Introducing a mobile-connected umbilical doppler device (UmbiFlow™) into a primary care maternity setting : does this reduce unnecessary referrals to specialised care? results of a pilot study in Kraaifontein, South Africa

CITATION: Mufenda, J., et al. 2015. Introducing a mobile-connected umbilical doppler device (UmbiFlow™) into a primary care maternity setting : does this reduce unnecessary referrals to specialised care? results of a pilot study in Kraaifontein, South Africa. PLoS ONE, 10(11):1-13, doi:10.1371/journal.pone.0142743.The original publication is available at http://journals.plos.org/plosoneObjectives: UmbiFlow™ is a mobile-connected Doppler device that utilises a continuous waveform to measure resistance in the umbilical artery. The main aim of this pilot study was to determine whether the use of UmbiFlow™ for umbilical artery Doppler in patients with a suspected decreased symphysis fundal (SF) growth could safely lead to a decreased number of patients requiring referral to a more specialised level of care. A secondary aim of the study was to evaluate the effectiveness of UmbiFlow™ Doppler as a screening tool for concealed placental insufficiency in late bookers by using a single screening cut-off value that will be abnormal for any gestation >28 weeks. Methods: The cohort comprised two groups of patients: The first group included all follow-up patients with suspected intra-uterine growth restriction (a decreased symphysis-fundus measurement based on serial assessment) who underwent on-site UmbiFlow™Doppler testing performed by the midwife directly after the clinical examination. The second group included late bookers, where gestation was uncertain; but estimated >28 weeks based on clinical grounds. This group was comprised of unselected patients who report to antenatal care late for the first time and received an UmbiFlow™Doppler test for concealed placental insufficiency. Results: UmbiFlow™Doppler could reduce the number of false referrals to hospital by 55%. A single UmbiFlow™Doppler test in late bookers appeared to identify a group of women at moderate risk of lower birth weight babies.http://journals.plos.org/plosone/article?id=10.1371/journal.pone.0142743Publisher's versio

Algorithm of participating women in the poor SF group.

<p>Algorithm of participating women in the poor SF group.</p

The UmbiFlow™ setup in a clinic.

<p>The UmbiFlow™ setup in a clinic.</p

Demographic characteristics of the study population.

<p>Demographic characteristics of the study population.</p

Results from an UmbiFlow™ Doppler measurement plotted against the gestation.

<p>Results from an UmbiFlow™ Doppler measurement plotted against the gestation.</p

A schematic representation, showing that at any gestation ≥28 weeks, an umbilical artery resistance of >0.8 would be abnormal (≥95th centile) (shaded area).

<p>A schematic representation, showing that at any gestation ≥28 weeks, an umbilical artery resistance of >0.8 would be abnormal (≥95th centile) (shaded area).</p

Algorithm of participating women in the late bookers group.

<p>Algorithm of participating women in the late bookers group.</p