Holmlund Sophia, Ntaganira Joseph, Edvardsson Kristina, Lan Pham Thi, Semasaka Sengoma Jean Paul, Åhman Annika, Small Rhonda, Mogren Ingrid
a Department of Clinical Sciences, Obstetrics and Gynecology , Umeå University , Umeå , Sweden.
c School of Public Health, College of Medicine and Health Sciences , University of Rwanda , Kigali , Rwanda.
Glob Health Action. 2017;10(1):1350451. doi: 10.1080/16549716.2017.1350451.
Obstetric ultrasound has become an indispensable part of antenatal care worldwide. Although the use of ultrasound has shown benefits in the reduction of maternal and foetal morbidity and mortality, it has also raised many ethical challenges. Because of insufficient numbers of midwives in Rwanda, uncomplicated pregnancy care is usually provided by nurses in local health centres. Obstetric ultrasound is generally performed by physicians at higher levels of healthcare, where midwives are also more likely to be employed.
To explore Rwandan midwives' experiences and views of the role of obstetric ultrasound in relation to clinical management, including ethical aspects.
A qualitative study design was employed. Six focus group discussions were held in 2015 with 23 midwives working in maternity care in rural and urban areas of Rwanda, as part of the CROss Country Ultrasound Study (CROCUS).
Obstetric ultrasound was experienced as playing a very important role in clinical management of pregnant women, but participants emphasised that it should not overshadow other clinical examinations. The unequal distribution of ultrasound services throughout Rwanda was considered a challenge, and access was described as low, especially in rural areas. To increase the quality of maternity care, some advocated strongly for midwives to be trained in ultrasound and for physicians to receive additional training. In general, pregnant women were perceived both as requesting more ultrasound examinations than they received, and as not being satisfied with an antenatal consultation if ultrasound was not performed.
Obstetric ultrasound plays a significant role in maternity care in Rwanda. Increasing demand for ultrasound examinations from pregnant women needs to be balanced with medical indication and health benefits. Training of midwives to perform obstetric ultrasound and further training for physicians would help to address access to ultrasound for greater numbers of women across Rwanda. RESPONSIBLE EDITOR Virgilio Mariano Salazar Torres, Karolinska Institute, Sweden.
产科超声已成为全球产前护理不可或缺的一部分。尽管超声的使用已显示出在降低孕产妇和胎儿发病率及死亡率方面的益处，但它也引发了许多伦理挑战。由于卢旺达助产士数量不足，当地卫生中心的护士通常提供无并发症的孕期护理。产科超声一般由医疗水平较高的医生进行，而助产士也更可能受雇于这些机构。
探讨卢旺达助产士对产科超声在临床管理（包括伦理方面）中作用的经验和看法。
采用定性研究设计。作为跨国超声研究（CROCUS）的一部分，2015年与卢旺达城乡从事产科护理工作的23名助产士进行了6次焦点小组讨论。
产科超声在孕妇临床管理中被认为发挥着非常重要的作用，但参与者强调它不应掩盖其他临床检查。卢旺达各地超声服务分布不均被视为一项挑战，其可及性较低，尤其是在农村地区。为提高产科护理质量，一些人强烈主张对助产士进行超声培训，并让医生接受额外培训。总体而言，孕妇被认为既要求进行比实际更多的超声检查，又若未进行超声检查就对产前咨询不满意。
产科超声在卢旺达的产科护理中发挥着重要作用。孕妇对超声检查需求的增加需要与医学指征和健康益处相平衡。培训助产士进行产科超声检查以及对医生进行进一步培训，将有助于解决卢旺达更多妇女获得超声检查的问题。责任编辑：瑞典卡罗林斯卡学院的维吉ilio·马里亚诺·萨拉萨尔·托雷斯
