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Testing telediagnostic obstetric ultrasound in Peru: a new horizon in expanding access to prenatal ultrasound

  • Toscano, Marika1
  • Marini, Thomas J.1
  • Drennan, Kathryn1
  • Baran, Timothy M.1
  • Kan, Jonah2
  • Garra, Brian3
  • Dozier, Ann M.4
  • Ortega, Rafael L.2
  • Quinn, Rosemary A.2
  • Zhao, Yu T.2
  • Egoavil, Miguel S.5
  • Tamayo, Lorena5
  • Carlotto, Claudia5
  • Castaneda, Benjamin6
  • 1 University of Rochester Medical Center, 601 Elmwood Ave, Rochester, NY, 14642, USA , Rochester (United States)
  • 2 University of Rochester School of Medicine and Dentistry, 601 Elmwood Ave, Rochester, NY, 14642, USA , Rochester (United States)
  • 3 Medical Imaging Ministries of the Americas, 10810 Lake Minneola Shores, Clermont, FL, 34711, USA , Clermont (United States)
  • 4 University of Rochester Medical Center, 265 Crittenden Blvd., Rochester, NY, 14642, USA , Rochester (United States)
  • 5 Medical Innovation and Technology, Calle Los Libertadores 635, San Isidro, 15046, Peru , San Isidro (Peru)
  • 6 Pontificia Universidad Catolica del Peru, Av. Universitaria 1801, San Miguel, 15088, Peru , San Miguel (Peru)
Published Article
BMC Pregnancy and Childbirth
Springer (Biomed Central Ltd.)
Publication Date
Apr 26, 2021
DOI: 10.1186/s12884-021-03720-w
Springer Nature


BackgroundNinety-four percent of all maternal deaths occur in low- and middle-income countries, and the majority are preventable. Access to quality Obstetric ultrasound can identify some complications leading to maternal and neonatal/perinatal mortality or morbidity and may allow timely referral to higher-resource centers. However, there are significant global inequalities in access to imaging and many challenges to deploying ultrasound to rural areas. In this study, we tested a novel, innovative Obstetric telediagnostic ultrasound system in which the imaging acquisitions are obtained by an operator without prior ultrasound experience using simple scan protocols based only on external body landmarks and uploaded using low-bandwidth internet for asynchronous remote interpretation by an off-site specialist.MethodsThis is a single-center pilot study. A nurse and care technician underwent 8 h of training on the telediagnostic system. Subsequently, 126 patients (68 second trimester and 58 third trimester) were recruited at a health center in Lima, Peru and scanned by these ultrasound-naïve operators. The imaging acquisitions were uploaded by the telemedicine platform and interpreted remotely in the United States. Comparison of telediagnostic imaging was made to a concurrently performed standard of care ultrasound obtained and interpreted by an experienced attending radiologist. Cohen’s Kappa was used to test agreement between categorical variables. Intraclass correlation and Bland-Altman plots were used to test agreement between continuous variables.ResultsObstetric ultrasound telediagnosis showed excellent agreement with standard of care ultrasound allowing the identification of number of fetuses (100% agreement), fetal presentation (95.8% agreement, κ =0.78 (p < 0.0001)), placental location (85.6% agreement, κ =0.74 (p < 0.0001)), and assessment of normal/abnormal amniotic fluid volume (99.2% agreement) with sensitivity and specificity > 95% for all variables. Intraclass correlation was good or excellent for all fetal biometric measurements (0.81–0.95). The majority (88.5%) of second trimester ultrasound exam biometry measurements produced dating within 14 days of standard of care ultrasound.ConclusionThis Obstetric ultrasound telediagnostic system is a promising means to increase access to diagnostic Obstetric ultrasound in low-resource settings. The telediagnostic system demonstrated excellent agreement with standard of care ultrasound. Fetal biometric measurements were acceptable for use in the detection of gross discrepancies in fetal size requiring further follow up.

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