{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,8]],"date-time":"2026-10-08T13:30:52Z","timestamp":1791466252637,"version":"4.3.4"},"reference-count":31,"publisher":"Wiley","issue":"12","license":[{"start":{"date-parts":[[2018,6,15]],"date-time":"2018-06-15T00:00:00Z","timestamp":1529020800000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"funder":[{"DOI":"10.13039\/100000865","name":"Bill and Melinda Gates Foundation","doi-asserted-by":"publisher","id":[{"id":"10.13039\/100000865","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100009633","name":"Eunice Kennedy Shriver National Institute of Child Health and Human Development","doi-asserted-by":"publisher","id":[{"id":"10.13039\/100009633","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["obgyn.onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["BJOG"],"published-print":{"date-parts":[[2018,11]]},"abstract":"<jats:sec><jats:title>Objective<\/jats:title><jats:p>Ultrasound is widely regarded as an important adjunct to antenatal care (<jats:styled-content style=\"fixed-case\">ANC<\/jats:styled-content>) to guide practice and reduce perinatal mortality. We assessed the impact of <jats:styled-content style=\"fixed-case\">ANC<\/jats:styled-content> ultrasound use at health centres in resource\u2010limited countries.<\/jats:p><\/jats:sec><jats:sec><jats:title>Design<\/jats:title><jats:p>Cluster randomised trial.<\/jats:p><\/jats:sec><jats:sec><jats:title>Setting<\/jats:title><jats:p>Clusters within five countries (Democratic Republic of Congo, Guatemala, Kenya, Pakistan, and Zambia)<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>Clusters were randomised to standard <jats:styled-content style=\"fixed-case\">ANC<\/jats:styled-content> or standard care plus two ultrasounds and referral for complications. The study trained providers in intervention clusters to perform basic obstetric ultrasounds.<\/jats:p><\/jats:sec><jats:sec><jats:title>Main outcome measures<\/jats:title><jats:p>The primary outcome was a composite of maternal mortality, maternal near\u2010miss mortality, stillbirth, and neonatal mortality.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>During the 24\u2010month trial, 28 intervention and 28 control clusters had 24 263 and 23 160 births, respectively; 78% in the intervention clusters received at least one study ultrasound; 60% received two. The prevalence of conditions noted including twins, placenta previa, and abnormal lie was within expected ranges. 9% were referred for an ultrasound\u2010diagnosed condition, and 71% attended the referral. The <jats:styled-content style=\"fixed-case\">ANC<\/jats:styled-content> (<jats:styled-content style=\"fixed-case\">RR<\/jats:styled-content> 1.0 95% <jats:styled-content style=\"fixed-case\">CI<\/jats:styled-content> 1.00, 1.01) and hospital delivery rates for complicated pregnancies (<jats:styled-content style=\"fixed-case\">RR<\/jats:styled-content> 1.03 95% <jats:styled-content style=\"fixed-case\">CI<\/jats:styled-content> 0.89, 1.20) did not differ between intervention and control clusters nor did the composite outcome (<jats:styled-content style=\"fixed-case\">RR<\/jats:styled-content> 1.09 95% <jats:styled-content style=\"fixed-case\">CI<\/jats:styled-content> 0.97, 1.23) or its individual components.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>Despite availability of ultrasound at <jats:styled-content style=\"fixed-case\">ANC<\/jats:styled-content> in the intervention clusters, neither <jats:styled-content style=\"fixed-case\">ANC<\/jats:styled-content> nor hospital delivery for complicated pregnancies increased. The composite outcome and the individual components were not reduced.<\/jats:p><\/jats:sec><jats:sec><jats:title>Tweetable abstract<\/jats:title><jats:p>Antenatal care ultrasound did not improve a composite outcome that included maternal, fetal, and neonatal mortality.<\/jats:p><\/jats:sec>","DOI":"10.1111\/1471-0528.15287","type":"journal-article","created":{"date-parts":[[2018,5,21]],"date-time":"2018-05-21T19:20:44Z","timestamp":1526930444000},"page":"1591-1599","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":71,"title":["Routine antenatal ultrasound in low\u2010 and middle\u2010income countries: first look \u2013 a cluster randomised trial"],"prefix":"10.1111","volume":"125","author":[{"given":"RL","family":"Goldenberg","sequence":"first","affiliation":[{"name":"Columbia University New York NY 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