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. 2015 Nov 23;10(11):e0142743. doi: 10.1371/journal.pone.0142743. eCollection 2015.

Abstract

Objectives: 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.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adolescent
  • Adult
  • Algorithms
  • Cell Phone
  • Cohort Studies
  • Female
  • Fetal Growth Retardation / diagnostic imaging
  • Humans
  • Image Processing, Computer-Assisted
  • Mobile Health Units
  • Pilot Projects
  • Pregnancy
  • Prenatal Care / methods*
  • Primary Health Care / methods*
  • Referral and Consultation
  • Software
  • South Africa
  • Ultrasonography, Doppler / instrumentation*
  • Ultrasonography, Doppler / methods
  • Ultrasonography, Prenatal / instrumentation*
  • Ultrasonography, Prenatal / methods
  • Umbilical Arteries / diagnostic imaging*
  • Young Adult

Grants and funding

The equipment used in this study as well as the salary for the research nurse was sponsored and funded entirely by the Medical Research Council of South Africa as well as the Council for Scientific and Industrial Research of South Africa. The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript. The Council for Scientific & Industrial Research (CSIR), in collaboration with the Medical Research Council (MRC), developed the UmbiFlow™ system for use at primary health care clinics, aimed at ante-natal care. In order to test the system's impact in a primary health care setting, CSIR contracted Rita van Rooyen, of mHealth Inc., to help facilitate the running of a clinical study. This required consultation with the other authors of the study. CSIR's financial contribution was to the salary of Rita van Rooyen as well as to provide the UmbiFlow™ systems to the study. The CSIR did not have any additional role in the study design, data collection and analysis, decision to publish, or preparation of the manuscript. The specific role of Rita van Rooyen as an author is articulated in the "author contributions" section.