READING SUB-TEST – QUESTION PAPER: PART A (SET – 2)

1. Text A

An ultrasound scan, also referred to as sonography, uses high frequency sound waves to create an image of some part of the inside of the body, such as the stomach or muscles, by bouncing sound energy off tissue and translating the returning sound information into a visual representation. The word ultrasound", in physics, refers to all sound with a frequency humans cannot hear; in diagnostic ultrasound this is usually between 2 and 10 MHz. Higher frequencies provide better quality images, but are more readily absorbed by the skin and other tissue, so they cannot penetrate as deeply as lower frequencies. Lower frequencies can penetrate deeper, but the image quality is inferior. Obstetric ultrasound is performed routinely in most U.S. medical communities at about 20

weeks of gestation. Benefits include accurate dating, placental location, the diagnosis of multiple gestation or congenital abnormalities and the possible detection of maternal health risks.

Text B

Abstract: Implementing a obstetric ultrasound training program in rural Africa

Objective: To evaluate the feasibility and sustainability of basic obstetric ultrasound training in rural Africa.

Methods: An 8-week training course, led by UK-based sonographers, was supported by training videos and followed by 10 months of remotely supported scanning in Mandimba, Mozambique. Data were collected using an Android tablet and the EpiCollect web application.

Results : The study group included 1744 pregnant women: 804 scanned by trainees under direct supervision and 940 scanned by trainees alone. Ultrasound identified 36 (2.1%) twin pregnancies, 230 (13.2%) breech presentations, 83 (4.8%) transverse presentations, and 22 (1.3%) cases of placenta previa. The detection rates for the above features were similar in the 2 groups. A subgroup of 230 (13.2%) women had a follow-up scan and 62 (3.6%) were referred to a doctor; 21 of these women required cesarean delivery.

Conclusion: Ultrasound training in a rural setting supported remotely is feasible and sustainable. It can help local healthcare workers to screen their prenatal populations for obstetric and neonatal risks, and therefore has the potential to improve outcomes at delivery and provide site specific epidemiologic data that can be used to develop new healthcare provision strategies.

Text C

The Role of Obstetric Ultrasound in Low Resource Settings

Poor maternal and child health (MCH) outcomes are a global, yet highly preventable problem. Evidence informs that the developing world accounts for the majority of the maternal mortality burden. Half a million women died of complications related to pregnancy in 2005, half of these in Africa and another third in South East Asia. Infant mortality is closely related and the trend is similar. About 3.1 million babies died before 28 days of age with 99% of these deaths occurring in middle and low income countries. Maternal mortality is the health indicator that shows the widest gap between rich and poor, both between and within countries. In Africa the maternal mortality ratio is 620 per 100,000 live births compared to 14 per 100,000 live births in developed countries. Within countries there are also disparities between urban and rural populations, with rural areas suffering worse outcomes. The potential to reduce maternal and neonatal deaths through the use of ultrasound is significant and addresses two of the millennium development goals (MDGs) including (i) MDG 4 which aims to reduce child mortality and (ii) MDG 5 which aims to improve maternal health. Improving the level of obstetric care is critical to address MCH outcomes and to accelerate progress toward achieving MDG 4 and 5 targets.

Text D

"Entertainment" Ultrasound Examinations

It has been proposed that natural-appearing 3-D ultrasound images of the fetus could improve parent fetal bonding. Given the recognized importance of maternal-child bonding immediately postpartum, it seems reasonable that extending this bonding experience into the fetal period could be beneficial. However, a psychological benefit of viewing fetal photos has not been proven, and obtaining such images largely remains in the realm of "entertainment". In some countries, parents are able to enter a photography studio with ultrasound facilities and leave with pictures suitable for framing: no physician involvement is needed for this event. The use of ultrasound for non-diagnostic purposes has been condemned by the American Institute of Ultrasound in Medicine and the American College of Obstetricians and Gynecologists. Concerns that were raised in their policy statements include possible adverse bio-effects of ultrasound energy, the possibility that an examination could give false reassurance to women, and the fact that abnormalities may be detected in settings where personnel are not prepared to discuss and provide follow-up for concerning findings.

alternative name for professionals who do ultrasound scan?
________

2. Text A

An ultrasound scan, also referred to as sonography, uses high frequency sound waves to create an image of some part of the inside of the body, such as the stomach or muscles, by bouncing sound energy off tissue and translating the returning sound information into a visual representation. The word ultrasound", in physics, refers to all sound with a frequency humans cannot hear; in diagnostic ultrasound this is usually between 2 and 10 MHz. Higher frequencies provide better quality images, but are more readily absorbed by the skin and other tissue, so they cannot penetrate as deeply as lower frequencies. Lower frequencies can penetrate deeper, but the image quality is inferior. Obstetric ultrasound is performed routinely in most U.S. medical communities at about 20

weeks of gestation. Benefits include accurate dating, placental location, the diagnosis of multiple gestation or congenital abnormalities and the possible detection of maternal health risks.

Text B

Abstract: Implementing a obstetric ultrasound training program in rural Africa

Objective: To evaluate the feasibility and sustainability of basic obstetric ultrasound training in rural Africa.

Methods: An 8-week training course, led by UK-based sonographers, was supported by training videos and followed by 10 months of remotely supported scanning in Mandimba, Mozambique. Data were collected using an Android tablet and the EpiCollect web application.

Results : The study group included 1744 pregnant women: 804 scanned by trainees under direct supervision and 940 scanned by trainees alone. Ultrasound identified 36 (2.1%) twin pregnancies, 230 (13.2%) breech presentations, 83 (4.8%) transverse presentations, and 22 (1.3%) cases of placenta previa. The detection rates for the above features were similar in the 2 groups. A subgroup of 230 (13.2%) women had a follow-up scan and 62 (3.6%) were referred to a doctor; 21 of these women required cesarean delivery.

Conclusion: Ultrasound training in a rural setting supported remotely is feasible and sustainable. It can help local healthcare workers to screen their prenatal populations for obstetric and neonatal risks, and therefore has the potential to improve outcomes at delivery and provide site specific epidemiologic data that can be used to develop new healthcare provision strategies.

Text C

The Role of Obstetric Ultrasound in Low Resource Settings

Poor maternal and child health (MCH) outcomes are a global, yet highly preventable problem. Evidence informs that the developing world accounts for the majority of the maternal mortality burden. Half a million women died of complications related to pregnancy in 2005, half of these in Africa and another third in South East Asia. Infant mortality is closely related and the trend is similar. About 3.1 million babies died before 28 days of age with 99% of these deaths occurring in middle and low income countries. Maternal mortality is the health indicator that shows the widest gap between rich and poor, both between and within countries. In Africa the maternal mortality ratio is 620 per 100,000 live births compared to 14 per 100,000 live births in developed countries. Within countries there are also disparities between urban and rural populations, with rural areas suffering worse outcomes. The potential to reduce maternal and neonatal deaths through the use of ultrasound is significant and addresses two of the millennium development goals (MDGs) including (i) MDG 4 which aims to reduce child mortality and (ii) MDG 5 which aims to improve maternal health. Improving the level of obstetric care is critical to address MCH outcomes and to accelerate progress toward achieving MDG 4 and 5 targets.

Text D

"Entertainment" Ultrasound Examinations

It has been proposed that natural-appearing 3-D ultrasound images of the fetus could improve parent fetal bonding. Given the recognized importance of maternal-child bonding immediately postpartum, it seems reasonable that extending this bonding experience into the fetal period could be beneficial. However, a psychological benefit of viewing fetal photos has not been proven, and obtaining such images largely remains in the realm of "entertainment". In some countries, parents are able to enter a photography studio with ultrasound facilities and leave with pictures suitable for framing: no physician involvement is needed for this event. The use of ultrasound for non-diagnostic purposes has been condemned by the American Institute of Ultrasound in Medicine and the American College of Obstetricians and Gynecologists. Concerns that were raised in their policy statements include possible adverse bio-effects of ultrasound energy, the possibility that an examination could give false reassurance to women, and the fact that abnormalities may be detected in settings where personnel are not prepared to discuss and provide follow-up for concerning findings.

benefits of obstetric ultrasound scan?
________

3. Text A

An ultrasound scan, also referred to as sonography, uses high frequency sound waves to create an image of some part of the inside of the body, such as the stomach or muscles, by bouncing sound energy off tissue and translating the returning sound information into a visual representation. The word ultrasound", in physics, refers to all sound with a frequency humans cannot hear; in diagnostic ultrasound this is usually between 2 and 10 MHz. Higher frequencies provide better quality images, but are more readily absorbed by the skin and other tissue, so they cannot penetrate as deeply as lower frequencies. Lower frequencies can penetrate deeper, but the image quality is inferior. Obstetric ultrasound is performed routinely in most U.S. medical communities at about 20

weeks of gestation. Benefits include accurate dating, placental location, the diagnosis of multiple gestation or congenital abnormalities and the possible detection of maternal health risks.

Text B

Abstract: Implementing a obstetric ultrasound training program in rural Africa

Objective: To evaluate the feasibility and sustainability of basic obstetric ultrasound training in rural Africa.

Methods: An 8-week training course, led by UK-based sonographers, was supported by training videos and followed by 10 months of remotely supported scanning in Mandimba, Mozambique. Data were collected using an Android tablet and the EpiCollect web application.

Results : The study group included 1744 pregnant women: 804 scanned by trainees under direct supervision and 940 scanned by trainees alone. Ultrasound identified 36 (2.1%) twin pregnancies, 230 (13.2%) breech presentations, 83 (4.8%) transverse presentations, and 22 (1.3%) cases of placenta previa. The detection rates for the above features were similar in the 2 groups. A subgroup of 230 (13.2%) women had a follow-up scan and 62 (3.6%) were referred to a doctor; 21 of these women required cesarean delivery.

Conclusion: Ultrasound training in a rural setting supported remotely is feasible and sustainable. It can help local healthcare workers to screen their prenatal populations for obstetric and neonatal risks, and therefore has the potential to improve outcomes at delivery and provide site specific epidemiologic data that can be used to develop new healthcare provision strategies.

Text C

The Role of Obstetric Ultrasound in Low Resource Settings

Poor maternal and child health (MCH) outcomes are a global, yet highly preventable problem. Evidence informs that the developing world accounts for the majority of the maternal mortality burden. Half a million women died of complications related to pregnancy in 2005, half of these in Africa and another third in South East Asia. Infant mortality is closely related and the trend is similar. About 3.1 million babies died before 28 days of age with 99% of these deaths occurring in middle and low income countries. Maternal mortality is the health indicator that shows the widest gap between rich and poor, both between and within countries. In Africa the maternal mortality ratio is 620 per 100,000 live births compared to 14 per 100,000 live births in developed countries. Within countries there are also disparities between urban and rural populations, with rural areas suffering worse outcomes. The potential to reduce maternal and neonatal deaths through the use of ultrasound is significant and addresses two of the millennium development goals (MDGs) including (i) MDG 4 which aims to reduce child mortality and (ii) MDG 5 which aims to improve maternal health. Improving the level of obstetric care is critical to address MCH outcomes and to accelerate progress toward achieving MDG 4 and 5 targets.

Text D

"Entertainment" Ultrasound Examinations

It has been proposed that natural-appearing 3-D ultrasound images of the fetus could improve parent fetal bonding. Given the recognized importance of maternal-child bonding immediately postpartum, it seems reasonable that extending this bonding experience into the fetal period could be beneficial. However, a psychological benefit of viewing fetal photos has not been proven, and obtaining such images largely remains in the realm of "entertainment". In some countries, parents are able to enter a photography studio with ultrasound facilities and leave with pictures suitable for framing: no physician involvement is needed for this event. The use of ultrasound for non-diagnostic purposes has been condemned by the American Institute of Ultrasound in Medicine and the American College of Obstetricians and Gynecologists. Concerns that were raised in their policy statements include possible adverse bio-effects of ultrasound energy, the possibility that an examination could give false reassurance to women, and the fact that abnormalities may be detected in settings where personnel are not prepared to discuss and provide follow-up for concerning findings.

benefits of three dimensional ultrasound images?
________

4. Text A

An ultrasound scan, also referred to as sonography, uses high frequency sound waves to create an image of some part of the inside of the body, such as the stomach or muscles, by bouncing sound energy off tissue and translating the returning sound information into a visual representation. The word ultrasound", in physics, refers to all sound with a frequency humans cannot hear; in diagnostic ultrasound this is usually between 2 and 10 MHz. Higher frequencies provide better quality images, but are more readily absorbed by the skin and other tissue, so they cannot penetrate as deeply as lower frequencies. Lower frequencies can penetrate deeper, but the image quality is inferior. Obstetric ultrasound is performed routinely in most U.S. medical communities at about 20

weeks of gestation. Benefits include accurate dating, placental location, the diagnosis of multiple gestation or congenital abnormalities and the possible detection of maternal health risks.

Text B

Abstract: Implementing a obstetric ultrasound training program in rural Africa

Objective: To evaluate the feasibility and sustainability of basic obstetric ultrasound training in rural Africa.

Methods: An 8-week training course, led by UK-based sonographers, was supported by training videos and followed by 10 months of remotely supported scanning in Mandimba, Mozambique. Data were collected using an Android tablet and the EpiCollect web application.

Results : The study group included 1744 pregnant women: 804 scanned by trainees under direct supervision and 940 scanned by trainees alone. Ultrasound identified 36 (2.1%) twin pregnancies, 230 (13.2%) breech presentations, 83 (4.8%) transverse presentations, and 22 (1.3%) cases of placenta previa. The detection rates for the above features were similar in the 2 groups. A subgroup of 230 (13.2%) women had a follow-up scan and 62 (3.6%) were referred to a doctor; 21 of these women required cesarean delivery.

Conclusion: Ultrasound training in a rural setting supported remotely is feasible and sustainable. It can help local healthcare workers to screen their prenatal populations for obstetric and neonatal risks, and therefore has the potential to improve outcomes at delivery and provide site specific epidemiologic data that can be used to develop new healthcare provision strategies.

Text C

The Role of Obstetric Ultrasound in Low Resource Settings

Poor maternal and child health (MCH) outcomes are a global, yet highly preventable problem. Evidence informs that the developing world accounts for the majority of the maternal mortality burden. Half a million women died of complications related to pregnancy in 2005, half of these in Africa and another third in South East Asia. Infant mortality is closely related and the trend is similar. About 3.1 million babies died before 28 days of age with 99% of these deaths occurring in middle and low income countries. Maternal mortality is the health indicator that shows the widest gap between rich and poor, both between and within countries. In Africa the maternal mortality ratio is 620 per 100,000 live births compared to 14 per 100,000 live births in developed countries. Within countries there are also disparities between urban and rural populations, with rural areas suffering worse outcomes. The potential to reduce maternal and neonatal deaths through the use of ultrasound is significant and addresses two of the millennium development goals (MDGs) including (i) MDG 4 which aims to reduce child mortality and (ii) MDG 5 which aims to improve maternal health. Improving the level of obstetric care is critical to address MCH outcomes and to accelerate progress toward achieving MDG 4 and 5 targets.

Text D

"Entertainment" Ultrasound Examinations

It has been proposed that natural-appearing 3-D ultrasound images of the fetus could improve parent fetal bonding. Given the recognized importance of maternal-child bonding immediately postpartum, it seems reasonable that extending this bonding experience into the fetal period could be beneficial. However, a psychological benefit of viewing fetal photos has not been proven, and obtaining such images largely remains in the realm of "entertainment". In some countries, parents are able to enter a photography studio with ultrasound facilities and leave with pictures suitable for framing: no physician involvement is needed for this event. The use of ultrasound for non-diagnostic purposes has been condemned by the American Institute of Ultrasound in Medicine and the American College of Obstetricians and Gynecologists. Concerns that were raised in their policy statements include possible adverse bio-effects of ultrasound energy, the possibility that an examination could give false reassurance to women, and the fact that abnormalities may be detected in settings where personnel are not prepared to discuss and provide follow-up for concerning findings.

places which recorded high maternal mortality?
________

5. Text A

An ultrasound scan, also referred to as sonography, uses high frequency sound waves to create an image of some part of the inside of the body, such as the stomach or muscles, by bouncing sound energy off tissue and translating the returning sound information into a visual representation. The word ultrasound", in physics, refers to all sound with a frequency humans cannot hear; in diagnostic ultrasound this is usually between 2 and 10 MHz. Higher frequencies provide better quality images, but are more readily absorbed by the skin and other tissue, so they cannot penetrate as deeply as lower frequencies. Lower frequencies can penetrate deeper, but the image quality is inferior. Obstetric ultrasound is performed routinely in most U.S. medical communities at about 20

weeks of gestation. Benefits include accurate dating, placental location, the diagnosis of multiple gestation or congenital abnormalities and the possible detection of maternal health risks.

Text B

Abstract: Implementing a obstetric ultrasound training program in rural Africa

Objective: To evaluate the feasibility and sustainability of basic obstetric ultrasound training in rural Africa.

Methods: An 8-week training course, led by UK-based sonographers, was supported by training videos and followed by 10 months of remotely supported scanning in Mandimba, Mozambique. Data were collected using an Android tablet and the EpiCollect web application.

Results : The study group included 1744 pregnant women: 804 scanned by trainees under direct supervision and 940 scanned by trainees alone. Ultrasound identified 36 (2.1%) twin pregnancies, 230 (13.2%) breech presentations, 83 (4.8%) transverse presentations, and 22 (1.3%) cases of placenta previa. The detection rates for the above features were similar in the 2 groups. A subgroup of 230 (13.2%) women had a follow-up scan and 62 (3.6%) were referred to a doctor; 21 of these women required cesarean delivery.

Conclusion: Ultrasound training in a rural setting supported remotely is feasible and sustainable. It can help local healthcare workers to screen their prenatal populations for obstetric and neonatal risks, and therefore has the potential to improve outcomes at delivery and provide site specific epidemiologic data that can be used to develop new healthcare provision strategies.

Text C

The Role of Obstetric Ultrasound in Low Resource Settings

Poor maternal and child health (MCH) outcomes are a global, yet highly preventable problem. Evidence informs that the developing world accounts for the majority of the maternal mortality burden. Half a million women died of complications related to pregnancy in 2005, half of these in Africa and another third in South East Asia. Infant mortality is closely related and the trend is similar. About 3.1 million babies died before 28 days of age with 99% of these deaths occurring in middle and low income countries. Maternal mortality is the health indicator that shows the widest gap between rich and poor, both between and within countries. In Africa the maternal mortality ratio is 620 per 100,000 live births compared to 14 per 100,000 live births in developed countries. Within countries there are also disparities between urban and rural populations, with rural areas suffering worse outcomes. The potential to reduce maternal and neonatal deaths through the use of ultrasound is significant and addresses two of the millennium development goals (MDGs) including (i) MDG 4 which aims to reduce child mortality and (ii) MDG 5 which aims to improve maternal health. Improving the level of obstetric care is critical to address MCH outcomes and to accelerate progress toward achieving MDG 4 and 5 targets.

Text D

"Entertainment" Ultrasound Examinations

It has been proposed that natural-appearing 3-D ultrasound images of the fetus could improve parent fetal bonding. Given the recognized importance of maternal-child bonding immediately postpartum, it seems reasonable that extending this bonding experience into the fetal period could be beneficial. However, a psychological benefit of viewing fetal photos has not been proven, and obtaining such images largely remains in the realm of "entertainment". In some countries, parents are able to enter a photography studio with ultrasound facilities and leave with pictures suitable for framing: no physician involvement is needed for this event. The use of ultrasound for non-diagnostic purposes has been condemned by the American Institute of Ultrasound in Medicine and the American College of Obstetricians and Gynecologists. Concerns that were raised in their policy statements include possible adverse bio-effects of ultrasound energy, the possibility that an examination could give false reassurance to women, and the fact that abnormalities may be detected in settings where personnel are not prepared to discuss and provide follow-up for concerning findings.

who condemned non-diagnostic uses of ultrasound?
________

6. Text A

An ultrasound scan, also referred to as sonography, uses high frequency sound waves to create an image of some part of the inside of the body, such as the stomach or muscles, by bouncing sound energy off tissue and translating the returning sound information into a visual representation. The word ultrasound", in physics, refers to all sound with a frequency humans cannot hear; in diagnostic ultrasound this is usually between 2 and 10 MHz. Higher frequencies provide better quality images, but are more readily absorbed by the skin and other tissue, so they cannot penetrate as deeply as lower frequencies. Lower frequencies can penetrate deeper, but the image quality is inferior. Obstetric ultrasound is performed routinely in most U.S. medical communities at about 20

weeks of gestation. Benefits include accurate dating, placental location, the diagnosis of multiple gestation or congenital abnormalities and the possible detection of maternal health risks.

Text B

Abstract: Implementing a obstetric ultrasound training program in rural Africa

Objective: To evaluate the feasibility and sustainability of basic obstetric ultrasound training in rural Africa.

Methods: An 8-week training course, led by UK-based sonographers, was supported by training videos and followed by 10 months of remotely supported scanning in Mandimba, Mozambique. Data were collected using an Android tablet and the EpiCollect web application.

Results : The study group included 1744 pregnant women: 804 scanned by trainees under direct supervision and 940 scanned by trainees alone. Ultrasound identified 36 (2.1%) twin pregnancies, 230 (13.2%) breech presentations, 83 (4.8%) transverse presentations, and 22 (1.3%) cases of placenta previa. The detection rates for the above features were similar in the 2 groups. A subgroup of 230 (13.2%) women had a follow-up scan and 62 (3.6%) were referred to a doctor; 21 of these women required cesarean delivery.

Conclusion: Ultrasound training in a rural setting supported remotely is feasible and sustainable. It can help local healthcare workers to screen their prenatal populations for obstetric and neonatal risks, and therefore has the potential to improve outcomes at delivery and provide site specific epidemiologic data that can be used to develop new healthcare provision strategies.

Text C

The Role of Obstetric Ultrasound in Low Resource Settings

Poor maternal and child health (MCH) outcomes are a global, yet highly preventable problem. Evidence informs that the developing world accounts for the majority of the maternal mortality burden. Half a million women died of complications related to pregnancy in 2005, half of these in Africa and another third in South East Asia. Infant mortality is closely related and the trend is similar. About 3.1 million babies died before 28 days of age with 99% of these deaths occurring in middle and low income countries. Maternal mortality is the health indicator that shows the widest gap between rich and poor, both between and within countries. In Africa the maternal mortality ratio is 620 per 100,000 live births compared to 14 per 100,000 live births in developed countries. Within countries there are also disparities between urban and rural populations, with rural areas suffering worse outcomes. The potential to reduce maternal and neonatal deaths through the use of ultrasound is significant and addresses two of the millennium development goals (MDGs) including (i) MDG 4 which aims to reduce child mortality and (ii) MDG 5 which aims to improve maternal health. Improving the level of obstetric care is critical to address MCH outcomes and to accelerate progress toward achieving MDG 4 and 5 targets.

Text D

"Entertainment" Ultrasound Examinations

It has been proposed that natural-appearing 3-D ultrasound images of the fetus could improve parent fetal bonding. Given the recognized importance of maternal-child bonding immediately postpartum, it seems reasonable that extending this bonding experience into the fetal period could be beneficial. However, a psychological benefit of viewing fetal photos has not been proven, and obtaining such images largely remains in the realm of "entertainment". In some countries, parents are able to enter a photography studio with ultrasound facilities and leave with pictures suitable for framing: no physician involvement is needed for this event. The use of ultrasound for non-diagnostic purposes has been condemned by the American Institute of Ultrasound in Medicine and the American College of Obstetricians and Gynecologists. Concerns that were raised in their policy statements include possible adverse bio-effects of ultrasound energy, the possibility that an examination could give false reassurance to women, and the fact that abnormalities may be detected in settings where personnel are not prepared to discuss and provide follow-up for concerning findings.

6. who conducted the study in rural Africa?
________

7. Text A

An ultrasound scan, also referred to as sonography, uses high frequency sound waves to create an image of some part of the inside of the body, such as the stomach or muscles, by bouncing sound energy off tissue and translating the returning sound information into a visual representation. The word ultrasound", in physics, refers to all sound with a frequency humans cannot hear; in diagnostic ultrasound this is usually between 2 and 10 MHz. Higher frequencies provide better quality images, but are more readily absorbed by the skin and other tissue, so they cannot penetrate as deeply as lower frequencies. Lower frequencies can penetrate deeper, but the image quality is inferior. Obstetric ultrasound is performed routinely in most U.S. medical communities at about 20

weeks of gestation. Benefits include accurate dating, placental location, the diagnosis of multiple gestation or congenital abnormalities and the possible detection of maternal health risks.

Text B

Abstract: Implementing a obstetric ultrasound training program in rural Africa

Objective: To evaluate the feasibility and sustainability of basic obstetric ultrasound training in rural Africa.

Methods: An 8-week training course, led by UK-based sonographers, was supported by training videos and followed by 10 months of remotely supported scanning in Mandimba, Mozambique. Data were collected using an Android tablet and the EpiCollect web application.

Results : The study group included 1744 pregnant women: 804 scanned by trainees under direct supervision and 940 scanned by trainees alone. Ultrasound identified 36 (2.1%) twin pregnancies, 230 (13.2%) breech presentations, 83 (4.8%) transverse presentations, and 22 (1.3%) cases of placenta previa. The detection rates for the above features were similar in the 2 groups. A subgroup of 230 (13.2%) women had a follow-up scan and 62 (3.6%) were referred to a doctor; 21 of these women required cesarean delivery.

Conclusion: Ultrasound training in a rural setting supported remotely is feasible and sustainable. It can help local healthcare workers to screen their prenatal populations for obstetric and neonatal risks, and therefore has the potential to improve outcomes at delivery and provide site specific epidemiologic data that can be used to develop new healthcare provision strategies.

Text C

The Role of Obstetric Ultrasound in Low Resource Settings

Poor maternal and child health (MCH) outcomes are a global, yet highly preventable problem. Evidence informs that the developing world accounts for the majority of the maternal mortality burden. Half a million women died of complications related to pregnancy in 2005, half of these in Africa and another third in South East Asia. Infant mortality is closely related and the trend is similar. About 3.1 million babies died before 28 days of age with 99% of these deaths occurring in middle and low income countries. Maternal mortality is the health indicator that shows the widest gap between rich and poor, both between and within countries. In Africa the maternal mortality ratio is 620 per 100,000 live births compared to 14 per 100,000 live births in developed countries. Within countries there are also disparities between urban and rural populations, with rural areas suffering worse outcomes. The potential to reduce maternal and neonatal deaths through the use of ultrasound is significant and addresses two of the millennium development goals (MDGs) including (i) MDG 4 which aims to reduce child mortality and (ii) MDG 5 which aims to improve maternal health. Improving the level of obstetric care is critical to address MCH outcomes and to accelerate progress toward achieving MDG 4 and 5 targets.

Text D

"Entertainment" Ultrasound Examinations

It has been proposed that natural-appearing 3-D ultrasound images of the fetus could improve parent fetal bonding. Given the recognized importance of maternal-child bonding immediately postpartum, it seems reasonable that extending this bonding experience into the fetal period could be beneficial. However, a psychological benefit of viewing fetal photos has not been proven, and obtaining such images largely remains in the realm of "entertainment". In some countries, parents are able to enter a photography studio with ultrasound facilities and leave with pictures suitable for framing: no physician involvement is needed for this event. The use of ultrasound for non-diagnostic purposes has been condemned by the American Institute of Ultrasound in Medicine and the American College of Obstetricians and Gynecologists. Concerns that were raised in their policy statements include possible adverse bio-effects of ultrasound energy, the possibility that an examination could give false reassurance to women, and the fact that abnormalities may be detected in settings where personnel are not prepared to discuss and provide follow-up for concerning findings.

7. differences among countries regarding maternal mortality?
________

8. Text A

An ultrasound scan, also referred to as sonography, uses high frequency sound waves to create an image of some part of the inside of the body, such as the stomach or muscles, by bouncing sound energy off tissue and translating the returning sound information into a visual representation. The word ultrasound", in physics, refers to all sound with a frequency humans cannot hear; in diagnostic ultrasound this is usually between 2 and 10 MHz. Higher frequencies provide better quality images, but are more readily absorbed by the skin and other tissue, so they cannot penetrate as deeply as lower frequencies. Lower frequencies can penetrate deeper, but the image quality is inferior. Obstetric ultrasound is performed routinely in most U.S. medical communities at about 20

weeks of gestation. Benefits include accurate dating, placental location, the diagnosis of multiple gestation or congenital abnormalities and the possible detection of maternal health risks.

Text B

Abstract: Implementing a obstetric ultrasound training program in rural Africa

Objective: To evaluate the feasibility and sustainability of basic obstetric ultrasound training in rural Africa.

Methods: An 8-week training course, led by UK-based sonographers, was supported by training videos and followed by 10 months of remotely supported scanning in Mandimba, Mozambique. Data were collected using an Android tablet and the EpiCollect web application.

Results : The study group included 1744 pregnant women: 804 scanned by trainees under direct supervision and 940 scanned by trainees alone. Ultrasound identified 36 (2.1%) twin pregnancies, 230 (13.2%) breech presentations, 83 (4.8%) transverse presentations, and 22 (1.3%) cases of placenta previa. The detection rates for the above features were similar in the 2 groups. A subgroup of 230 (13.2%) women had a follow-up scan and 62 (3.6%) were referred to a doctor; 21 of these women required cesarean delivery.

Conclusion: Ultrasound training in a rural setting supported remotely is feasible and sustainable. It can help local healthcare workers to screen their prenatal populations for obstetric and neonatal risks, and therefore has the potential to improve outcomes at delivery and provide site specific epidemiologic data that can be used to develop new healthcare provision strategies.

Text C

The Role of Obstetric Ultrasound in Low Resource Settings

Poor maternal and child health (MCH) outcomes are a global, yet highly preventable problem. Evidence informs that the developing world accounts for the majority of the maternal mortality burden. Half a million women died of complications related to pregnancy in 2005, half of these in Africa and another third in South East Asia. Infant mortality is closely related and the trend is similar. About 3.1 million babies died before 28 days of age with 99% of these deaths occurring in middle and low income countries. Maternal mortality is the health indicator that shows the widest gap between rich and poor, both between and within countries. In Africa the maternal mortality ratio is 620 per 100,000 live births compared to 14 per 100,000 live births in developed countries. Within countries there are also disparities between urban and rural populations, with rural areas suffering worse outcomes. The potential to reduce maternal and neonatal deaths through the use of ultrasound is significant and addresses two of the millennium development goals (MDGs) including (i) MDG 4 which aims to reduce child mortality and (ii) MDG 5 which aims to improve maternal health. Improving the level of obstetric care is critical to address MCH outcomes and to accelerate progress toward achieving MDG 4 and 5 targets.

Text D

"Entertainment" Ultrasound Examinations

It has been proposed that natural-appearing 3-D ultrasound images of the fetus could improve parent fetal bonding. Given the recognized importance of maternal-child bonding immediately postpartum, it seems reasonable that extending this bonding experience into the fetal period could be beneficial. However, a psychological benefit of viewing fetal photos has not been proven, and obtaining such images largely remains in the realm of "entertainment". In some countries, parents are able to enter a photography studio with ultrasound facilities and leave with pictures suitable for framing: no physician involvement is needed for this event. The use of ultrasound for non-diagnostic purposes has been condemned by the American Institute of Ultrasound in Medicine and the American College of Obstetricians and Gynecologists. Concerns that were raised in their policy statements include possible adverse bio-effects of ultrasound energy, the possibility that an examination could give false reassurance to women, and the fact that abnormalities may be detected in settings where personnel are not prepared to discuss and provide follow-up for concerning findings.

8. What is the maximum frequency limit of diagnostic ultrasound?
________

9. Text A

An ultrasound scan, also referred to as sonography, uses high frequency sound waves to create an image of some part of the inside of the body, such as the stomach or muscles, by bouncing sound energy off tissue and translating the returning sound information into a visual representation. The word ultrasound", in physics, refers to all sound with a frequency humans cannot hear; in diagnostic ultrasound this is usually between 2 and 10 MHz. Higher frequencies provide better quality images, but are more readily absorbed by the skin and other tissue, so they cannot penetrate as deeply as lower frequencies. Lower frequencies can penetrate deeper, but the image quality is inferior. Obstetric ultrasound is performed routinely in most U.S. medical communities at about 20

weeks of gestation. Benefits include accurate dating, placental location, the diagnosis of multiple gestation or congenital abnormalities and the possible detection of maternal health risks.

Text B

Abstract: Implementing a obstetric ultrasound training program in rural Africa

Objective: To evaluate the feasibility and sustainability of basic obstetric ultrasound training in rural Africa.

Methods: An 8-week training course, led by UK-based sonographers, was supported by training videos and followed by 10 months of remotely supported scanning in Mandimba, Mozambique. Data were collected using an Android tablet and the EpiCollect web application.

Results : The study group included 1744 pregnant women: 804 scanned by trainees under direct supervision and 940 scanned by trainees alone. Ultrasound identified 36 (2.1%) twin pregnancies, 230 (13.2%) breech presentations, 83 (4.8%) transverse presentations, and 22 (1.3%) cases of placenta previa. The detection rates for the above features were similar in the 2 groups. A subgroup of 230 (13.2%) women had a follow-up scan and 62 (3.6%) were referred to a doctor; 21 of these women required cesarean delivery.

Conclusion: Ultrasound training in a rural setting supported remotely is feasible and sustainable. It can help local healthcare workers to screen their prenatal populations for obstetric and neonatal risks, and therefore has the potential to improve outcomes at delivery and provide site specific epidemiologic data that can be used to develop new healthcare provision strategies.

Text C

The Role of Obstetric Ultrasound in Low Resource Settings

Poor maternal and child health (MCH) outcomes are a global, yet highly preventable problem. Evidence informs that the developing world accounts for the majority of the maternal mortality burden. Half a million women died of complications related to pregnancy in 2005, half of these in Africa and another third in South East Asia. Infant mortality is closely related and the trend is similar. About 3.1 million babies died before 28 days of age with 99% of these deaths occurring in middle and low income countries. Maternal mortality is the health indicator that shows the widest gap between rich and poor, both between and within countries. In Africa the maternal mortality ratio is 620 per 100,000 live births compared to 14 per 100,000 live births in developed countries. Within countries there are also disparities between urban and rural populations, with rural areas suffering worse outcomes. The potential to reduce maternal and neonatal deaths through the use of ultrasound is significant and addresses two of the millennium development goals (MDGs) including (i) MDG 4 which aims to reduce child mortality and (ii) MDG 5 which aims to improve maternal health. Improving the level of obstetric care is critical to address MCH outcomes and to accelerate progress toward achieving MDG 4 and 5 targets.

Text D

"Entertainment" Ultrasound Examinations

It has been proposed that natural-appearing 3-D ultrasound images of the fetus could improve parent fetal bonding. Given the recognized importance of maternal-child bonding immediately postpartum, it seems reasonable that extending this bonding experience into the fetal period could be beneficial. However, a psychological benefit of viewing fetal photos has not been proven, and obtaining such images largely remains in the realm of "entertainment". In some countries, parents are able to enter a photography studio with ultrasound facilities and leave with pictures suitable for framing: no physician involvement is needed for this event. The use of ultrasound for non-diagnostic purposes has been condemned by the American Institute of Ultrasound in Medicine and the American College of Obstetricians and Gynecologists. Concerns that were raised in their policy statements include possible adverse bio-effects of ultrasound energy, the possibility that an examination could give false reassurance to women, and the fact that abnormalities may be detected in settings where personnel are not prepared to discuss and provide follow-up for concerning findings.

9. What does ‘MDG’ stand for based on the information given in the texts?
________

10. Text A

An ultrasound scan, also referred to as sonography, uses high frequency sound waves to create an image of some part of the inside of the body, such as the stomach or muscles, by bouncing sound energy off tissue and translating the returning sound information into a visual representation. The word ultrasound", in physics, refers to all sound with a frequency humans cannot hear; in diagnostic ultrasound this is usually between 2 and 10 MHz. Higher frequencies provide better quality images, but are more readily absorbed by the skin and other tissue, so they cannot penetrate as deeply as lower frequencies. Lower frequencies can penetrate deeper, but the image quality is inferior. Obstetric ultrasound is performed routinely in most U.S. medical communities at about 20

weeks of gestation. Benefits include accurate dating, placental location, the diagnosis of multiple gestation or congenital abnormalities and the possible detection of maternal health risks.

Text B

Abstract: Implementing a obstetric ultrasound training program in rural Africa

Objective: To evaluate the feasibility and sustainability of basic obstetric ultrasound training in rural Africa.

Methods: An 8-week training course, led by UK-based sonographers, was supported by training videos and followed by 10 months of remotely supported scanning in Mandimba, Mozambique. Data were collected using an Android tablet and the EpiCollect web application.

Results : The study group included 1744 pregnant women: 804 scanned by trainees under direct supervision and 940 scanned by trainees alone. Ultrasound identified 36 (2.1%) twin pregnancies, 230 (13.2%) breech presentations, 83 (4.8%) transverse presentations, and 22 (1.3%) cases of placenta previa. The detection rates for the above features were similar in the 2 groups. A subgroup of 230 (13.2%) women had a follow-up scan and 62 (3.6%) were referred to a doctor; 21 of these women required cesarean delivery.

Conclusion: Ultrasound training in a rural setting supported remotely is feasible and sustainable. It can help local healthcare workers to screen their prenatal populations for obstetric and neonatal risks, and therefore has the potential to improve outcomes at delivery and provide site specific epidemiologic data that can be used to develop new healthcare provision strategies.

Text C

The Role of Obstetric Ultrasound in Low Resource Settings

Poor maternal and child health (MCH) outcomes are a global, yet highly preventable problem. Evidence informs that the developing world accounts for the majority of the maternal mortality burden. Half a million women died of complications related to pregnancy in 2005, half of these in Africa and another third in South East Asia. Infant mortality is closely related and the trend is similar. About 3.1 million babies died before 28 days of age with 99% of these deaths occurring in middle and low income countries. Maternal mortality is the health indicator that shows the widest gap between rich and poor, both between and within countries. In Africa the maternal mortality ratio is 620 per 100,000 live births compared to 14 per 100,000 live births in developed countries. Within countries there are also disparities between urban and rural populations, with rural areas suffering worse outcomes. The potential to reduce maternal and neonatal deaths through the use of ultrasound is significant and addresses two of the millennium development goals (MDGs) including (i) MDG 4 which aims to reduce child mortality and (ii) MDG 5 which aims to improve maternal health. Improving the level of obstetric care is critical to address MCH outcomes and to accelerate progress toward achieving MDG 4 and 5 targets.

Text D

"Entertainment" Ultrasound Examinations

It has been proposed that natural-appearing 3-D ultrasound images of the fetus could improve parent fetal bonding. Given the recognized importance of maternal-child bonding immediately postpartum, it seems reasonable that extending this bonding experience into the fetal period could be beneficial. However, a psychological benefit of viewing fetal photos has not been proven, and obtaining such images largely remains in the realm of "entertainment". In some countries, parents are able to enter a photography studio with ultrasound facilities and leave with pictures suitable for framing: no physician involvement is needed for this event. The use of ultrasound for non-diagnostic purposes has been condemned by the American Institute of Ultrasound in Medicine and the American College of Obstetricians and Gynecologists. Concerns that were raised in their policy statements include possible adverse bio-effects of ultrasound energy, the possibility that an examination could give false reassurance to women, and the fact that abnormalities may be detected in settings where personnel are not prepared to discuss and provide follow-up for concerning findings.

10. How many participants were there in the study conducted in rural Africa?
________

11. Text A

An ultrasound scan, also referred to as sonography, uses high frequency sound waves to create an image of some part of the inside of the body, such as the stomach or muscles, by bouncing sound energy off tissue and translating the returning sound information into a visual representation. The word ultrasound", in physics, refers to all sound with a frequency humans cannot hear; in diagnostic ultrasound this is usually between 2 and 10 MHz. Higher frequencies provide better quality images, but are more readily absorbed by the skin and other tissue, so they cannot penetrate as deeply as lower frequencies. Lower frequencies can penetrate deeper, but the image quality is inferior. Obstetric ultrasound is performed routinely in most U.S. medical communities at about 20

weeks of gestation. Benefits include accurate dating, placental location, the diagnosis of multiple gestation or congenital abnormalities and the possible detection of maternal health risks.

Text B

Abstract: Implementing a obstetric ultrasound training program in rural Africa

Objective: To evaluate the feasibility and sustainability of basic obstetric ultrasound training in rural Africa.

Methods: An 8-week training course, led by UK-based sonographers, was supported by training videos and followed by 10 months of remotely supported scanning in Mandimba, Mozambique. Data were collected using an Android tablet and the EpiCollect web application.

Results : The study group included 1744 pregnant women: 804 scanned by trainees under direct supervision and 940 scanned by trainees alone. Ultrasound identified 36 (2.1%) twin pregnancies, 230 (13.2%) breech presentations, 83 (4.8%) transverse presentations, and 22 (1.3%) cases of placenta previa. The detection rates for the above features were similar in the 2 groups. A subgroup of 230 (13.2%) women had a follow-up scan and 62 (3.6%) were referred to a doctor; 21 of these women required cesarean delivery.

Conclusion: Ultrasound training in a rural setting supported remotely is feasible and sustainable. It can help local healthcare workers to screen their prenatal populations for obstetric and neonatal risks, and therefore has the potential to improve outcomes at delivery and provide site specific epidemiologic data that can be used to develop new healthcare provision strategies.

Text C

The Role of Obstetric Ultrasound in Low Resource Settings

Poor maternal and child health (MCH) outcomes are a global, yet highly preventable problem. Evidence informs that the developing world accounts for the majority of the maternal mortality burden. Half a million women died of complications related to pregnancy in 2005, half of these in Africa and another third in South East Asia. Infant mortality is closely related and the trend is similar. About 3.1 million babies died before 28 days of age with 99% of these deaths occurring in middle and low income countries. Maternal mortality is the health indicator that shows the widest gap between rich and poor, both between and within countries. In Africa the maternal mortality ratio is 620 per 100,000 live births compared to 14 per 100,000 live births in developed countries. Within countries there are also disparities between urban and rural populations, with rural areas suffering worse outcomes. The potential to reduce maternal and neonatal deaths through the use of ultrasound is significant and addresses two of the millennium development goals (MDGs) including (i) MDG 4 which aims to reduce child mortality and (ii) MDG 5 which aims to improve maternal health. Improving the level of obstetric care is critical to address MCH outcomes and to accelerate progress toward achieving MDG 4 and 5 targets.

Text D

"Entertainment" Ultrasound Examinations

It has been proposed that natural-appearing 3-D ultrasound images of the fetus could improve parent fetal bonding. Given the recognized importance of maternal-child bonding immediately postpartum, it seems reasonable that extending this bonding experience into the fetal period could be beneficial. However, a psychological benefit of viewing fetal photos has not been proven, and obtaining such images largely remains in the realm of "entertainment". In some countries, parents are able to enter a photography studio with ultrasound facilities and leave with pictures suitable for framing: no physician involvement is needed for this event. The use of ultrasound for non-diagnostic purposes has been condemned by the American Institute of Ultrasound in Medicine and the American College of Obstetricians and Gynecologists. Concerns that were raised in their policy statements include possible adverse bio-effects of ultrasound energy, the possibility that an examination could give false reassurance to women, and the fact that abnormalities may be detected in settings where personnel are not prepared to discuss and provide follow-up for concerning findings.

11. What type of frequencies travel more into human body?
________

12. Text A

An ultrasound scan, also referred to as sonography, uses high frequency sound waves to create an image of some part of the inside of the body, such as the stomach or muscles, by bouncing sound energy off tissue and translating the returning sound information into a visual representation. The word ultrasound", in physics, refers to all sound with a frequency humans cannot hear; in diagnostic ultrasound this is usually between 2 and 10 MHz. Higher frequencies provide better quality images, but are more readily absorbed by the skin and other tissue, so they cannot penetrate as deeply as lower frequencies. Lower frequencies can penetrate deeper, but the image quality is inferior. Obstetric ultrasound is performed routinely in most U.S. medical communities at about 20

weeks of gestation. Benefits include accurate dating, placental location, the diagnosis of multiple gestation or congenital abnormalities and the possible detection of maternal health risks.

Text B

Abstract: Implementing a obstetric ultrasound training program in rural Africa

Objective: To evaluate the feasibility and sustainability of basic obstetric ultrasound training in rural Africa.

Methods: An 8-week training course, led by UK-based sonographers, was supported by training videos and followed by 10 months of remotely supported scanning in Mandimba, Mozambique. Data were collected using an Android tablet and the EpiCollect web application.

Results : The study group included 1744 pregnant women: 804 scanned by trainees under direct supervision and 940 scanned by trainees alone. Ultrasound identified 36 (2.1%) twin pregnancies, 230 (13.2%) breech presentations, 83 (4.8%) transverse presentations, and 22 (1.3%) cases of placenta previa. The detection rates for the above features were similar in the 2 groups. A subgroup of 230 (13.2%) women had a follow-up scan and 62 (3.6%) were referred to a doctor; 21 of these women required cesarean delivery.

Conclusion: Ultrasound training in a rural setting supported remotely is feasible and sustainable. It can help local healthcare workers to screen their prenatal populations for obstetric and neonatal risks, and therefore has the potential to improve outcomes at delivery and provide site specific epidemiologic data that can be used to develop new healthcare provision strategies.

Text C

The Role of Obstetric Ultrasound in Low Resource Settings

Poor maternal and child health (MCH) outcomes are a global, yet highly preventable problem. Evidence informs that the developing world accounts for the majority of the maternal mortality burden. Half a million women died of complications related to pregnancy in 2005, half of these in Africa and another third in South East Asia. Infant mortality is closely related and the trend is similar. About 3.1 million babies died before 28 days of age with 99% of these deaths occurring in middle and low income countries. Maternal mortality is the health indicator that shows the widest gap between rich and poor, both between and within countries. In Africa the maternal mortality ratio is 620 per 100,000 live births compared to 14 per 100,000 live births in developed countries. Within countries there are also disparities between urban and rural populations, with rural areas suffering worse outcomes. The potential to reduce maternal and neonatal deaths through the use of ultrasound is significant and addresses two of the millennium development goals (MDGs) including (i) MDG 4 which aims to reduce child mortality and (ii) MDG 5 which aims to improve maternal health. Improving the level of obstetric care is critical to address MCH outcomes and to accelerate progress toward achieving MDG 4 and 5 targets.

Text D

"Entertainment" Ultrasound Examinations

It has been proposed that natural-appearing 3-D ultrasound images of the fetus could improve parent fetal bonding. Given the recognized importance of maternal-child bonding immediately postpartum, it seems reasonable that extending this bonding experience into the fetal period could be beneficial. However, a psychological benefit of viewing fetal photos has not been proven, and obtaining such images largely remains in the realm of "entertainment". In some countries, parents are able to enter a photography studio with ultrasound facilities and leave with pictures suitable for framing: no physician involvement is needed for this event. The use of ultrasound for non-diagnostic purposes has been condemned by the American Institute of Ultrasound in Medicine and the American College of Obstetricians and Gynecologists. Concerns that were raised in their policy statements include possible adverse bio-effects of ultrasound energy, the possibility that an examination could give false reassurance to women, and the fact that abnormalities may be detected in settings where personnel are not prepared to discuss and provide follow-up for concerning findings.

12. Which millennium development goal aim to reduce maternal mortality?
________

13. Text A

An ultrasound scan, also referred to as sonography, uses high frequency sound waves to create an image of some part of the inside of the body, such as the stomach or muscles, by bouncing sound energy off tissue and translating the returning sound information into a visual representation. The word ultrasound", in physics, refers to all sound with a frequency humans cannot hear; in diagnostic ultrasound this is usually between 2 and 10 MHz. Higher frequencies provide better quality images, but are more readily absorbed by the skin and other tissue, so they cannot penetrate as deeply as lower frequencies. Lower frequencies can penetrate deeper, but the image quality is inferior. Obstetric ultrasound is performed routinely in most U.S. medical communities at about 20

weeks of gestation. Benefits include accurate dating, placental location, the diagnosis of multiple gestation or congenital abnormalities and the possible detection of maternal health risks.

Text B

Abstract: Implementing a obstetric ultrasound training program in rural Africa

Objective: To evaluate the feasibility and sustainability of basic obstetric ultrasound training in rural Africa.

Methods: An 8-week training course, led by UK-based sonographers, was supported by training videos and followed by 10 months of remotely supported scanning in Mandimba, Mozambique. Data were collected using an Android tablet and the EpiCollect web application.

Results : The study group included 1744 pregnant women: 804 scanned by trainees under direct supervision and 940 scanned by trainees alone. Ultrasound identified 36 (2.1%) twin pregnancies, 230 (13.2%) breech presentations, 83 (4.8%) transverse presentations, and 22 (1.3%) cases of placenta previa. The detection rates for the above features were similar in the 2 groups. A subgroup of 230 (13.2%) women had a follow-up scan and 62 (3.6%) were referred to a doctor; 21 of these women required cesarean delivery.

Conclusion: Ultrasound training in a rural setting supported remotely is feasible and sustainable. It can help local healthcare workers to screen their prenatal populations for obstetric and neonatal risks, and therefore has the potential to improve outcomes at delivery and provide site specific epidemiologic data that can be used to develop new healthcare provision strategies.

Text C

The Role of Obstetric Ultrasound in Low Resource Settings

Poor maternal and child health (MCH) outcomes are a global, yet highly preventable problem. Evidence informs that the developing world accounts for the majority of the maternal mortality burden. Half a million women died of complications related to pregnancy in 2005, half of these in Africa and another third in South East Asia. Infant mortality is closely related and the trend is similar. About 3.1 million babies died before 28 days of age with 99% of these deaths occurring in middle and low income countries. Maternal mortality is the health indicator that shows the widest gap between rich and poor, both between and within countries. In Africa the maternal mortality ratio is 620 per 100,000 live births compared to 14 per 100,000 live births in developed countries. Within countries there are also disparities between urban and rural populations, with rural areas suffering worse outcomes. The potential to reduce maternal and neonatal deaths through the use of ultrasound is significant and addresses two of the millennium development goals (MDGs) including (i) MDG 4 which aims to reduce child mortality and (ii) MDG 5 which aims to improve maternal health. Improving the level of obstetric care is critical to address MCH outcomes and to accelerate progress toward achieving MDG 4 and 5 targets.

Text D

"Entertainment" Ultrasound Examinations

It has been proposed that natural-appearing 3-D ultrasound images of the fetus could improve parent fetal bonding. Given the recognized importance of maternal-child bonding immediately postpartum, it seems reasonable that extending this bonding experience into the fetal period could be beneficial. However, a psychological benefit of viewing fetal photos has not been proven, and obtaining such images largely remains in the realm of "entertainment". In some countries, parents are able to enter a photography studio with ultrasound facilities and leave with pictures suitable for framing: no physician involvement is needed for this event. The use of ultrasound for non-diagnostic purposes has been condemned by the American Institute of Ultrasound in Medicine and the American College of Obstetricians and Gynecologists. Concerns that were raised in their policy statements include possible adverse bio-effects of ultrasound energy, the possibility that an examination could give false reassurance to women, and the fact that abnormalities may be detected in settings where personnel are not prepared to discuss and provide follow-up for concerning findings.

13. What is the alternate term for ultrasound scan?
________

14. Text A

An ultrasound scan, also referred to as sonography, uses high frequency sound waves to create an image of some part of the inside of the body, such as the stomach or muscles, by bouncing sound energy off tissue and translating the returning sound information into a visual representation. The word ultrasound", in physics, refers to all sound with a frequency humans cannot hear; in diagnostic ultrasound this is usually between 2 and 10 MHz. Higher frequencies provide better quality images, but are more readily absorbed by the skin and other tissue, so they cannot penetrate as deeply as lower frequencies. Lower frequencies can penetrate deeper, but the image quality is inferior. Obstetric ultrasound is performed routinely in most U.S. medical communities at about 20

weeks of gestation. Benefits include accurate dating, placental location, the diagnosis of multiple gestation or congenital abnormalities and the possible detection of maternal health risks.

Text B

Abstract: Implementing a obstetric ultrasound training program in rural Africa

Objective: To evaluate the feasibility and sustainability of basic obstetric ultrasound training in rural Africa.

Methods: An 8-week training course, led by UK-based sonographers, was supported by training videos and followed by 10 months of remotely supported scanning in Mandimba, Mozambique. Data were collected using an Android tablet and the EpiCollect web application.

Results : The study group included 1744 pregnant women: 804 scanned by trainees under direct supervision and 940 scanned by trainees alone. Ultrasound identified 36 (2.1%) twin pregnancies, 230 (13.2%) breech presentations, 83 (4.8%) transverse presentations, and 22 (1.3%) cases of placenta previa. The detection rates for the above features were similar in the 2 groups. A subgroup of 230 (13.2%) women had a follow-up scan and 62 (3.6%) were referred to a doctor; 21 of these women required cesarean delivery.

Conclusion: Ultrasound training in a rural setting supported remotely is feasible and sustainable. It can help local healthcare workers to screen their prenatal populations for obstetric and neonatal risks, and therefore has the potential to improve outcomes at delivery and provide site specific epidemiologic data that can be used to develop new healthcare provision strategies.

Text C

The Role of Obstetric Ultrasound in Low Resource Settings

Poor maternal and child health (MCH) outcomes are a global, yet highly preventable problem. Evidence informs that the developing world accounts for the majority of the maternal mortality burden. Half a million women died of complications related to pregnancy in 2005, half of these in Africa and another third in South East Asia. Infant mortality is closely related and the trend is similar. About 3.1 million babies died before 28 days of age with 99% of these deaths occurring in middle and low income countries. Maternal mortality is the health indicator that shows the widest gap between rich and poor, both between and within countries. In Africa the maternal mortality ratio is 620 per 100,000 live births compared to 14 per 100,000 live births in developed countries. Within countries there are also disparities between urban and rural populations, with rural areas suffering worse outcomes. The potential to reduce maternal and neonatal deaths through the use of ultrasound is significant and addresses two of the millennium development goals (MDGs) including (i) MDG 4 which aims to reduce child mortality and (ii) MDG 5 which aims to improve maternal health. Improving the level of obstetric care is critical to address MCH outcomes and to accelerate progress toward achieving MDG 4 and 5 targets.

Text D

"Entertainment" Ultrasound Examinations

It has been proposed that natural-appearing 3-D ultrasound images of the fetus could improve parent fetal bonding. Given the recognized importance of maternal-child bonding immediately postpartum, it seems reasonable that extending this bonding experience into the fetal period could be beneficial. However, a psychological benefit of viewing fetal photos has not been proven, and obtaining such images largely remains in the realm of "entertainment". In some countries, parents are able to enter a photography studio with ultrasound facilities and leave with pictures suitable for framing: no physician involvement is needed for this event. The use of ultrasound for non-diagnostic purposes has been condemned by the American Institute of Ultrasound in Medicine and the American College of Obstetricians and Gynecologists. Concerns that were raised in their policy statements include possible adverse bio-effects of ultrasound energy, the possibility that an examination could give false reassurance to women, and the fact that abnormalities may be detected in settings where personnel are not prepared to discuss and provide follow-up for concerning findings.

14. What is the maternal mortality ratio in comparison with live births in developed nations?
________

15. Text A

An ultrasound scan, also referred to as sonography, uses high frequency sound waves to create an image of some part of the inside of the body, such as the stomach or muscles, by bouncing sound energy off tissue and translating the returning sound information into a visual representation. The word ultrasound", in physics, refers to all sound with a frequency humans cannot hear; in diagnostic ultrasound this is usually between 2 and 10 MHz. Higher frequencies provide better quality images, but are more readily absorbed by the skin and other tissue, so they cannot penetrate as deeply as lower frequencies. Lower frequencies can penetrate deeper, but the image quality is inferior. Obstetric ultrasound is performed routinely in most U.S. medical communities at about 20

weeks of gestation. Benefits include accurate dating, placental location, the diagnosis of multiple gestation or congenital abnormalities and the possible detection of maternal health risks.

Text B

Abstract: Implementing a obstetric ultrasound training program in rural Africa

Objective: To evaluate the feasibility and sustainability of basic obstetric ultrasound training in rural Africa.

Methods: An 8-week training course, led by UK-based sonographers, was supported by training videos and followed by 10 months of remotely supported scanning in Mandimba, Mozambique. Data were collected using an Android tablet and the EpiCollect web application.

Results : The study group included 1744 pregnant women: 804 scanned by trainees under direct supervision and 940 scanned by trainees alone. Ultrasound identified 36 (2.1%) twin pregnancies, 230 (13.2%) breech presentations, 83 (4.8%) transverse presentations, and 22 (1.3%) cases of placenta previa. The detection rates for the above features were similar in the 2 groups. A subgroup of 230 (13.2%) women had a follow-up scan and 62 (3.6%) were referred to a doctor; 21 of these women required cesarean delivery.

Conclusion: Ultrasound training in a rural setting supported remotely is feasible and sustainable. It can help local healthcare workers to screen their prenatal populations for obstetric and neonatal risks, and therefore has the potential to improve outcomes at delivery and provide site specific epidemiologic data that can be used to develop new healthcare provision strategies.

Text C

The Role of Obstetric Ultrasound in Low Resource Settings

Poor maternal and child health (MCH) outcomes are a global, yet highly preventable problem. Evidence informs that the developing world accounts for the majority of the maternal mortality burden. Half a million women died of complications related to pregnancy in 2005, half of these in Africa and another third in South East Asia. Infant mortality is closely related and the trend is similar. About 3.1 million babies died before 28 days of age with 99% of these deaths occurring in middle and low income countries. Maternal mortality is the health indicator that shows the widest gap between rich and poor, both between and within countries. In Africa the maternal mortality ratio is 620 per 100,000 live births compared to 14 per 100,000 live births in developed countries. Within countries there are also disparities between urban and rural populations, with rural areas suffering worse outcomes. The potential to reduce maternal and neonatal deaths through the use of ultrasound is significant and addresses two of the millennium development goals (MDGs) including (i) MDG 4 which aims to reduce child mortality and (ii) MDG 5 which aims to improve maternal health. Improving the level of obstetric care is critical to address MCH outcomes and to accelerate progress toward achieving MDG 4 and 5 targets.

Text D

"Entertainment" Ultrasound Examinations

It has been proposed that natural-appearing 3-D ultrasound images of the fetus could improve parent fetal bonding. Given the recognized importance of maternal-child bonding immediately postpartum, it seems reasonable that extending this bonding experience into the fetal period could be beneficial. However, a psychological benefit of viewing fetal photos has not been proven, and obtaining such images largely remains in the realm of "entertainment". In some countries, parents are able to enter a photography studio with ultrasound facilities and leave with pictures suitable for framing: no physician involvement is needed for this event. The use of ultrasound for non-diagnostic purposes has been condemned by the American Institute of Ultrasound in Medicine and the American College of Obstetricians and Gynecologists. Concerns that were raised in their policy statements include possible adverse bio-effects of ultrasound energy, the possibility that an examination could give false reassurance to women, and the fact that abnormalities may be detected in settings where personnel are not prepared to discuss and provide follow-up for concerning findings.

15. How many transverse presentations were identified in the study conducted in rural Africa?
________

16. Text A

An ultrasound scan, also referred to as sonography, uses high frequency sound waves to create an image of some part of the inside of the body, such as the stomach or muscles, by bouncing sound energy off tissue and translating the returning sound information into a visual representation. The word ultrasound", in physics, refers to all sound with a frequency humans cannot hear; in diagnostic ultrasound this is usually between 2 and 10 MHz. Higher frequencies provide better quality images, but are more readily absorbed by the skin and other tissue, so they cannot penetrate as deeply as lower frequencies. Lower frequencies can penetrate deeper, but the image quality is inferior. Obstetric ultrasound is performed routinely in most U.S. medical communities at about 20

weeks of gestation. Benefits include accurate dating, placental location, the diagnosis of multiple gestation or congenital abnormalities and the possible detection of maternal health risks.

Text B

Abstract: Implementing a obstetric ultrasound training program in rural Africa

Objective: To evaluate the feasibility and sustainability of basic obstetric ultrasound training in rural Africa.

Methods: An 8-week training course, led by UK-based sonographers, was supported by training videos and followed by 10 months of remotely supported scanning in Mandimba, Mozambique. Data were collected using an Android tablet and the EpiCollect web application.

Results : The study group included 1744 pregnant women: 804 scanned by trainees under direct supervision and 940 scanned by trainees alone. Ultrasound identified 36 (2.1%) twin pregnancies, 230 (13.2%) breech presentations, 83 (4.8%) transverse presentations, and 22 (1.3%) cases of placenta previa. The detection rates for the above features were similar in the 2 groups. A subgroup of 230 (13.2%) women had a follow-up scan and 62 (3.6%) were referred to a doctor; 21 of these women required cesarean delivery.

Conclusion: Ultrasound training in a rural setting supported remotely is feasible and sustainable. It can help local healthcare workers to screen their prenatal populations for obstetric and neonatal risks, and therefore has the potential to improve outcomes at delivery and provide site specific epidemiologic data that can be used to develop new healthcare provision strategies.

Text C

The Role of Obstetric Ultrasound in Low Resource Settings

Poor maternal and child health (MCH) outcomes are a global, yet highly preventable problem. Evidence informs that the developing world accounts for the majority of the maternal mortality burden. Half a million women died of complications related to pregnancy in 2005, half of these in Africa and another third in South East Asia. Infant mortality is closely related and the trend is similar. About 3.1 million babies died before 28 days of age with 99% of these deaths occurring in middle and low income countries. Maternal mortality is the health indicator that shows the widest gap between rich and poor, both between and within countries. In Africa the maternal mortality ratio is 620 per 100,000 live births compared to 14 per 100,000 live births in developed countries. Within countries there are also disparities between urban and rural populations, with rural areas suffering worse outcomes. The potential to reduce maternal and neonatal deaths through the use of ultrasound is significant and addresses two of the millennium development goals (MDGs) including (i) MDG 4 which aims to reduce child mortality and (ii) MDG 5 which aims to improve maternal health. Improving the level of obstetric care is critical to address MCH outcomes and to accelerate progress toward achieving MDG 4 and 5 targets.

Text D

"Entertainment" Ultrasound Examinations

It has been proposed that natural-appearing 3-D ultrasound images of the fetus could improve parent fetal bonding. Given the recognized importance of maternal-child bonding immediately postpartum, it seems reasonable that extending this bonding experience into the fetal period could be beneficial. However, a psychological benefit of viewing fetal photos has not been proven, and obtaining such images largely remains in the realm of "entertainment". In some countries, parents are able to enter a photography studio with ultrasound facilities and leave with pictures suitable for framing: no physician involvement is needed for this event. The use of ultrasound for non-diagnostic purposes has been condemned by the American Institute of Ultrasound in Medicine and the American College of Obstetricians and Gynecologists. Concerns that were raised in their policy statements include possible adverse bio-effects of ultrasound energy, the possibility that an examination could give false reassurance to women, and the fact that abnormalities may be detected in settings where personnel are not prepared to discuss and provide follow-up for concerning findings.

16. ____________________________ in a hinterland backdrop, which is assisted remotely is very practical.

17. Text A

An ultrasound scan, also referred to as sonography, uses high frequency sound waves to create an image of some part of the inside of the body, such as the stomach or muscles, by bouncing sound energy off tissue and translating the returning sound information into a visual representation. The word ultrasound", in physics, refers to all sound with a frequency humans cannot hear; in diagnostic ultrasound this is usually between 2 and 10 MHz. Higher frequencies provide better quality images, but are more readily absorbed by the skin and other tissue, so they cannot penetrate as deeply as lower frequencies. Lower frequencies can penetrate deeper, but the image quality is inferior. Obstetric ultrasound is performed routinely in most U.S. medical communities at about 20

weeks of gestation. Benefits include accurate dating, placental location, the diagnosis of multiple gestation or congenital abnormalities and the possible detection of maternal health risks.

Text B

Abstract: Implementing a obstetric ultrasound training program in rural Africa

Objective: To evaluate the feasibility and sustainability of basic obstetric ultrasound training in rural Africa.

Methods: An 8-week training course, led by UK-based sonographers, was supported by training videos and followed by 10 months of remotely supported scanning in Mandimba, Mozambique. Data were collected using an Android tablet and the EpiCollect web application.

Results : The study group included 1744 pregnant women: 804 scanned by trainees under direct supervision and 940 scanned by trainees alone. Ultrasound identified 36 (2.1%) twin pregnancies, 230 (13.2%) breech presentations, 83 (4.8%) transverse presentations, and 22 (1.3%) cases of placenta previa. The detection rates for the above features were similar in the 2 groups. A subgroup of 230 (13.2%) women had a follow-up scan and 62 (3.6%) were referred to a doctor; 21 of these women required cesarean delivery.

Conclusion: Ultrasound training in a rural setting supported remotely is feasible and sustainable. It can help local healthcare workers to screen their prenatal populations for obstetric and neonatal risks, and therefore has the potential to improve outcomes at delivery and provide site specific epidemiologic data that can be used to develop new healthcare provision strategies.

Text C

The Role of Obstetric Ultrasound in Low Resource Settings

Poor maternal and child health (MCH) outcomes are a global, yet highly preventable problem. Evidence informs that the developing world accounts for the majority of the maternal mortality burden. Half a million women died of complications related to pregnancy in 2005, half of these in Africa and another third in South East Asia. Infant mortality is closely related and the trend is similar. About 3.1 million babies died before 28 days of age with 99% of these deaths occurring in middle and low income countries. Maternal mortality is the health indicator that shows the widest gap between rich and poor, both between and within countries. In Africa the maternal mortality ratio is 620 per 100,000 live births compared to 14 per 100,000 live births in developed countries. Within countries there are also disparities between urban and rural populations, with rural areas suffering worse outcomes. The potential to reduce maternal and neonatal deaths through the use of ultrasound is significant and addresses two of the millennium development goals (MDGs) including (i) MDG 4 which aims to reduce child mortality and (ii) MDG 5 which aims to improve maternal health. Improving the level of obstetric care is critical to address MCH outcomes and to accelerate progress toward achieving MDG 4 and 5 targets.

Text D

"Entertainment" Ultrasound Examinations

It has been proposed that natural-appearing 3-D ultrasound images of the fetus could improve parent fetal bonding. Given the recognized importance of maternal-child bonding immediately postpartum, it seems reasonable that extending this bonding experience into the fetal period could be beneficial. However, a psychological benefit of viewing fetal photos has not been proven, and obtaining such images largely remains in the realm of "entertainment". In some countries, parents are able to enter a photography studio with ultrasound facilities and leave with pictures suitable for framing: no physician involvement is needed for this event. The use of ultrasound for non-diagnostic purposes has been condemned by the American Institute of Ultrasound in Medicine and the American College of Obstetricians and Gynecologists. Concerns that were raised in their policy statements include possible adverse bio-effects of ultrasound energy, the possibility that an examination could give false reassurance to women, and the fact that abnormalities may be detected in settings where personnel are not prepared to discuss and provide follow-up for concerning findings.

17. The adverse bio-effects of ultrasound energy is a major _________________ brought up by the American Institute of Ultrasound in Medicine.

18. Text A

An ultrasound scan, also referred to as sonography, uses high frequency sound waves to create an image of some part of the inside of the body, such as the stomach or muscles, by bouncing sound energy off tissue and translating the returning sound information into a visual representation. The word ultrasound", in physics, refers to all sound with a frequency humans cannot hear; in diagnostic ultrasound this is usually between 2 and 10 MHz. Higher frequencies provide better quality images, but are more readily absorbed by the skin and other tissue, so they cannot penetrate as deeply as lower frequencies. Lower frequencies can penetrate deeper, but the image quality is inferior. Obstetric ultrasound is performed routinely in most U.S. medical communities at about 20

weeks of gestation. Benefits include accurate dating, placental location, the diagnosis of multiple gestation or congenital abnormalities and the possible detection of maternal health risks.

Text B

Abstract: Implementing a obstetric ultrasound training program in rural Africa

Objective: To evaluate the feasibility and sustainability of basic obstetric ultrasound training in rural Africa.

Methods: An 8-week training course, led by UK-based sonographers, was supported by training videos and followed by 10 months of remotely supported scanning in Mandimba, Mozambique. Data were collected using an Android tablet and the EpiCollect web application.

Results : The study group included 1744 pregnant women: 804 scanned by trainees under direct supervision and 940 scanned by trainees alone. Ultrasound identified 36 (2.1%) twin pregnancies, 230 (13.2%) breech presentations, 83 (4.8%) transverse presentations, and 22 (1.3%) cases of placenta previa. The detection rates for the above features were similar in the 2 groups. A subgroup of 230 (13.2%) women had a follow-up scan and 62 (3.6%) were referred to a doctor; 21 of these women required cesarean delivery.

Conclusion: Ultrasound training in a rural setting supported remotely is feasible and sustainable. It can help local healthcare workers to screen their prenatal populations for obstetric and neonatal risks, and therefore has the potential to improve outcomes at delivery and provide site specific epidemiologic data that can be used to develop new healthcare provision strategies.

Text C

The Role of Obstetric Ultrasound in Low Resource Settings

Poor maternal and child health (MCH) outcomes are a global, yet highly preventable problem. Evidence informs that the developing world accounts for the majority of the maternal mortality burden. Half a million women died of complications related to pregnancy in 2005, half of these in Africa and another third in South East Asia. Infant mortality is closely related and the trend is similar. About 3.1 million babies died before 28 days of age with 99% of these deaths occurring in middle and low income countries. Maternal mortality is the health indicator that shows the widest gap between rich and poor, both between and within countries. In Africa the maternal mortality ratio is 620 per 100,000 live births compared to 14 per 100,000 live births in developed countries. Within countries there are also disparities between urban and rural populations, with rural areas suffering worse outcomes. The potential to reduce maternal and neonatal deaths through the use of ultrasound is significant and addresses two of the millennium development goals (MDGs) including (i) MDG 4 which aims to reduce child mortality and (ii) MDG 5 which aims to improve maternal health. Improving the level of obstetric care is critical to address MCH outcomes and to accelerate progress toward achieving MDG 4 and 5 targets.

Text D

"Entertainment" Ultrasound Examinations

It has been proposed that natural-appearing 3-D ultrasound images of the fetus could improve parent fetal bonding. Given the recognized importance of maternal-child bonding immediately postpartum, it seems reasonable that extending this bonding experience into the fetal period could be beneficial. However, a psychological benefit of viewing fetal photos has not been proven, and obtaining such images largely remains in the realm of "entertainment". In some countries, parents are able to enter a photography studio with ultrasound facilities and leave with pictures suitable for framing: no physician involvement is needed for this event. The use of ultrasound for non-diagnostic purposes has been condemned by the American Institute of Ultrasound in Medicine and the American College of Obstetricians and Gynecologists. Concerns that were raised in their policy statements include possible adverse bio-effects of ultrasound energy, the possibility that an examination could give false reassurance to women, and the fact that abnormalities may be detected in settings where personnel are not prepared to discuss and provide follow-up for concerning findings.

18. Advancements in ____________________________ is vital to eliminate the adverse outcomes of MCH globally.

19. Text A

An ultrasound scan, also referred to as sonography, uses high frequency sound waves to create an image of some part of the inside of the body, such as the stomach or muscles, by bouncing sound energy off tissue and translating the returning sound information into a visual representation. The word ultrasound", in physics, refers to all sound with a frequency humans cannot hear; in diagnostic ultrasound this is usually between 2 and 10 MHz. Higher frequencies provide better quality images, but are more readily absorbed by the skin and other tissue, so they cannot penetrate as deeply as lower frequencies. Lower frequencies can penetrate deeper, but the image quality is inferior. Obstetric ultrasound is performed routinely in most U.S. medical communities at about 20

weeks of gestation. Benefits include accurate dating, placental location, the diagnosis of multiple gestation or congenital abnormalities and the possible detection of maternal health risks.

Text B

Abstract: Implementing a obstetric ultrasound training program in rural Africa

Objective: To evaluate the feasibility and sustainability of basic obstetric ultrasound training in rural Africa.

Methods: An 8-week training course, led by UK-based sonographers, was supported by training videos and followed by 10 months of remotely supported scanning in Mandimba, Mozambique. Data were collected using an Android tablet and the EpiCollect web application.

Results : The study group included 1744 pregnant women: 804 scanned by trainees under direct supervision and 940 scanned by trainees alone. Ultrasound identified 36 (2.1%) twin pregnancies, 230 (13.2%) breech presentations, 83 (4.8%) transverse presentations, and 22 (1.3%) cases of placenta previa. The detection rates for the above features were similar in the 2 groups. A subgroup of 230 (13.2%) women had a follow-up scan and 62 (3.6%) were referred to a doctor; 21 of these women required cesarean delivery.

Conclusion: Ultrasound training in a rural setting supported remotely is feasible and sustainable. It can help local healthcare workers to screen their prenatal populations for obstetric and neonatal risks, and therefore has the potential to improve outcomes at delivery and provide site specific epidemiologic data that can be used to develop new healthcare provision strategies.

Text C

The Role of Obstetric Ultrasound in Low Resource Settings

Poor maternal and child health (MCH) outcomes are a global, yet highly preventable problem. Evidence informs that the developing world accounts for the majority of the maternal mortality burden. Half a million women died of complications related to pregnancy in 2005, half of these in Africa and another third in South East Asia. Infant mortality is closely related and the trend is similar. About 3.1 million babies died before 28 days of age with 99% of these deaths occurring in middle and low income countries. Maternal mortality is the health indicator that shows the widest gap between rich and poor, both between and within countries. In Africa the maternal mortality ratio is 620 per 100,000 live births compared to 14 per 100,000 live births in developed countries. Within countries there are also disparities between urban and rural populations, with rural areas suffering worse outcomes. The potential to reduce maternal and neonatal deaths through the use of ultrasound is significant and addresses two of the millennium development goals (MDGs) including (i) MDG 4 which aims to reduce child mortality and (ii) MDG 5 which aims to improve maternal health. Improving the level of obstetric care is critical to address MCH outcomes and to accelerate progress toward achieving MDG 4 and 5 targets.

Text D

"Entertainment" Ultrasound Examinations

It has been proposed that natural-appearing 3-D ultrasound images of the fetus could improve parent fetal bonding. Given the recognized importance of maternal-child bonding immediately postpartum, it seems reasonable that extending this bonding experience into the fetal period could be beneficial. However, a psychological benefit of viewing fetal photos has not been proven, and obtaining such images largely remains in the realm of "entertainment". In some countries, parents are able to enter a photography studio with ultrasound facilities and leave with pictures suitable for framing: no physician involvement is needed for this event. The use of ultrasound for non-diagnostic purposes has been condemned by the American Institute of Ultrasound in Medicine and the American College of Obstetricians and Gynecologists. Concerns that were raised in their policy statements include possible adverse bio-effects of ultrasound energy, the possibility that an examination could give false reassurance to women, and the fact that abnormalities may be detected in settings where personnel are not prepared to discuss and provide follow-up for concerning findings.

19. ____________________________ can penetrate through skin and provide superior image quality.

20. Text A

An ultrasound scan, also referred to as sonography, uses high frequency sound waves to create an image of some part of the inside of the body, such as the stomach or muscles, by bouncing sound energy off tissue and translating the returning sound information into a visual representation. The word ultrasound", in physics, refers to all sound with a frequency humans cannot hear; in diagnostic ultrasound this is usually between 2 and 10 MHz. Higher frequencies provide better quality images, but are more readily absorbed by the skin and other tissue, so they cannot penetrate as deeply as lower frequencies. Lower frequencies can penetrate deeper, but the image quality is inferior. Obstetric ultrasound is performed routinely in most U.S. medical communities at about 20

weeks of gestation. Benefits include accurate dating, placental location, the diagnosis of multiple gestation or congenital abnormalities and the possible detection of maternal health risks.

Text B

Abstract: Implementing a obstetric ultrasound training program in rural Africa

Objective: To evaluate the feasibility and sustainability of basic obstetric ultrasound training in rural Africa.

Methods: An 8-week training course, led by UK-based sonographers, was supported by training videos and followed by 10 months of remotely supported scanning in Mandimba, Mozambique. Data were collected using an Android tablet and the EpiCollect web application.

Results : The study group included 1744 pregnant women: 804 scanned by trainees under direct supervision and 940 scanned by trainees alone. Ultrasound identified 36 (2.1%) twin pregnancies, 230 (13.2%) breech presentations, 83 (4.8%) transverse presentations, and 22 (1.3%) cases of placenta previa. The detection rates for the above features were similar in the 2 groups. A subgroup of 230 (13.2%) women had a follow-up scan and 62 (3.6%) were referred to a doctor; 21 of these women required cesarean delivery.

Conclusion: Ultrasound training in a rural setting supported remotely is feasible and sustainable. It can help local healthcare workers to screen their prenatal populations for obstetric and neonatal risks, and therefore has the potential to improve outcomes at delivery and provide site specific epidemiologic data that can be used to develop new healthcare provision strategies.

Text C

The Role of Obstetric Ultrasound in Low Resource Settings

Poor maternal and child health (MCH) outcomes are a global, yet highly preventable problem. Evidence informs that the developing world accounts for the majority of the maternal mortality burden. Half a million women died of complications related to pregnancy in 2005, half of these in Africa and another third in South East Asia. Infant mortality is closely related and the trend is similar. About 3.1 million babies died before 28 days of age with 99% of these deaths occurring in middle and low income countries. Maternal mortality is the health indicator that shows the widest gap between rich and poor, both between and within countries. In Africa the maternal mortality ratio is 620 per 100,000 live births compared to 14 per 100,000 live births in developed countries. Within countries there are also disparities between urban and rural populations, with rural areas suffering worse outcomes. The potential to reduce maternal and neonatal deaths through the use of ultrasound is significant and addresses two of the millennium development goals (MDGs) including (i) MDG 4 which aims to reduce child mortality and (ii) MDG 5 which aims to improve maternal health. Improving the level of obstetric care is critical to address MCH outcomes and to accelerate progress toward achieving MDG 4 and 5 targets.

Text D

"Entertainment" Ultrasound Examinations

It has been proposed that natural-appearing 3-D ultrasound images of the fetus could improve parent fetal bonding. Given the recognized importance of maternal-child bonding immediately postpartum, it seems reasonable that extending this bonding experience into the fetal period could be beneficial. However, a psychological benefit of viewing fetal photos has not been proven, and obtaining such images largely remains in the realm of "entertainment". In some countries, parents are able to enter a photography studio with ultrasound facilities and leave with pictures suitable for framing: no physician involvement is needed for this event. The use of ultrasound for non-diagnostic purposes has been condemned by the American Institute of Ultrasound in Medicine and the American College of Obstetricians and Gynecologists. Concerns that were raised in their policy statements include possible adverse bio-effects of ultrasound energy, the possibility that an examination could give false reassurance to women, and the fact that abnormalities may be detected in settings where personnel are not prepared to discuss and provide follow-up for concerning findings.

20. The significance of ____________________________ is identified as essential, soon after the fetal period.