Ultrasound imaging and the culture of pregnancy management in low-and middle-income countries: A systematic review

Abstract

Background: Obstetric ultrasound imaging is a relatively new, but rapidly expanding, technology in low- and middle-income countries (LMICs). Given that new technologies modify practices, the influence of ultrasound on pregnancy management in LMICs is not comprehensively understood. Objectives: To map how ultrasound technology may be modulating the culture of pregnancy management in LMICs. Search Strategy: A search of five databases up to November 18, 2022. Selection Criteria: Original, peer-reviewed articles from LMICs, published in English from 2000 to 2022. Data Collection and Analysis: All articles were assessed for quality using the GRADE approach. Data were analyzed thematically to generate new interpretive constructs and explanations. Results: Forty articles involving 113 000 respondents suggests that obstetric ultrasound is becoming the preferred method of pregnancy surveillance, replacing clinically important components of prenatal care. Mothers overestimate ultrasound as an all-powerful diagnostic and “therapeutic” tool that can deliver the perfect baby. For-profit providers are driving medically unnecessary scans while the poor do not receive the recommended scans. Conclusion: Ultrasound technology has modified the culture of pregnancy management in LMICs in unintended and possibly harmful ways. Private health services are pushing the detrimental trends. Limitations include generalizability of qualitative studies and insufficient attention to inequities.