obstetric care rather than delivering at home.

Thank you & Continue to Spread the Word

Dear Funders, We want to thank you for supporting our project to create publicly available videos to teach ultrasound to prevent maternal deaths in low-income countries. We are still fundraising – please help us to spread the word! Rob and Kristina continue to look for other avenues of support to help complete this project. Kristina (in collaboration with a large team) has just received a $1.4 million dollar grant from the Bill & Melinda Gates Foundation and the Global Alliance to Prevent Prematurity and Stillbirth to study preterm birth in low-income countries. Performing early ultrasound will be critical to this project to help date the pregnancy and identify dangerous conditions that might help save the mother’s life if she delivered in a hospital (and not at home). We are also exploring collaboration with the University of Washington Institute for Simulation and Interprofessional Studies (ISIS). A video library of how to perform pregnancy ultrasound would also be valuable for their learners. Thank you for your support! We will continue looking for collaborators and other funding sources to help get us to our goal. In the meantime, we will start on our first video. Cheers! Kristina and Rob

Video Production Begins in January

Dr. Nathan and I are excited to announce that we will begin producing the first pregnancy ultrasound videos in January. The University of Washington Institute for Simulation and Interprofessional Studies (ISIS) will partner with us to produce the videos. When we post the first videos on YouTube, we will send you a link so that you can see the product. It is very exciting to be part of a project that has the potential to help many thousands of women. Thank you again for your support. Kristina

Project Complete

Hi everyone, I wanted to let you know that our Consano-funded project to develop ultrasound training videos for health care providers in low- and middle-income countries is now complete. The training videos can be found on our website: tinyurl.com/uwultrasound There are 17 training videos that last between 20 and 45 minutes covering many aspects of pregnancy ultrasound. The course teaches all the concepts typically taught in obstetrics & gynecology residency, but also go beyond by including training on identifying ectopic pregnancies and birth defects. All of the videos are targeted to teaching providers in low- and middle-income countries, who are unlikely to have any experience with ultrasound. The concepts are presented very clearly with excellent examples of a range of normal and abnormal ultrasound findings. We are very grateful for the funding we received via Consano, and we would like to thank you for your support. Creation of the videos were truly a group effort! Kristina