Abstract
The state of maternal-fetal and women’s health in low- and middle-income countries remains appalling despite growing global attention. Every year approximately 350,000 women in the world die while pregnant or giving birth, up to million newborns die within their first year of life, and there are 2.6 million stillbirths (Faveau V, Contributing Editor. The state of the world’s midwifery, 2011: delivering health, saving lives. United Nations Population Fund. http://www.unfpa.org/sowmy). Each day 3500 women experience birth complications and 900 are likely to die. Since the adoption of the Millennium Development goals (MDGs) by the United Nations in 2000, deployment of resources toward Goals 3 and 4 (reducing child mortality and improving maternal health) yielded little improvement by the end of the target deadline of 2015. A renewal effort known as the Sustainable Development Goals (SDGs) replaced and expanded the original eight MDGs to include 17 distinct targets. Developed by a group of 190 world leaders, these goals focus on ending extreme poverty, fighting inequality and injustice, and repairing global climate change.
Examination of the published epidemiologic data from around the world reveals unique characteristics and dissimilarities of countries with high maternal mortality. This chapter examines the scope of morbidity and mortality for women of reproductive age and their offspring, with special attention to conditions that can be diagnosed by ultrasound imaging. An overview is presented on the impact of regional, legal, and sociopolitical customs in target communities on practice of prenatal ultrasonography and how obstetric imaging may play a crucial role in reducing maternal and perinatal mortality. Published outcomes of projects using trained indigenous healthcare providers in the use of ultrasound are promising. With increasing availability of ultrasound technology, the replication of these prototype projects (coupled with other social and educational changes) could lead to improved maternal-fetal outcomes and achievement of Sustainable Development Goal 3 – “Ensure healthy lives and promote well-being for all at all ages” (United Nations 2017. Sustainable development goals, goal 3. Good health and well-being. www.un.ort/sustainabledevelopment/health/).
Access this chapter
Tax calculation will be finalised at checkout
Purchases are for personal use only
References
Faveau V, Contributing Editor. The state of the world’s midwifery, 2011: delivering health, saving lives. United Nations Population Fund. http://www.unfpa.org/sowmy.
United Nations 2017. Sustainable development goals, goal 3. Good health and well-being. www.un.ort/sustainabledevelopment/health/.
Hogan MC, Foreman KJ, Naghavi M, et al. Maternal mortality for 181 countries, 1980-2008: a systematic analysis of progress towards Millennium Development Goal 5. Lancet. 2010;375(9726):1609–23.
World Health Organization Trends in maternal mortality 2015. WHO map: maternal mortality ratio (per 100,000 live births), 2015, Health Stats and Info Systems, http://gamapserverwhoint/mapLibrary/Files/Maps/Global_mmr_2015png. Accessed 10 Mar 2018.
Lawn JE, Cousens S, Zupan J. Lancet neonatal survival steering team. 4 million neonatal deaths: when, where, why? Lancet. 2005;365(9462):891–900.
Stanton K, Mwanri L. Global maternal and child health outcomes of obstetric ultrasound in low resource settings. World J Preventive Med. 2013;1(3):22–9.
World Health Organization. Achieving Millennium Development Goal 5: target 5A and 5B on reducing maternal mortality and achieving universal access to reproductive health. http://whqlibdoc.who.int/hq/2009/WHO_RHR_09.06. Accessed 10 July 2012.
Nour N. An introduction to maternal mortality. Rev Obstet Gynecol. 2008;1(2):77–81.
Khan KS, Wojdyla D, Say L, Gulmezoglu AM, Van Look PFA. WHO analysis of causes of maternal death: a systematic review. Lancet. 2006;367(9516):1066–74.
Hofmeyr GJ, Haws RA, Bergstrom S, Lee AC, Okong P, Darmstadt GL, et al. Obstetric care in low-resource settings: what, who, and how to overcome challenges to scale up? Int J Gynaecol Obstet. 2009;107(1):S21–44, S44–5.
Sachs JD, McArthur JW. The millenium project: a plan for meeting the millenium development goals. Lancet. 2005;365(9456):347–53.
Campbell OMR, Graham WJ. Strategies for reducing maternal mortality: getting on with what works. Lancet. 2006;368(9543):1284–99.
World Health Organization. Standards for improving quality of maternal and newborn care in health facilities. Geneva: WHO Press, World Health Organization; 2016. p. 61. (http://www.who.int).
Orazulike NC, Alegbeleye JO, Obiorah CC, Nyengidiki TK, Uzoigwe SA. A 3-year retrospective review of mortality in women of reproductive age in a tertiary health facility in Port Harcourt. Nigeria Int J Women’s Health. 2017;9:769–75.
Oestergaard MZ, Inoue M, Yoshida S, Mahanani WR, Gore FM, Cousens S, on behalf of the United Nations Inter-agency Group for Child Mortality Estimation and the Child Health Epidemiology Reference Group, et al. Neonatal mortality levels for 193 countries in 2009 with trends since 1990: a systematic analysis of progress, projections, and priorities. PLoS Med. 2011;8(8):e1001080.
Bhutta ZA, Chopra M, Axelson H, et al. Countdown to 2015 decade report (2000-10): taking stock of maternal, newborn, and child survival. Lancet. 2010;375(9730):2032–44.
Frates MC, Kumar AJ, Benson CB, Ward VL, Tempany CM. Fetal anomalies: comparison of MR imaging and US for diagnosis. Radiology. 2004;232:398–404.
Seffah JD, Adanu RM. Obstetric ultrasonography in low-income countries. Clin Obstet Gynecol. 2009;52:250–5.
Grandjean H, Larroque D, Levi S. The performance of routine ultrasonographic screening of pregnancies in the Eurofetus Study. Am J Obstet Gynecol. 1999;181(2):446.
FIGO Working Group on Best Practice in Maternal-Fetal Medicine. Best practice in maternal-fetal medicine. Int J Gynaecol Obstet. 2015;238:80–2.
Harris RD, Marks WM. Compact US for improving maternal and perinatal care in low-resource setting: review of potential benefits, implementation, challenges and public health issues. J Ultrasound Med. 2009;28(8):1067–76.
Sayasneh A, Preisler J, Smith A, Saso S, Naji O, Abdallah Y, et al. Do pocket-sized ultrasound machines have the potential to be used as a tool to triage patients in obstetrics and gynecology? Ultrasound Obstet Gynecol. 2012;40:2.
Sippel S, Muruganandan K, Levine A, Shah S. Review article: use of ultrasound in the developing world. Int J Emerg Med. 2011;4:72–83. http://222.intjem.com/content//4/1/72.
Omonuwa T, Small M, Ghate S. Prenatal maternal-fetal imaging for global health radiology. In: Mollura DP, Lungren MP, editors. Radiology in global health. 1st ed. New York: Springer; 2014. p. 219–32.
Goldner TE, Lawson HW, Xia Z, Atrash HK. Surveillance for ectopic pregnancy—United States, 1970–1989. MMWR CDC Surveill Summ. 1993;42(6):73–85.
CDC. Ectopic pregnancy—United States, 1990–1992. MMWR Morb Mortal Wkly Rep. 1995;44(3):46–8, 145–50.
Sy T, Diallo Y, Toure A, et al. Management of ectopic pregnancy in Conakry, Guinea. Med Trop (Mars). 2009;69(6):565–8.
Nayama M, Gallais A, Ousmane N, et al. Management of ectopic pregnancy in developing countries: example of a Nigerian reference maternity. Gynecol Obstet Fertil. 2006;34(1):14–8.
Baughman WC, Corteville JE, Shah RR. Placenta accreta: spectrum of US and MR imaging findings. Radiographics. 2008;28(7):1905–16.
Oyelese KO, Schwarzler P, Coates S, Sanusi FA, Hamid R, Campbell S. A strategy for reducing the mortality rate from vasa previa using transvaginal sonography with color Doppler. Ultrasound Obstet Gynecol. 1998;12:434–8.
Hou JL, Wan XR, Xiang Y, Qi QW, Yang XY. Changes of clinical features in hydatidiform mole: analysis of 113 cases. J Reprod Med. 2008;53(8):629–33.
Grimes DA, Benson J, Singh S, Romero M, Ganatra B, et al. Unsafe abortion: the preventable pandemic. Lancet. 2006;368(9550):1908–19.
WHO. Unsafe abortion: global and regional estimates of the incidence of unsafe abortion and associated mortality in 2000. 4th ed. Geneva: World Health Organization; 2004.
Hussein J, Fortney JA. Puerperal sepsis and maternal mortality: what role can new technologies play? Int J Gynaecol Obstet. 2004;85(Suppl 1):s52–61.
van Dillen J, Zwart J, et al. Maternal sepsis: epidemiology, etiology and outcome. Curr Opin Infect Dis. 2010;23(3):249–54.
Abouzahr C, Aaahman E, Guidotti R. Puerperal sepsis and other puerperal infections. In: Murray CJL, Lopez AD, editors. Health dimensions of sex and reproduction: the global burden of sexually transmitted diseases, maternal conditions, perinatal disorders, and congenital anomalies. Geneva: WHO; 1998.
Verburg BO, Steegers EAP, De Ridder M, Snijders RJM, Smith E, Hofman A, et al. New charts for ultrasound dating of pregnancy and assessment of fetal growth: longitudinal data from a population-based cohort study. Ultrasound Obstet Gynecol. 2008;31(4):388–96.
Irgens LM. Early death, morbidity, and need for treatment among extremely premature infants. Pediatrics. 2005;115(5):1289–98.
Benson CB, Belville JS, Lentini JF, Saltzman DH, Doubilet PM. Intrauterine growth retardation: diagnosis based on multiple parameters—a prospective study. Radiology. 1990;177(2):499–502.
Nielson JP, Munjanja SP, Whitfield CR. Screening for small for dates fetuses: a controlled trial. BMJ. 1984;289(6453):1179–82.
Conde-Agudelo A, Belizan J, Lindmark G. Maternal morbidity and mortality associated with multiple gestations. Obstet Gynecol. 2000;95(6):899–904.
Kahn B, Lumey LH, Zybert PA, Lorenz JM, Cleary-Goodman J, D’Alton ME, Robinson JN. Prospective risk of fetal death in singleton, twin and triplet gestations: implications for practice. Obstet Gynecol. 2003;102(4):685–92.
Sebire NJ, Snijders RJM, Huges K, Markestad T, Kaaresen PI, Ronnestad A, et al. The hidden mortality of monochorionic twin pregnancies. BJOG. 1997;104:1203–7.
Trop I. The twin peak sign. Radiology. 2001;220:68–9.
Sepulveda W, Sebire NJ, Hughes K, Odibo A, Nicolaides KH. The lambda sign at 10–14 weeks of gestation as a predictor of chorionicity in twin pregnancies. Ultrasound Obstet Gynecol. 1996;7(6):421–3.
Norwitz E, Edusa V, Park J. Maternal physiology and complications of multiple pregnancy. Semin Perinatol. 2005;29(5):338–48.
Carbillon L, Oury JF, Guerin JM, Azancot A, Blot P. Clinical biological features of Ballantyne syndrome and the role of placental hydrops. Obstet Gynaecol Surv. 1997;52:310–4.
Midgley DY, Harding K. The mirror syndrome. Eur J Obstet Gynecol Reprod Med. 2000;88(2):201–2.
Braun T, Brauer M, Fuchs I, Czernik C, Dudenhausen JW, Henrich W, Sarioglu N. Mirror syndrome: a systematic review of fetal associated conditions, maternal presentation and perinatal outcome. Fetal Diagn Ther. 2010;27:191–203.
Kotlyar S, Moore C. Assessing the utility of ultrasound in Liberia. J Emerg Trauma Shock. 2008;1(1):10–4.
Steinmetz J, Berger J. Ultrasonography as an aid to diagnosis and treatment in a rural African hospital: a prospective study of 1,119 cases. Am J Trop Med Hyg. 1999;60(1):119–23.
Adler D, et al. Introduction of a portable ultrasound unit into the health services of the Lugufu refugee camp, Kigoma District, Tanzania. Int J Emerg Med. 2008;1(4):261–6.
Shah SP, Epino H, Bukhman G, Umulisa I, Dushimiyimana JM, et al. Impact of the introduction of ultrasound services in a limited resource setting: rural Rwanda 2008. BMC Int Health Hum Rights. 2009;9:4.
Bussmann H, Koen E, Arhin-Tenkorang D, Munyadzwe G, Troeger J. Feasibility of an ultrasound service on district health care level in Botswana. Tropical Med Int Health. 2001;6(12):1023–31.
Vinayak S, Sande J, Nisenbaum H, Nolsoe CP. Training midwives to perform basic obstetric point-of-care ultrasound in rural areas using a tablet platform and mobile phone transmission technology – A WFUMB COE project. Ultrasound Med Biol. 2017;43(10):2125–32.
Nathan R, Swanson J, Marks W, Goldsmith N, Vance C, Sserwanga N, et al. Screening obstetric ultrasound training for a 5-country cluster randomized controlled trial. Ultrasound Q. 2014;30(4):262–6.
Geerts L, Theron AM, Grove D, Theron GB, Odendaal HJ. A community-based obstetric ultrasound service. Int J Gynaecol Obstet. 2004;84(1):23–31.
Torloni MR, Vedmedovska N, Merialdi M, Betrán AP, Allen T, González R, Platt LD. Safety of ultrasonography in pregnancy: WHO systematic review of the literature and meta-analysis. Ultrasound Obstet Gynecol. 2009;33(5):599–608.
American Institute of Ultrasound in Medicine, Official Statement, Prudent Use and Clinical Safety, American Institute of Ultrasound in Medicine, March 2007.
Center for Devices and Radiological Health. Information for manufacturers seeking marketing clearance of diagnostic ultrasound systems and transducers. www.fda.gov/cdrh/ode/ulstran.pdf.
Guilmoto CZ. The sex ratio transition in Asia. Popul Dev Rev. 2009;35(3):519–49.
Chervenak FA, McCullough LB. Sex determination by ultrasound: ethical challenges of sex ratio imbalances and invidious discrimination. Ultrasound Obstet Gynecol. 2009;34:245.
Miller BD. Female-selective abortion in Asia: patterns, polices, and debates. Am Anthropol. 2001;103(4):1083–95.
Hudson VM, Den Boer A. A surplus of men, a deficit of peace: security and sex ratios in Asia’s largest states. Int Secur. 2002;26(4):5–38.
Li S. Imbalanced sex ratio at birth and comprehensive intervention in China. Presentation at 4th Asia Pacific Conference on reproductive and sexual health and rights, Hyderabad, 2007 Oct 29–31. www.unfpa.org/gender/docs/studies/china.pdf . Accessed Sept 2012.
Sen A. Missing women—revisited. BMJ. 2003;327(7427):1297–8.
Renzetti C. Gender-based violence. Lancet. 2005;365(9464):1009–10.
UNFPA. Sex-selective abortions and fertility decline: the case of Haryana and Punjab. New Delhi: United Nations Population Fund; 2001.
Bumgarner A. A right to choose? Sex selection in the international context. Duke J Gend Law Policy. 2007;14:1289.
Chigbu CO, Odugu B, Okezie O. Implications of incorrect determination of fetal sex by ultrasound. Int J Gynaecol Obstet. 2008;100(3):287–90.
Gammeltoft T, Nguyen HT. The commodification of obstetric ultrasound scanning in Hanoi. Viet Nam Reprod Health Matters. 2007;15(29):163–71.
Kohli HS. Ultrasound scanning in pregnancy: the hope and the shame. Natl Med J India. 2003;16(6):332–3.
Okonta PI, Okogbenin SA, Adeoye-Sunday I. Pregnant Nigerian woman’s view of her prenatal sex determination. J Obstet Gynaecol. 2004;24(8):875–7.
Gammeltoft T, Nguyen HT. Fetal conditions and fatal decisions: ethical dilemmas in ultrasound screening in Vietnam. Soc Sci Med. 2007;64(11):2248–59.
Tautz S, Jahn A, Molokomme I, Gorgen R. Between fear and relief: how rural pregnant women experience foetal ultrasound in a Botswana district hospital. Soc Sci Med. 2000;50(5):698–701.
Scott S, Ronsmans C. The relationship between birth with a health professional and maternal mortality in observational studies: a review of the literature. Tropical Med Int Health. 2009;14(12):1523–33.
Parkhurst JO, Penn-Kekana L, Blaauw D, Balabanova D, Danishevski K, Rahman SA, et al. Health systems factors influencing maternal health services: a four-country comparison. Health Policy. 2005;73(2):127–38.
Grahm WJ, Bell J, Bullough C. Can skilled attendance at delivery reduce maternal mortality in developing countries? In: De Brouwere V, van Lerberghe W, editors. Safe motherhood strategies: a review of the evidence. Antwerp: ITG Press; 2001. p. 97–130.
Fauveau V, Stewart K, Khan SA, Chakraborty J. Effect on mortality of community-based maternity-care programme in rural Bangladesh. Lancet. 1991;338(8776):1183–6.
Pathmanathan I, Liljestrand J, Martins JM, Rajapaksa LC, Lissner C, Silva AD, et al. Investing in maternal health: learning from Malaysia and Sri Lanka. Washington, DC: The World Bank, Human Development Network; 2003.
Koblinsky M. Reducing maternal mortality: learning from Bolivia, Egypt, Honduras, Indonesia, Jamaica, and Zimbabwe. Washington, DC: World Bank; 2003.
Wilson A, Gallos ID, Plana N, et al. Effectiveness of strategies incorporating training and support of traditional birth attendants on perinatal and maternal mortality: meta-analysis. BMJ. 2011;343:d7102.
Doctor HV, Findley SE, Ager A, et al. Using community-based research to shape the design and delivery of maternal health services in Northern Nigeria. Reprod Health Matters. 2012;20:104.
Oyerinde K, Harding Y, Amara P, et al. A qualitative evaluation of the choice of traditional birth attendants for maternity care in 2008 Sierra Leone: implications for universal skilled attendance at delivery. Matern Child Health J. 2013;17(5):862–8.
Ahmed S, Li Q, Liu L, Tsui AO. Maternal deaths averted by contraceptive use: an analysis of 172 countries. Lancet. 2012;380(9837):111–25.
Conde-Agudelo A, Rosas-Bermúdez A, Kafury-Goeta AC. Effects of birth spacing on maternal health: a systematic review. Am J Obstet Gynecol. 2007;196(4):297–308.
Author information
Authors and Affiliations
Corresponding author
Editor information
Editors and Affiliations
Rights and permissions
Copyright information
© 2019 Springer Nature Switzerland AG
About this chapter
Cite this chapter
Dowdy, D., Omofoye, T. (2019). Maternal-Fetal and Women’s Imaging for Global Health Radiology. In: Mollura, D., Culp, M., Lungren, M. (eds) Radiology in Global Health. Springer, Cham. https://doi.org/10.1007/978-3-319-98485-8_19
Download citation
DOI: https://doi.org/10.1007/978-3-319-98485-8_19
Published:
Publisher Name: Springer, Cham
Print ISBN: 978-3-319-98484-1
Online ISBN: 978-3-319-98485-8
eBook Packages: MedicineMedicine (R0)