Fetal anomaly scan rates, information collected, and prenatal referral patterns among pregnant women at Kawempe Hospital: A prospective observational study

Abstract

Background: Congenital anomalies account for approximately 5% of global neonatal mortality and 8% of under-five mortality, with 90% of these deaths occurring in LMICs. The disparities between HICs and LMICs are largely due to delays in diagnosing and managing congenital anomalies. It is recommended that pregnant women undergo anomaly scans between 18 and 24 weeks of gestation, and those with fetal anomalies be referred to multidisciplinary fetal medicine centers for comprehensive management. Efforts to reduce neonatal and under-five mortality rates have plateaued in LMICs, primarily due to congenital anomalies. Objective: To assess the fetal anomaly scan rates, information collected, and prenatal referral patterns for pregnant women with anomalous scans in Kawempe National Referral Hospital Methods: This hospital-based, prospective observational study employed quantitative methods. A total of 427 respondents were consecutively recruited. Data on the proportion and information gathered from anomaly scans were collected using semi-structured, interviewer-administered questionnaires. Referral patterns were determined through follow-up phone calls to women with anomalous scans seven days after the scan was performed. Data analysis was conducted using Stata software version 15.0. Results: The mean age of the participants was 26.9 years (standard deviation [SD]: 6.7), with a mean gestational age of 21.6 weeks (SD: 2.0). Of the 1,141 gravid women between 18 and 24 weeks seen at the study center during the study period, only 427 (37.4%) underwent ultrasound scans. However, none of the 472 scans performed met the minimum criteria for an anomaly scan. The most commonly reported items were fetal movements and cardiac activity, both noted in 100% of the scans. Only five (1.2%) of the 427 scans detected abnormalities, and none of these women were referred for prenatal care to a multidisciplinary team or a pediatric surgical specialist. Conclusion and recommendations: The proportion of fetal anomaly scans performed was low, and none of the scans met the minimum requirements for an anomaly scan. Furthermore, no prenatal referrals were made for the detected fetal anomalies. It is essential to assess the knowledge of healthcare workers on congenital anomalies, the appropriate timing of anomaly scans, and referral patterns to multidisciplinary teams. Additionally, the expertise of imaging personnel in performing and reporting on anomaly scans should be evaluated to improve outcomes.