Screening and managing a low-risk pregnant population using continuous-wave Doppler ultrasound in a low-income population : a cohort analytical study

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dc.contributor.author Nkosi, Spencer
dc.contributor.author Makin, J.A.
dc.contributor.author Hlongwane, T.M.A.G.
dc.contributor.author Pattinson, Robert Clive
dc.date.accessioned 2020-07-29T10:35:34Z
dc.date.available 2020-07-29T10:35:34Z
dc.date.issued 2019-05
dc.description.abstract BACKGROUND: In South Africa (SA), the largest category of perinatal deaths is unexplained stillbirths. Two-thirds of these occur in the antenatal period and most fetuses are macerated, but at antenatal clinics the mothers were generally regarded as healthy, with low-risk pregnancies. Innovative methods are urgently required to detect fetuses at risk of stillbirth and manage the mothers appropriately. OBJECTIVES: To determine the prevalence of raised resistance indices (RIs) of the umbilical artery in a low-risk, low-income population and ascertain whether use of this information can prevent perinatal deaths. METHODS: A descriptive study was performed in Mamelodi township, east of Pretoria, SA, on pregnant women attending antenatal clinics draining to two community health centres (CHCs). These women, classified as having low-risk pregnancies, were screened for placental insufficiency using a continuous-wave Doppler ultrasound apparatus (Umbiflow) between 28 and 32 weeks’ gestation. When a raised RI was detected, the mother was referred to a high-risk clinic and managed according to a standard protocol. A cohort analytical study compared women who attended antenatal care at the same clinics as the Umbiflow group but did not have an Umbiflow test with those who had an Umbiflow test. The outcomes of all the deliveries in Mamelodi were recorded. The prevalences of abnormal RIs, absent end-diastolic flow (AEDF), stillbirths and neonatal deaths were the main outcome measures. RESULTS: An Umbiflow RI was performed in 2 868 women, and pregnancy outcome was available for 2 539 fetuses (88.5%); 297 fetuses (11.7%) were regarded as at high risk. AEDF was found in 1.5% of the population screened with an outcome. There were 29 perinatal deaths in the Umbiflow group (low risk n=18, high risk n=11). The perinatal mortality rate for 12 168 women attending the CHCs and the antenatal clinics draining to the CHCs who did not have an RI was 21.3/1 000 births, significantly higher than that in the Umbiflow group (11.4/1 000 births) (risk ratio 0.58, 95% confidence interval 0.42 - 0.81). CONCLUSIONS: The prevalence of AEDF in this low-risk population is ~10 times higher than that previously recorded. Use of the information prevented a number of perinatal deaths, most of which would have been macerated stillbirths. Screening a low-risk pregnant population using continuous-wave Doppler ultrasound may substantially reduce the prevalence of unexplained stillbirths in SA. en_ZA
dc.description.department Obstetrics and Gynaecology en_ZA
dc.description.librarian pm2020 en_ZA
dc.description.sponsorship The South African Medical Research Council and the CSIR. en_ZA
dc.description.uri http://www.samj.org.za en_ZA
dc.identifier.citation Nkosi, S., Makin, J., Hlongwane, T .et al. 2019, 'Screening and managing a low-risk pregnant population using continuous-wave Doppler ultrasound in a low-income population : a cohort analytical study', South African Medical Journal, vol. 109, no. 5, pp. 347-352. en_ZA
dc.identifier.issn 0256-9574 (print)
dc.identifier.issn 2078-5135 (online)
dc.identifier.other 10.7196/SAMJ.2019.v109i5.13611
dc.identifier.uri http://hdl.handle.net/2263/75492
dc.language.iso en en_ZA
dc.publisher Health and Medical Publishing Group en_ZA
dc.rights © 2019, South African Medical Association. This article is licensed under a Creative Commons Attribution-NonCommercial Works License (CC BY-NC 3.0). en_ZA
dc.subject Doppler ultrasound en_ZA
dc.subject Low-risk pregnancy en_ZA
dc.subject Stillbirth en_ZA
dc.subject South Africa (SA) en_ZA
dc.subject Screening en_ZA
dc.subject Managing en_ZA
dc.subject Resistance indices (RIs) en_ZA
dc.subject Neonatal deaths en_ZA
dc.subject Absent end-diastolic flow (AEDF) en_ZA
dc.title Screening and managing a low-risk pregnant population using continuous-wave Doppler ultrasound in a low-income population : a cohort analytical study en_ZA
dc.type Article en_ZA


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