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Gestational Age Assessment in the Ghana Randomized Air Pollution and Health Study (GRAPHS): Ultrasound Capacity Building, Fetal Biometry Protocol Development, and Ongoing Quality Control.

Boamah EA, Asante K, Ae-Ngibise K, Kinney PL, Jack DW, Manu G, Azindow IT, Owusu-Agyei S, Wylie BJ - JMIR Res Protoc (2014)

Bottom Line: Four million premature deaths occur yearly as a result of smoke from cooking fires.Training included a basic obstetric ultrasound course offered to all midwives performing antenatal care at the two study hospitals, followed by a more intense period of hands-on training focused on fetal biometry for a select group of providers demonstrating aptitude in the basic course.A standard operating procedure was developed describing how to obtain all fetal biometric measurements.

View Article: PubMed Central - HTML - PubMed

Affiliation: Kintampo Health Research Centre, Brong Ahafo Region, Kintampo, Ghana.

ABSTRACT

Background: Four million premature deaths occur yearly as a result of smoke from cooking fires. The Ghana Randomized Air Pollution and Health Study (GRAPHS) is underway in the Kintampo North municipality and South district of rural Ghana to evaluate the impact of improved cook stoves introduced during pregnancy on birth weight and childhood pneumonia. These hypotheses are being tested in a cluster-randomized intervention trial among 1415 maternal-infant pairs within 35 communities assigned to a control arm (traditional cooking) or one of two intervention arms (cooking with an improved biomass stove; cooking with liquefied petroleum gas stoves).

Objective: The trial is designed to ensure delivery of the stove intervention prior to the period of maximal fetal growth. To answer questions about the impact of household air pollution on pregnancy outcome, accurate gestational age assessment is critical. This manuscript describes in detail the development of the gestational dating protocol, intensive ultrasound training involved, ultrasound capacity building, and ultrasound quality control program.

Methods: Ultrasound training occurred in several phases over the course of 2 years. Training included a basic obstetric ultrasound course offered to all midwives performing antenatal care at the two study hospitals, followed by a more intense period of hands-on training focused on fetal biometry for a select group of providers demonstrating aptitude in the basic course. A standard operating procedure was developed describing how to obtain all fetal biometric measurements. Consensus was obtained on how biometric images are used in the trial to establish gestational age and estimate the delivery date. An ongoing ultrasound quality control program including the use of an image scorecard was also designed.

Results: Publication of trial results is anticipated in late 2016.

Conclusions: Use of ultrasound should be strongly considered in field-based trials involving pregnant women to accurately establish gestational age, as menstrual dates may be incorrect or unknown. The inclusion of ultrasound in areas where ultrasound capacity does not previously exist requires a significant investment of time and resources. Such investment ensures appropriate training, high quality images, and accurate dating pregnancies. We outline our ultrasound training, image acquisition, quality control, and dating protocols in detail.

Trial registration: Clinicaltrials.gov NCT01335490; http://clinicaltrials.gov/ct2/show/NCT01335490 (Archived by WebCite at http://www.webcitation.org/6UbERJNO6).

No MeSH data available.


Related in: MedlinePlus

Representative sample image of crown-rump length from Ghana Randomized Air Pollution and Health Study (GRAPHS) participant.
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figure2: Representative sample image of crown-rump length from Ghana Randomized Air Pollution and Health Study (GRAPHS) participant.

Mentions: For first trimester scans, midwives are instructed to obtain CRL measurements for pregnancies less than 14 weeks. When both the crown and rump are visible on the screen in the approximate midsagital plane imaged horizontally on the ultrasound screen, the image is zoomed to occupy more than 50% of the screen and frozen. Calipers are placed at the exterior edge of the skull (the crown) and at the inferior aspect of the pelvic bones (the rump). A sample GRAPHS CRL image is shown in Figure 2. The measured image is then saved to the portable ultrasound machine. A total of three CRL images are obtained. A summary report is generated by the ultrasound machine, which averages the three saved images to estimate an overall gestational age and corresponding estimated date of delivery. Both the measurements and the corresponding gestational age estimated by the machine software are recorded onto the Ultrasound Gestational Age Form. The machine-generated delivery date is considered the Working Estimated Delivery Date for the trial and is used to schedule all other trial activities and to anticipate the delivery.


Gestational Age Assessment in the Ghana Randomized Air Pollution and Health Study (GRAPHS): Ultrasound Capacity Building, Fetal Biometry Protocol Development, and Ongoing Quality Control.

Boamah EA, Asante K, Ae-Ngibise K, Kinney PL, Jack DW, Manu G, Azindow IT, Owusu-Agyei S, Wylie BJ - JMIR Res Protoc (2014)

Representative sample image of crown-rump length from Ghana Randomized Air Pollution and Health Study (GRAPHS) participant.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4376157&req=5

figure2: Representative sample image of crown-rump length from Ghana Randomized Air Pollution and Health Study (GRAPHS) participant.
Mentions: For first trimester scans, midwives are instructed to obtain CRL measurements for pregnancies less than 14 weeks. When both the crown and rump are visible on the screen in the approximate midsagital plane imaged horizontally on the ultrasound screen, the image is zoomed to occupy more than 50% of the screen and frozen. Calipers are placed at the exterior edge of the skull (the crown) and at the inferior aspect of the pelvic bones (the rump). A sample GRAPHS CRL image is shown in Figure 2. The measured image is then saved to the portable ultrasound machine. A total of three CRL images are obtained. A summary report is generated by the ultrasound machine, which averages the three saved images to estimate an overall gestational age and corresponding estimated date of delivery. Both the measurements and the corresponding gestational age estimated by the machine software are recorded onto the Ultrasound Gestational Age Form. The machine-generated delivery date is considered the Working Estimated Delivery Date for the trial and is used to schedule all other trial activities and to anticipate the delivery.

Bottom Line: Four million premature deaths occur yearly as a result of smoke from cooking fires.Training included a basic obstetric ultrasound course offered to all midwives performing antenatal care at the two study hospitals, followed by a more intense period of hands-on training focused on fetal biometry for a select group of providers demonstrating aptitude in the basic course.A standard operating procedure was developed describing how to obtain all fetal biometric measurements.

View Article: PubMed Central - HTML - PubMed

Affiliation: Kintampo Health Research Centre, Brong Ahafo Region, Kintampo, Ghana.

ABSTRACT

Background: Four million premature deaths occur yearly as a result of smoke from cooking fires. The Ghana Randomized Air Pollution and Health Study (GRAPHS) is underway in the Kintampo North municipality and South district of rural Ghana to evaluate the impact of improved cook stoves introduced during pregnancy on birth weight and childhood pneumonia. These hypotheses are being tested in a cluster-randomized intervention trial among 1415 maternal-infant pairs within 35 communities assigned to a control arm (traditional cooking) or one of two intervention arms (cooking with an improved biomass stove; cooking with liquefied petroleum gas stoves).

Objective: The trial is designed to ensure delivery of the stove intervention prior to the period of maximal fetal growth. To answer questions about the impact of household air pollution on pregnancy outcome, accurate gestational age assessment is critical. This manuscript describes in detail the development of the gestational dating protocol, intensive ultrasound training involved, ultrasound capacity building, and ultrasound quality control program.

Methods: Ultrasound training occurred in several phases over the course of 2 years. Training included a basic obstetric ultrasound course offered to all midwives performing antenatal care at the two study hospitals, followed by a more intense period of hands-on training focused on fetal biometry for a select group of providers demonstrating aptitude in the basic course. A standard operating procedure was developed describing how to obtain all fetal biometric measurements. Consensus was obtained on how biometric images are used in the trial to establish gestational age and estimate the delivery date. An ongoing ultrasound quality control program including the use of an image scorecard was also designed.

Results: Publication of trial results is anticipated in late 2016.

Conclusions: Use of ultrasound should be strongly considered in field-based trials involving pregnant women to accurately establish gestational age, as menstrual dates may be incorrect or unknown. The inclusion of ultrasound in areas where ultrasound capacity does not previously exist requires a significant investment of time and resources. Such investment ensures appropriate training, high quality images, and accurate dating pregnancies. We outline our ultrasound training, image acquisition, quality control, and dating protocols in detail.

Trial registration: Clinicaltrials.gov NCT01335490; http://clinicaltrials.gov/ct2/show/NCT01335490 (Archived by WebCite at http://www.webcitation.org/6UbERJNO6).

No MeSH data available.


Related in: MedlinePlus