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Edvardsson, Kristina
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Publications (10 of 35) Show all publications
Åhman, A., Edvardsson, K., Fagerli, T. A., Darj, E., Holmlund, S., Small, R. & Mogren, I. (2019). A much valued tool that also brings ethical dilemmas: a qualitative study of Norwegian midwives' experiences and views on the role of obstetric ultrasound. BMC Pregnancy and Childbirth, 19, Article ID 33.
Open this publication in new window or tab >>A much valued tool that also brings ethical dilemmas: a qualitative study of Norwegian midwives' experiences and views on the role of obstetric ultrasound
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2019 (English)In: BMC Pregnancy and Childbirth, ISSN 1471-2393, E-ISSN 1471-2393, Vol. 19, article id 33Article in journal (Refereed) Published
Abstract [en]

Background: Midwives are the main providers of routine antenatal care services including the routine ultrasound examination in Norway. The ultrasound examination can be perceived by expectant parents not only as a medical examination but also as a social event facilitating attachment to their fetus. This study explores Norwegian midwives' experiences and views on the role of ultrasound in clinical management of pregnancy.

Methods: A qualitative study design was applied. Twenty-four midwives who all performed obstetric ultrasound examinations were recruited for focus group discussions and individual interviews. Data collection took place in 2015 in five hospitals in two different regions of Norway. Data were analyzed using qualitative content analysis.

Results: Midwives described obstetric ultrasound examinations as very valuable although doing ultrasounds placed high demands on their operational and counselling skills. Increasing requests for ultrasound from pregnant women were mentioned. Advancements in ultrasound diagnosis were considered to have put the fetus in the position of a patient, and that pregnant women declining ultrasound could be viewed as irresponsible by some health professionals. Ethical concerns were raised regarding the possibility of pregnancy termination when fetal anomalies were detected. Fears were also expressed that prenatal diagnoses including those following ultrasound, might create a society where only perfect' children are valued. However, participants stressed that their intention in performing ultrasound was to optimize pregnancy outcome and thereby assist expectant couples and their unborn children.

Conclusions: Midwives in Norwegian maternity care services describe obstetric ultrasound as very valuable, playing a central role in pregnancy management by optimizing pregnancy outcomes. Although high demands are placed on operators' technical skills and counseling, midwives described performing obstetric ultrasound as very satisfying work. However, midwives believed that expectant parents' approach to the ultrasound examination, both its medical value and the precious images obtained of the fetus, could put extra strain on the midwives performing ultrasounds. The potential of ultrasound to detect fetal anomalies and the possibility that this may lead to termination of pregnancy, seemed to create some ambivalent feelings in midwives towards its use.

Place, publisher, year, edition, pages
BioMed Central, 2019
Keywords
Pregnancy, Ultrasonography, Midwives, Qualitative research, Norway
National Category
Obstetrics, Gynecology and Reproductive Medicine
Identifiers
urn:nbn:se:umu:diva-162773 (URN)10.1186/s12884-019-2178-x (DOI)000455891900001 ()30651083 (PubMedID)
Available from: 2019-09-04 Created: 2019-09-04 Last updated: 2019-09-04Bibliographically approved
Holmlund, S., Lan, P. T., Edvardsson, K., Phuc, H. D., Ntaganira, J., Small, R., . . . Mogren, I. (2019). Health professionals’ experiences and views on obstetric ultrasound in Vietnam: a regional, cross-sectional study. BMJ Open, 9, Article ID e031761.
Open this publication in new window or tab >>Health professionals’ experiences and views on obstetric ultrasound in Vietnam: a regional, cross-sectional study
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2019 (English)In: BMJ Open, ISSN 2044-6055, E-ISSN 2044-6055, Vol. 9, article id e031761Article in journal (Refereed) Published
Abstract [en]

Objectives: Obstetric ultrasound is an important part of antenatal care in Vietnam, although there are great differences in access to antenatal care and ultrasound services across the country. The aim of this study was to explore Vietnamese health professionals’ experiences and views of obstetric ultrasound in relation to clinical management, resources and skills.

Design: A cross-sectional questionnaire study was performed as part of the CROss Country UltraSound study.

Setting: Health facilities (n=29) in urban, semiurban and rural areas of Hanoi region in Vietnam.

Participants: Participants were 289 obstetricians/ gynaecologists and 535 midwives.

Results: A majority (88%) of participants agreed that ‘every woman should undergo ultrasound examination’ during pregnancy to determine gestational age. Participants reported an average of six ultrasound examinations as medically indicated during an uncomplicated pregnancy. Access to ultrasound at participants’ workplaces was reported as always available regardless of health facility level. Most participants performing ultrasound reported high-level skills for fetal heart rate examination (70%), whereas few (23%) reported being skilled in examination of the anatomy of the fetal heart. Insufficient ultrasound training leading to suboptimal pregnancy management was reported by 37% of all participants. ‘Better quality of ultrasound machines’, ‘more physicians trained in ultrasound’ and ‘more training for health professionals currently performing ultrasound’ were reported as ways to improve the utilisation of ultrasound.

Conclusions: Obstetric ultrasound is used as an integral part of antenatal care at all selected health facility levels in the region of Hanoi, and access was reported as high. However, reports of insufficient ultrasound training resulting in suboptimal pregnancy management indicate a need for additional training of ultraso

Place, publisher, year, edition, pages
BMJ Publishing Group Ltd, 2019
Keywords
prenatal ultrasonography, health personnel, obstetricians, midwives, prenatal care, pregnancy, Vietnam
National Category
Obstetrics, Gynecology and Reproductive Medicine
Research subject
Obstetrics and Gynaecology
Identifiers
urn:nbn:se:umu:diva-163499 (URN)10.1136/bmjopen-2019-031761 (DOI)31548354 (PubMedID)
Funder
Västerbotten County CouncilForte, Swedish Research Council for Health, Working Life and Welfare, 2013-2699Swedish Research Council, 2014-2672
Available from: 2019-09-23 Created: 2019-09-23 Last updated: 2019-09-26Bibliographically approved
Semasaka Sengoma, J. P., Krantz, G., Nzayirambaho, M., Munyanshongore, C., Edvardsson, K. & Mogren, I. (2019). “Not taken seriously”: A qualitative interview study of postpartum Rwandan women who have experienced pregnancy-related complications. PLoS ONE, 14(2), Article ID e0212001.
Open this publication in new window or tab >>“Not taken seriously”: A qualitative interview study of postpartum Rwandan women who have experienced pregnancy-related complications
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2019 (English)In: PLoS ONE, ISSN 1932-6203, E-ISSN 1932-6203, Vol. 14, no 2, article id e0212001Article in journal (Refereed) Published
Abstract [en]

Background: There is limited knowledge on the women’s experiences of pregnancy-related complications in Rwanda. This study aimed to investigate women’s experiences and perceptions of specific complications during pregnancy and delivery and the consequences of these complications on postpartum health and family situation.

Methods: Data were collected through individual in-depth interviews (N = 15). Participants who experienced complications such as postpartum haemorrhage, caesarean section due to prolonged labour/dystocia, pre-eclampsia, or fistula and who were 13–24 months postpartum were invited to participate in the study in July 2015. Interviews were held in Kinyarwanda, digitally recorded, transcribed verbatim, translated into English, and analysed using qualitative content analysis.

Results: Most participants reported that they were previously unaware of the complications they had developed, and they claimed that at discharge they should have been better informed about the potential consequences of these complications. Most participants blamed the health care system as the cause of their problems due to the provision of inadequate care. Participants elaborated different strategies for coping with persistent health problems. Pregnancy-related complications negatively affected participants’ economic situation due to increased health care expenses and lowered income because of impaired working capacity, and participants expressed fear of encountering the same pregnancy-related health problems during future pregnancies.

Conclusions: The findings of this study demonstrate how participants felt that inadequate health care provision during pregnancy, delivery, and the postpartum period was the source of their problems. Participants reported different coping strategies to improve their respective life situation despite persistent health problems. Women’s individual postpartum experiences need to be considered and actions taken at the policy level and also by the local community, in terms of the quality of antenatal and postpartum care services, and in sensitizing the local community about the existence of these complications and preparing the community to support the affected women.

Place, publisher, year, edition, pages
Public Library of Science, 2019
Keywords
Interviews, pregnancy, delivery, postpartum, experiences, complications, Rwanda, qualitative method, content analysis
National Category
Public Health, Global Health, Social Medicine and Epidemiology Obstetrics, Gynecology and Reproductive Medicine
Identifiers
urn:nbn:se:umu:diva-152493 (URN)10.1371/journal.pone.0212001 (DOI)000458761300067 ()30759136 (PubMedID)
Note

Originally included in thesis in manuscript form

Available from: 2018-10-08 Created: 2018-10-08 Last updated: 2019-03-26Bibliographically approved
Holmlund, S., Ntaganira, J., Edvardsson, K., Lan, P. T., Semasaka Sengoma, J. P., Kidanto, H. L., . . . Mogren, I. (2018). Health professionals' experiences and views on obstetric ultrasound in Rwanda: A cross-sectional study. PLoS ONE, 13(12), Article ID e0208387.
Open this publication in new window or tab >>Health professionals' experiences and views on obstetric ultrasound in Rwanda: A cross-sectional study
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2018 (English)In: PLoS ONE, ISSN 1932-6203, E-ISSN 1932-6203, Vol. 13, no 12, article id e0208387Article in journal (Refereed) Published
Abstract [en]

Objectives: Implementation of ultrasound in antenatal care (ANC) in low-income countries has been shown to increase pregnant women’s compliance with ANC visits, and facilitate detection of high-risk pregnancies. In Rwanda, as in other low-income countries, access to ultrasound has increased significantly, but lack of training is often a barrier to its use. The aim of this study was to investigate Rwandan health professionals’ experiences and views of obstetric ultrasound in relation to clinical management, resources and skills.

Methods: A cross-sectional questionnaire study was undertaken between November 2016 and March 2017, as part of the CROss Country UltraSound Study (CROCUS). Data were collected at 108 health facilities located in both rural and urban areas of Rwanda, including provincial, referral, district and private hospitals as well as health centres. Participants were obstetricians (n = 29), other physicians (n = 222), midwives (n = 269) and nurses (n = 387).

Results: Obstetricians/gynecologists/other physicians commonly performed ultrasound examinations but their self-rated skill levels implied insufficient training. Access to ultrasound when needed was reported as common in hospitals, but available to a very limited extent in health centres. The vast majority of participants, independent of health profession, agreed that maternity care would improve if midwives learned to perform basic ultrasound examinations.

Conclusions: Barriers to provision of high quality ultrasound services include variable access to ultrasound depending on health facility level and insufficient skills of ultrasound operators. Physicians in general need more training to perform ultrasound examinations. Implementation of a general dating ultrasound examination seems to be a relevant goal as most health professionals agree that pregnant woman would benefit from this service. To further improve maternity care services, the possibility of educating midwives to perform ultrasound examinations should be further explored.

Place, publisher, year, edition, pages
PUBLIC LIBRARY SCIENCE, 2018
National Category
Obstetrics, Gynecology and Reproductive Medicine
Identifiers
urn:nbn:se:umu:diva-154875 (URN)10.1371/journal.pone.0208387 (DOI)000452204800030 ()30513102 (PubMedID)2-s2.0-85057761963 (Scopus ID)
Available from: 2019-01-04 Created: 2019-01-04 Last updated: 2019-09-24Bibliographically approved
Connor, S., Edvardsson, K. & Spelten, E. (2018). Male adolescents' role in pregnancy prevention and unintended pregnancy in rural Victoria: health care professional's and educators' perspectives. BMC Pregnancy and Childbirth, 18, Article ID 245.
Open this publication in new window or tab >>Male adolescents' role in pregnancy prevention and unintended pregnancy in rural Victoria: health care professional's and educators' perspectives
2018 (English)In: BMC Pregnancy and Childbirth, ISSN 1471-2393, E-ISSN 1471-2393, Vol. 18, article id 245Article in journal (Refereed) Published
Abstract [en]

Background: While there has been a steady decline in adolescent pregnancies worldwide and in Australia over the last three decades, Australian rates still lank third highest among developed countnes. Adolescent pregnancies are defined as those that occur to girls between the ages of 15 and 19. The current pregnancy rate of 15 to 19 year old females rural Victoria is 21.19%, this is more than double the Victorian state rate of 8.2% and almost double the national Australian rate at 13.1% The aim of this study was to explore Health Care Professionals and Educator perspectives on these high adolescent pregnancy rates, with particular focus on the role of adolescent males, in a rural region in Victoria, Australia. Methods: A qualitative descriptive study using focus group discussion was undertaken with Health Care Providers and Educators (N = 8) in 2016. Data was analysed using thematic analysis. Results: Four themes emerged from analysis. The first, 'Gender Stereotyping' focused on the acceptance of traditional masculinities; the second 'Adolescent males as health consumers' was based on the consensus that adolescent males are poor consumers of health and 'invisible'; the third 'Complexity of Issues' identified that, particularly in a rural region, contributing issues are varied and complex; and the fourth 'Focus on Fatherhood', saw the participants diverge from the discussion about pregnancy prevention and the adolescent males' role in unintended pregnancy, and focus on the role adolescent males may have as unintended fathers. Conclusions: Participants did not consider young males to be of importance in the prevention of adolescent pregnancy. There is a need to further explore the role of young males in pregnancy prevention, including what role traditional gender stereotyping, from health professionals' and young males' perspectives, plays in provision of adolescent sexual health services.

Place, publisher, year, edition, pages
BioMed Central, 2018
Keywords
Rural adolescent males, Health care providers, Educators, Teenage pregnancy, Qualitative study
National Category
Obstetrics, Gynecology and Reproductive Medicine
Identifiers
urn:nbn:se:umu:diva-150781 (URN)10.1186/s12884-018-1886-y (DOI)000435457800008 ()29914419 (PubMedID)
Available from: 2018-08-23 Created: 2018-08-23 Last updated: 2018-08-23Bibliographically approved
Edvardsson, K., Axmon, A., Powell, R. & Davey, M.-A. (2018). Male-biased sex ratios in Australian migrant populations: a population-based study of 1 191 250 births 1999-2015. International Journal of Epidemiology, 47(6), 2025-2037
Open this publication in new window or tab >>Male-biased sex ratios in Australian migrant populations: a population-based study of 1 191 250 births 1999-2015
2018 (English)In: International Journal of Epidemiology, ISSN 0300-5771, E-ISSN 1464-3685, Vol. 47, no 6, p. 2025-2037Article in journal (Refereed) Published
Abstract [en]

Background: The naturally occurring male-to-female (M/F) ratio at birth is 1.05. Higher ratios found primarily in countries across Asia have been attributed to prenatal sex selection due to son preference. There is growing evidence that sex-selective practices continue following migration; however, little is known about these practices following migration to Australia.

Methods: In this population-based study we assessed M/F ratios at birth per mother’s country of birth for all registered births 1999–2015 in Victoria, Australia (n = 1 191 250). We also compared the M/F ratio among births to mothers born elsewhere to that of mothers born in Australia, stratified by time period and parity.

Results: Compared with the naturally occurring M/F ratio as well as to the M/F ratio among births to mothers born in Australia, there was an increased ratio of male births to mothers born in India, China and South-East Asia, particularly at higher parities and in more recent time periods (elevated M/F ratios ranged from 1·079 to 1·248, relative risks of male birth ranged from 1·012 to 1·084 with confidence intervals between 1·001 and 1·160 and P-values between 0·005 and 0·039). The most male-biased sex ratios were found among multiple births to Indian-born mothers, and parity of two or more births to Indian and Chinese-born mothers in 2011–15.

Conclusions: The male-biased sex ratios observed in this study indicate that prenatal sex selection may be continuing following migration to Australia from countries where these practices have been documented. The excess of males among multiple births raises the question as to what role assisted reproduction plays. Findings also suggest that systematic discrimination against females starts in the womb.

Place, publisher, year, edition, pages
Oxford University Press, 2018
Keywords
Australia, relative risk, sex ratio, pregnancy, sex selection, sex preselection
National Category
Public Health, Global Health, Social Medicine and Epidemiology
Identifiers
urn:nbn:se:umu:diva-156618 (URN)10.1093/ije/dyy148 (DOI)000456664500034 ()30052991 (PubMedID)
Available from: 2019-02-20 Created: 2019-02-20 Last updated: 2019-02-20Bibliographically approved
Mogren, I., Lindqvist, M., Petersson, K., Nilses, C., Small, R., Granåsen, G. & Edvardsson, K. (2018). Maternal height and risk of caesarean section in singleton births in Sweden D-A population-based study using data from the Swedish Pregnancy Register 2011 to 2016. PLoS ONE, 13(5), Article ID e0198124.
Open this publication in new window or tab >>Maternal height and risk of caesarean section in singleton births in Sweden D-A population-based study using data from the Swedish Pregnancy Register 2011 to 2016
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2018 (English)In: PLoS ONE, ISSN 1932-6203, E-ISSN 1932-6203, Vol. 13, no 5, article id e0198124Article in journal (Refereed) Published
Abstract [en]

Caesarean section (CS) has short and long term adverse health consequences, and should therefore only be undertaken when necessary. Risk factors such as maternal age, maternal body mass index (BMI) and fetal weight have been extensively investigated in relation to CS, but the significance of maternal height has been less explored in Sweden. The aim was to investigate the significance of maternal height on risk of CS in a representative, population-based sample from Sweden, also taking into account confounders. Data on singleton births in the Swedish Pregnancy Register 2011 to 2016 were collected, including women with heights of 140 cm and above, constituting a sample of 581,844 women. Data were analysed with epidemiological and biostatistical methods. Mean height was 166.1 cm. Women born outside Sweden were significantly shorter than women born in Sweden (162.8 cm vs. 167.1 cm, p < 0.001). There was a decreasing risk of CS with increasing maternal height. This effect remained after adjustment for other risk factors for CS such as maternal age, BMI, gestational age, parity, high birth weight and country of birth. Frequency of CS was higher among women born outside Sweden compared with Swedish-born women (17.3% vs. 16.0%), however, in a multiple regression model country of birth outside Sweden diminished as a risk factor for CS. Maternal height of 178-179 cm was associated with the lowest risk of CS (OR = 0.76, CI95% 0.71-0.81), whereas height below 160 cm explained 7% of CS cases. BMI and maternal age are established factors involved in clinical assessments related to birth, and maternal height should increasingly enjoy a similar status in these considerations. Moreover, when healthcare professionals are counselling pregnant women, taller stature should be more emphasized as a positive indicator for successful vaginal birth to increase pregnant women's confidence in giving birth vaginally, with possible positive impacts for lowering CS rates.

Place, publisher, year, edition, pages
PUBLIC LIBRARY SCIENCE, 2018
National Category
Obstetrics, Gynecology and Reproductive Medicine
Identifiers
urn:nbn:se:umu:diva-150693 (URN)10.1371/journal.pone.0198124 (DOI)000433521800045 ()29813118 (PubMedID)
Available from: 2018-09-11 Created: 2018-09-11 Last updated: 2018-09-11Bibliographically approved
Fagerli, T. A., Mogren, I., Adolfsson, A., Edvardsson, K., Åhman, A., Holmlund, S., . . . Eggebo, T. M. (2018). Midwives' and obstetricians' views on appropriate obstetric sonography in Norway. Sexual & Reproductive HealthCare, 16, 1-5
Open this publication in new window or tab >>Midwives' and obstetricians' views on appropriate obstetric sonography in Norway
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2018 (English)In: Sexual & Reproductive HealthCare, ISSN 1877-5756, E-ISSN 1877-5764, Vol. 16, p. 1-5Article, review/survey (Refereed) Published
Abstract [en]

Introduction: The primary aim of this study was to investigate midwives' and obstetricians' views on how many ultrasound examinations should be part of standard care during pregnancy in Norway. Material and methods: This study is a part of a larger study, the CROss-Country Ultrasound Study (CROCUS), an international investigation of midwives' and obstetricians' experiences of and views on the use of ultrasound. We distributed 400 questionnaires to respondents in all five health regions in Norway: 40 to municipal midwives, 180 to midwives working in hospitals and 180 to obstetricians. The questionnaire included specific questions about the appropriate number of examinations during pregnancy, examinations without medical indication, non-medical ultrasound, commercialisation and safety. Results: The response rate was 45%. Of the respondents, 58% reported satisfaction with the offer of one scheduled ultrasound examination during pregnancy, as recommended in the Norwegian guidelines. Health care professionals who used ultrasound themselves were significantly more likely to want to offer more ultrasound examinations: 52% of the ultrasound users wanted to offer two or more ultrasound examinations vs. 16% of the non-users (p < .01). The majority of obstetricians (80%) reported that pregnant women expect to undergo ultrasound examination, even in the absence of medical indication. Conclusion: The majority of Norwegian health care professionals participating in this study supported the national recommendation on ultrasound in pregnancy. Ultrasound users wanted to offer more ultrasound examinations during pregnancy, whereas non-users were generally content with the recommendation. The majority of respondents thought that commercialisation was not a problem at their institution, and reported that ultrasound is often performed without a medical indication. The ultrasound users thought that ultrasound is safe.

Place, publisher, year, edition, pages
ELSEVIER IRELAND LTD, 2018
Keywords
Ultrasonography, Health care professionals, Non-medical ultrasound, Safety
National Category
Obstetrics, Gynecology and Reproductive Medicine
Identifiers
urn:nbn:se:umu:diva-151072 (URN)10.1016/j.srhc.2017.12.006 (DOI)000440877700001 ()29804752 (PubMedID)2-s2.0-85044744044 (Scopus ID)
Available from: 2018-08-27 Created: 2018-08-27 Last updated: 2018-08-27Bibliographically approved
Edvardsson, K., Åhman, A., Fagerli, T. A., Darj, E., Holmlund, S., Small, R. & Mogren, I. (2018). Norwegian obstetricians' experiences of the use of ultrasound in pregnancy management: a qualitative study. Sexual & Reproductive HealthCare, 15, 69-76
Open this publication in new window or tab >>Norwegian obstetricians' experiences of the use of ultrasound in pregnancy management: a qualitative study
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2018 (English)In: Sexual & Reproductive HealthCare, ISSN 1877-5756, E-ISSN 1877-5764, Vol. 15, p. 69-76Article in journal (Refereed) Published
Abstract [en]

Objective: To explore obstetricians' experiences and views of the use of obstetric ultrasound in clinical management of pregnancy. Methods: A qualitative interview study was undertaken in 2015 with obstetricians (N = 20) in Norway as part of the CROss Country Ultrasound Study (CROCUS). Results: Three categories developed during analyses. 'Differing opinions about ultrasound and prenatal diagnosis policies' revealed divergent views in relation to Norwegian policies for ultrasound screening and prenatal diagnosis. Down syndrome screening was portrayed as a delicate and frequently debated issue, with increasing ethical challenges due to developments in prenatal diagnosis. 'Ultrasound's influence on the view of the fetus' illuminated how ultrasound influenced obstetricians' views of the fetus as a 'patient' and a 'person'. They also saw ultrasound as strongly influencing expectant parents' views of the fetus, and described how ultrasound was sometimes used as a means of comforting women when complications occurred. The complexity of information and counselling' revealed how obstetricians balanced the medical and social aspects of the ultrasound examination, and the difficulties of 'delivering bad news' and counselling in situations of uncertain findings. Conclusion: This study highlights obstetricians' experiences and views of ultrasound and prenatal diagnosis in Norwegian maternity care and the challenges associated with the provision of these services, including counselling dilemmas and perceived differences in expectations between caregivers and expectant parents. There was notable diversity among these obstetricians in relation to their support of, and adherence to Norwegian regulations about the use of ultrasound, which indicates that the care pregnant women receive may vary accordingly.

Place, publisher, year, edition, pages
Elsevier, 2018
Keywords
Ethics, Norway, Obstetrics, Pregnant women, Prenatal diagnosis, Ultrasonography, Qualitative search
National Category
Public Health, Global Health, Social Medicine and Epidemiology
Identifiers
urn:nbn:se:umu:diva-145366 (URN)10.1016/j.srhc.2017.12.001 (DOI)000424721100012 ()29389504 (PubMedID)
Available from: 2018-03-13 Created: 2018-03-13 Last updated: 2018-06-09Bibliographically approved
Åhman, A., Edvardsson, K., Kidanto, H. L., Ngarina, M., Small, R. & Mogren, I. (2018). 'Without ultrasound you can't reach the best decision': midwives' experiences and views of the role of ultrasound in maternity care in Dar Es Salaam, Tanzania. Sexual & Reproductive HealthCare, 15, 28-34
Open this publication in new window or tab >>'Without ultrasound you can't reach the best decision': midwives' experiences and views of the role of ultrasound in maternity care in Dar Es Salaam, Tanzania
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2018 (English)In: Sexual & Reproductive HealthCare, ISSN 1877-5756, E-ISSN 1877-5764, Vol. 15, p. 28-34Article in journal (Refereed) Published
Abstract [en]

Objective: To explore Tanzanian midwives' experiences and views of the role of obstetric ultrasound in relation to clinical management of pregnancy, and in situations where maternal and fetal health interests conflict. Method: In 2015, five focus group discussions were conducted with midwives (N = 31) at three public referral hospitals in the Dar es Salaam region as part of the CROss Country Ultrasound Study (CROCUS). Results: Ultrasound was described as decisive for proper management of pregnancy complications. Midwives noted an increasing interest in ultrasound among pregnant women. However, concerns were expressed about the lack of ultrasound equipment and staff capable of skilful operation. Further, counselling regarding medical management was perceived as difficult due to low levels of education among pregnant women. Conclusion: Ultrasound has an important role in management of pregnancy complications. However, lack of equipment and shortage of skilled healthcare professionals seem to hamper use of obstetric ultrasound in this particular low-resource setting. Increased availability of obstetric ultrasound seems warranted, but further investments need to be balanced with advanced clinical skills' training as barriers, including power outages and lack of functioning equipment, are likely to continue to limit the provision of pregnancy ultrasound in this setting.

Place, publisher, year, edition, pages
Elsevier, 2018
Keywords
Pregnancy, Obstetric ultrasound, Prenatal diagnosis, Tanzania, Midwives, Qualitative study
National Category
Public Health, Global Health, Social Medicine and Epidemiology
Identifiers
urn:nbn:se:umu:diva-145367 (URN)10.1016/j.srhc.2017.11.007 (DOI)000424721100006 ()29389498 (PubMedID)
Available from: 2018-03-13 Created: 2018-03-13 Last updated: 2018-06-09Bibliographically approved
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