The implementation of ultrasound and novel technologies within antenatal care in low-and-middle income countries

Background: Maternal and perinatal mortality remain disproportionately high in low- and middle-income countries (LMICs). While technological advancements have improved the prediction and management of pregnancy complications, integrating these tools into routine antenatal care remains a challenge. In this thesis, I explore the implementation of antenatal point-of-care ultrasound (POCUS) and examine the perspectives of healthcare providers and pregnant women on adopting novel technologies into antenatal care within LMICs. Objectives: Mixed methods were used to (1) identify and synthesize evidence on antenatal POCUS use in LMICs and (2) explore stakeholder perspectives on implementing medical technologies in routine pregnancy care. Methods: (1) A systematic review of studies published up to December 2024 was conducted across nine databases, assessing methodological quality using the Mixed Methods Appraisal Tool (MMAT). (2) A prospective, multi-site qualitative study in Uganda explored the views of pregnant women, healthcare providers, and community leaders. Data were collected through focus group discussions, in-depth interviews, and key informant interviews. Thematic analysis was conducted using inductive coding. Results: (1) Of 6,012 records screened, 30 studies from 17 countries were included, 68% of which were from Africa. The most common POCUS use was gestational age estimation, followed by cardiac activity (first trimester), placental location (second), and fetal presentation (third). Study methodological quality was consistently high. (2) Three overarching themes emerged: (i) ‘Acceptability of new technology’, (ii) ‘Integrating technology into routine care’, and (iii) ‘Adoption into health systems.’ Conclusions: POCUS offers broad clinical utility, with potential for expanded use in fetal anatomy and anomaly screening. AI-enabled ultrasound may further improve access to diagnostic imaging and support decision-making in resource-limited settings. Effective implementation of antenatal technologies in LMICs requires a person-centred approach, emphasising engagement and collaboration over technical factors alone.