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Feasibility and acceptability of point-of-care ultrasound delivered by midwives during routine antenatal care in Malawi: a prospective implementation science study

Year: 2025

Type: article

Abstract: OBJECTIVES: To evaluate the feasibility and acceptability of integrating point-of-care ultrasound scan (POCUS) by midwives into routine antenatal care (ANC) services. DESIGN: Prospective, observational, multiphase, implementation science study. MAIN OUTCOME MEASURES: Primary outcomes included the proportion of midwives who completed training and competency checks for basic obstetric scanning using a POCUS device; the feasibility and acceptability of midwife-delivered POCUS from the perspectives of midwives and pregnant women captured on structured questionnaires; and the proportion of scans meeting predefined quality standards. Secondary outcomes included responses to acceptability-related questionnaires administered to midwives and pregnant women. SETTING: Rural, periurban and urban health centres in Blantyre District, Malawi. PARTICIPANTS: Pregnant women attending ANC and midwives providing care at participating health facilities. RESULTS: Obstetric registrars trained and mentored 45 midwives, and 42 (93%) completed the training. Most midwives (95%, n=40) found providing POCUS during ANC was feasible and acceptable. Overall, device durability was rated positively. Of the 1499 pregnant women who received a scan, 99% (n=1484) reported that receiving an ultrasound from a midwife during ANC was acceptable. Independent assessors determined that over 70% of the subsample of reviewed scans met minimum quality standards. CONCLUSIONS: Midwife-delivered POCUS is feasible and highly acceptable in diverse antenatal settings in Malawi. These findings support task-sharing models as a means of expanding access to this essential ANC service, particularly in low-resource settings.

Source: BMJ Open

DOI: 10.1136/bmjopen-2025-100515