Training midwives to perform basic obstetric pocus in rural areas using a tablet platform and mobile phone transmission technology

Document Type



Imaging and Diagnostic Radiology (East Africa)


Point of care ultrasound (POCUS) has become a very topical subject and can be applied in a variety of ways with differing outcomes. Cost of all diagnostic procedures including obstetric ultrasound exams is a major factor in the developing world and POCUS is only useful if it can be equated to good outcomes and at a lower cost than a routine obstetric exam. The aim of this study was to train midwives to perform scans in a rural setting and identify high risk pregnancies who were then referred to specialist centers in established institutions for further management. We produced a curriculum for midwives who had no previous experience in ultrasound; they were given didactic lectures as well as hands on training in obstetric ultrasound. A comprehensive exit examination ensured that they were well trained to independently perform scans on their own. The midwives were stationed in rural locations where POCUS was available for the first time. After scanning the patients, an interim report was generated by them and sent with all images to the main hospital for validation. Unique software was used to send lossless images by mobile phone using a modem. Transmission times were short and image quality transmission was excellent. All reports were validated by two experienced Radiologists in our department and returned back to the centers. Transmission times, quality of scans, quality of reports and other parameters were recorded and monitored. Analysis showed excellent correlation between provisional and validated reports. Reporting accuracy of scans performed by the midwives was 99.63%. Overall flow turnaround time (from patient presentation to validated report) was initially 35 minutes but reduced to 25 minutes. The unique mobile phone transmission was faultless and there was no degradation of image quality. There was also excellent correlation between final outcomes of the pregnancies and diagnosis based on reports generated by the midwives. Only one discrepancy was found in the midwives reports. Scan results versus actual outcomes revealed 2 discrepancies in the 20 patients labeled as high risk. In conclusion, training midwives in POCUS to use an ultrasound tablet device and transmit their images and reports via internet for review of accuracy by a radiologist; focusing identification of high risk patients can be valuable in a remote health facility.


Ultrasound in Medicine and Biology