Why Pregnancy Dating Matters
The primary goal of this training was to teach point-of-care ultrasound so midwives can more accurately determine how far along a pregnancy is.
According to the World Health Organization, accurate pregnancy dating is important for guiding prenatal care, identifying high-risk pregnancies, and ensuring babies are delivered at the safest possible time.
The most accurate pregnancy dating occurs during the first trimester. Our hope is that having access to ultrasound will encourage more women to come for prenatal care early in pregnancy.
Earlier care means more opportunities to detect problems, provide counseling, and support healthier outcomes for both mothers and babies.
Ultrasound is already changing lives
On day 3 of our training, we had a patient added on who had been treated for sepsis and was now also having vaginal bleeding. The midwife that scanned found an empty uterus and a large mass containing what appeared to be fetal bones. Our differentials included partial molar pregnancy in a didelphic uterus, abdominal ectopic, or other adnexal mass. This patient was taken by ambulance to Lacor hospital for surgery. The final diagnosis was abdominal ectopic. Abdominal ectopic pregnancies are high-risk because the placenta implants on abdominal organs or peritoneum, leading to severe hemorrhage risk and higher maternal morbidity/mortality compared with other types of ectopics. Abdominal ectopics are very rare, with an occurrence rate of about 1:10,000. I feel certain that finding this mass on ultrasound saved this patients life.
Is Ultrasound Difficult to Learn?
When you first begin learning ultrasound, all you see are shades of gray.
At first glance the screen can look confusing—just patterns of light and dark. Learning to interpret those images takes time and practice. For some learners, it comes more naturally. They can quickly translate a two-dimensional image on the screen into a three-dimensional structure in their mind. But for most people, this skill develops gradually.
What we see on the ultrasound screen is only a slice of information. Each image represents a thin cross-section through the body. As the probe moves and more images appear, the clinician mentally assembles those slices into a three-dimensional picture of what is happening inside.
Some learners grasp this process quickly. For others, it takes repetition, patience, and many hours of scanning.
During our training in Uganda, we had five days of scanning patients in clinic. This was a great start for learning basic skills, but ultrasound is the kind of skill where more practice always helps. I found myself wishing we had a few more days to continue building those scanning habits.
Why Ultrasound Can Be Technically Challenging
During ultrasound lectures we teach learners what the fetus, uterus, and surrounding structures typically look like on ultrasound. But real-life imaging rarely looks exactly like the textbook.
Ultrasound images vary widely depending on many factors, including:
- Gestational age of the fetus
- The baby’s position and presentation
- Whether there is more than one fetus
- The orientation and position of the uterus
- Whether the scan is early pregnancy or a gynecologic exam
Because of this variation, ultrasound requires the midwives to think beyond the image itself. They must understand the full clinical picture and then correlate that information with what they see on the screen.
“I Found Something Abnormal… Now What?”
One of the most challenging aspects of learning ultrasound is not simply identifying structures, but knowing what to do when something doesn’t look normal.
This was a new challenge for many of the midwives we trained. Until recently, they had not had access to this technology.
One day in clinic, five of six scans showed abnormal findings.
The midwives then had to work through the clinical implications of those findings:
- Should the patient be referred?
- How urgently does she need follow-up?
- Is this something that requires immediate care?
- How can we help the patient access the medical services she needs?
Recognizing the image is only the first step. To detect abnormalities, learners must first develop a strong understanding of what normal looks like.
One of the most encouraging parts of the training was the teamwork among the midwives. When someone encountered a scan they were uncertain about, another midwife could review the images or take a look themselves.
This kind of collaboration is one of the best ways to learn. Discussing findings, comparing images, and asking questions helps build both confidence and clinical judgment.
The midwives also have access to a quality assurance (QA) process, where ultrasound images can be reviewed by clinicians in the United States or Canada. This allows them to receive feedback and continue learning even after the training ends.
In addition, after each scan the midwives complete a data collection sheet. This allows tracking of:
- where the ultrasound devices are being used
- who is performing the scans
- how often abnormalities are detected
These reports are also shared with government health officials, helping them understand how many women in each sub-county are receiving ultrasound care.
A Strong Desire to Learn
Throughout the training, the midwives were incredibly engaged. They asked thoughtful questions, supported each other, and were eager to practice whenever possible. They all understood an important truth about ultrasound: the more you scan, the easier it becomes. By the end of the week, the midwives were already becoming more comfortable with the probe, the images, and the decision-making that follows. Ultrasound is not mastered in five days, but those five days laid the foundation for something much bigger. With continued practice they will continue to grow in their skills, and most importantly, they now have access to information that can guide safer pregnancies and better care for both mother and baby.Bottom of Form
Amy (right) pictured with various WOTW colleagues & trainees