A Surprising, and Life-Saving, Diagnosis Using Ultrasound

 {Photo credit: Rui Pires.}A woman receiving antenatal care undergoes an ultrasound at Mpigi Health Center IV in Uganda.Photo credit: Rui Pires.

Annette Mbwirahe didn’t know what was wrong—the pain in her lower abdomen wasn’t getting any better. Finally, unable to endure it, she decided to get help.

Mbwirahe, 25, left Buyiwa village and went to Buwama Health Center III in the Mpigi district of Uganda where midwife Zura Kyotazaala examined her with an ultrasound scan.

“I discovered that she was carrying a seven-week twin pregnancy,” Kyotazaala said.

This surprised Mbwirahe. She had no idea she was pregnant because she was still menstruating. Not only that, but the ultrasound showed one fetus in her uterus and the other inside one of her fallopian tubes, a condition known as ectopic pregnancy. Without treatment, ectopic pregnancies can be fatal for the mother.

“The fetus in the uterus was dead while the one in the fallopian tube was alive,” Kyotazaala said “The pain was as a result of the pressure that was being exerted on the fallopian tube as the fetus was growing. The fallopian tube was almost rupturing.”

Kyotazaala referred Mbwirahe to Mulago Hospital in Kampala, 60 km away. A scan there confirmed Kyotazaala’s diagnosis, and Mbwirahe underwent emergency surgery.

“It was only after the operation was successful that I felt her life was out of danger,” Kyotazaala said.

At 435 deaths per 100,000 live births, Uganda has a high maternal mortality ratio with about 6,000 Ugandan women dying every year due to pregnancy-related causes, according to the Ministry of Health. Globally, as many as 1 of every 50 pregnancies is ectopic.

Use of the ultrasound scan at the health center was critical in diagnosing Mbwirahe. The STRIDES for Family Health project, funded by the US Agency for International Development (USAID) and led by Management Sciences for Health (MSH), supplied the ultrasound machine through a performance-based contract it awarded to the Ernest Cook Ultrasound Research and Education Institute (ECUREI). Through this funding and MSH’s partnership with the International Medical Equipment Collaborative, STRIDES provided seven health centers in Mpigi district with solar-powered, portable ultrasound machines.

The contract entitles each pregnant woman who receives antenatal care at any of the seven health centers to free scans. Health workers refer women with suspected complications to a hospital.

“We appreciate that with the scan we are able to refer women with complicated pregnancies early enough to avoid maternal deaths,” Kyotazaala said. “We are now able to detect cases of hydrocephaly, microcephaly, ectopic pregnancies, and other abnormalities.”

Kyotazaala also attributed an increase in women seeking antenatal exams to the use of ultrasounds.

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STRIDES for Family Health

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