Umbiflow low-cost Doppler ultrasound device for better primary health care services for pregnant women

CSIR researchers, together with their counterparts at the Medical Research Council, have developed a low-cost Doppler ultrasound device.

Contact Person

Jeremy Wallis

jwallis@csir.co.za

Technology that empowers nursing sisters, midwives and general practitioners (GPs) in mobile, rural and low-resource primary health care settings. CSIR researchers, together with their counterparts at the Medical Research Council, have developed a low-cost Doppler ultrasound device that aims to place Doppler technology at the primary health care level. It is a simple yet effective device that can assess foetuses considered to be ‘small for gestational age’ (SGA) at the primary point of care, thereby greatly reducing the cases of mothers being referred with healthy-SGA foetuses. Umbiflow, as the device is called, speaks directly to the Millennium Development Goals (4 & 5) around mother and child care. It also addresses three of the four priorities of the South African National Department of Health, namely, increasing life expectancy, decreasing mother and child mortality and strengthening the health system effectiveness. ”At present, we are working to establish Umbiflow’s effectiveness in a clinic environment, following which we are looking to roll out the systems to the primary health care sector,” says the CSIR’s Jeremy Wallis, who heads up the team that developed the technology. Filling a gap Foetal size is used as a simple metric to assess the health of a growing foetus during pregnancy and concerns are raised whenever a foetus is considered to be below the growth curve. Such foetuses are termed ‘small for gestational age’ or SGA. The current reality at the primary health care level is that foetuses are assessed regularly for SGA status using a tape measure measurement of the fundal height (measured from the pubic bone to the top of the uterus). This technique is able to correctly identify SGA foetuses (typically 10 in every 100 cases) but is unable to assess if the baby is “healthy-SGA” or “sick-SGA”, the latter often being consistent with placental insufficiency. A condition of placental insufficiency implies that the placenta is not able to provide sufficient blood flow to maintain the foetus on the standard growth curve and hence an intervention. Better primary health care services for pregnant women through Umbiflow Technology that empowers nursing sisters, midwives and general practitioners (GPs) in mobile, rural and low-resource primary health care settings. OPPORTUNITIES such as an early Caesarean section may be indicated in order to save its life. All SGA foetuses are referred to the secondary level of health care for a Doppler ultrasound measurement by a specialist. Up to nine out of 10 referred patients are found to have healthy-SGA foetuses and are referred back to the primary level for continued (standard) antenatal care. “With a hospital like Tygerberg in Cape Town currently doing 4500 such Doppler measurements per year, there is room for significantly reducing this figure for those cases linked specifically to the SGA condition,” says Wallis. The plan is therefore to implement the Umbiflow technology which will permit such Doppler measurements to be done at the primary health care level by nursing sisters and midwives, without the need for a specialist to operate the equipment.

Benefits & Advantages

Umbiflow aims to reduce the number of pregnant women who are referred to the secondary level for a Doppler ultrasound test to assess placental sufficiency as a result of having a SGA foetus. This will reduce the costs associated with Doppler measurements at the secondary level through the greatly reduced patient load. Through improved access to the Doppler measurement, Umbiflow can reduce the perinatal mortality rate. Literature suggests the mortality rate of sick-SGA foetuses can be reduced by, on average, 38% compared to a health care system that does not have access to Doppler ultrasound. “Umbiflow will also reduce the cost, inconvenience and emotional burden to pregnant women by avoiding referrals. Such referrals generally means that they need to book days off from work, arrange for costly transport and spend long waiting times in queues, all the while worrying about the health of their unborn babies,” says Wallis. Through connectivity, Umbiflow will furthermore be able to provide accurate and up to date statistics on the medical conditions being assessed at the point-of-care (primary level), and on the quality of data measurements being done by staff at this level. The effectiveness of the Doppler measurement has been shown at the secondary level to have considerable benefits, including reduced numbers of hospital admissions (e.g. by 44%), reduced numbers of induced labour (e.g. 20%) and reduced numbers of caesarean sections for foetal distress (e.g. 52%). This is according to studies published in the American Journal of Obstetrics and Gynaecology. “Umbiflow’s introduction at the primary level will see reduced referral numbers between the primary and secondary levels and, if implemented at secondary level facilities that do not currently have access to the Doppler measurement, could have the additionally mentioned impact,” says Wallis. A cost-effective, easy-to-use system The Umbiflow system uses Doppler ultrasound to measure blood flow in the umbilical artery of a third trimester foetus as a means to assessing placental sufficiency or insufficiency. Wallis explains that, in South Africa, an umbilical blood flow measurement is only available in the secondary level of health care and above, as it requires a specialist to operate the conventional equipment. “Cost is also a prohibiting factor. At the time development for Umbiflow started, stand-alone Doppler ultrasound units for umbilical blood flow analysis were available at more than R200 000 each. High-end ultrasound imaging systems, requiring a higher level of training, cost around R1.5 million. Prices for these devices have since dropped, but they are still not employed in the primary health care sector, with cost being a significant factor,” he says. Umbiflow is a PC-based or hand-held / tablet based system with an ultrasonic transducer. It displays data on a screen and provides diagnostic support, which means operators require very little training. “Other than the probe, the system uses a commercially available PC or tablet as display and processing device for the Umbiflow software to run on. This reduces time to market and development costs,” says Wallis. “This truly is technology that can empower every nursing sister, midwife or rural GP based in mobile clinics or resource poor primary health care settings. It has the potential for great impact in our health care system.”

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