AFJOG

REVIEW However, the Umbiflow™ is less cost-effective than scaling up labour and delivery management, neonatal resuscitation, antenatal corticosteroids for preterm labour, antibiotics for preterm rupture of membranes, handwashing with soap, the Hib vaccines, Kangaroo mother care, oral rehydration solution, oral antibiotics, case management of pneumonia in children and PMTCT. 33,34 It has been shown that non- specialist healthcare workers can effectively perform the screening test, that training takes about one week, the results of the test are immediate and the management depending on the result very clear cut, the test takes about 10 minutes and is painless. Furthermore, the results are auditable and quality control is simple as there is a record of each test, so the quality of the waveforms used can be easily assessed. The device can be battery powered and is estimated as ten times less expensive than a portable imaging ultrasound. Studies are underway at present to identify the barriers to full scale-up in a district in SA. CONCLUSION In re-thinking our approach to preventing antenatal stillbirths we need to appreciate that the main problem lies antenatally not intrapartum. FGR is a major cause of antenatal stillbirth; we do not have the means currently to detect FGR accurately at primary healthcare clinics; and undetected FGR leads to stillbirths. The seriousness of our failure to detect FGR is illustrated by Hirst et al., who showed that a fetus that has unidentified growth restriction is five times more likely to die than a fetus identified as having FGR.35 Studies in SA have demonstrated that the prevalence of abnormal RI and AEDF is high enough to warrant screening; we can identify the fetus at risk of stillbirth; and with this knowledge act to prevent the stillbirth without increasing neonatal deaths. Perhaps, we should be implementing screening with continuous wave Doppler ultrasound of the umbilical artery at all primary healthcare clinics performing antenatal care to prevent unexplained stillbirths in SA, and that it is cost effective to do so. We owe it to our mothers to enhance a positive pregnancy experience and a positive pregnancy outcome. Table 1: Demographic and outcome of the UmbiflowTM population with AEDF and Normal RI Indicator AEDF (87) (N= %) Normal RI (6169) (N= %) p value Age 18-19 5 (5.7) 446 (7.2) 0.1668 20-34 62 (71.3) 4751 (77.1) 35+ 20 (23.0) 964 (15·6) unknown 0 (0.0) 8 (0.1) mean Age (SD) 29.8 (6.2) 27.7 (6.6) 0.0017* Parity 0 to 0 30 (34.5) 2097 (34.0) 0.0751 1 to 4 54 (62.1) 4004 (65.0) 5+ 3 (3.4) 61 (1.0) unknown 0 (0.0) 7 (0.1) Median Parity (IQR) 1 (0 - 2) 1 (0 - 2) 0.9412 Gravidity 1 26 (29.9) 1921 (31.2) 0.7650 2 to 4 55 (63.2) 3921 (63.6) 5+ 6 (6.9) 319 (5.2) unknown 0 (0.0) 8 (0.1) Median Gravidity (IQR) 2 (1 - 3) 2 (1 - 3) 0.2721 HIV pos 23 (26.4) 1842 (29.9) 0.5634 neg 64 (73.6) 4324 (70.1) missing 0 (0.0) 3 (0.05) HDP HDP 21 (24.1) 212 (3.4) <0.0001* Outcomes AEDF (87) (N= %) Normal RI (5787) (N= %) GA @ Delivery 28-33 19 (22.1) 91 (1.6) <0.0001* 34-37 37 (43.0) 1005 (17.5) 38+ 30 (34.9) 4647 (80.9) unknown 1 (1.1) 44 (0.8) Mean GA @Del 35.6 (3.1) 38.6 (1.8) <0.0001* Weight @Delivery 1.0g-1.49g 14 (16.5) 11 (0.2) <0.0001* 1.5g-1.99g 23 (27.1) 83 (1.4) 2.0g-2.49g 24 (28.2) 472 (8.2) >2.5g 24 (28.2) 5189 (90.2) missing 2 (2.3) 32 (0.6) mean weight 2106.8 (±656.4) 3099.6 (±500.9) <0.0001* LBW <2500 61 (71.8) 566 (9.8) <0.0001* African Journal of Obstetrics and Gynaecology | Volume 1 | Issue 1 | 2023 | 07