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A lack of ultrasound equipment and training for rural clinicians is contributing to higher mortality and fetal abnormalities in remote Australia.

Rural health professionals identified significant obstacles in their ability to provide antenatal ultrasound services, in a national survey conducted by the University of South Australia (UniSA).

While a scarcity of ultrasound equipment and training are the major issues, costs of scans and travel, and limited awareness among pregnant rural women about the value of ultrasound are contributing factors to poorer perinatal outcomes. Maternal and perinatal death rates in these regions are double that of metropolitan and regional sites.

Rural patients faced complex sociocultural, economic and environmental barriers when accessing pregnancy services, UniSA lecturer in medical radiation, registered nurse and report co-author, Amber Bidner, said.

Amber Bidner pictured with pregnant volunteer Sophie Kieliszek

“We need a coordinated approach to combat the inequities between metropolitan, rural and remote areas when it comes to meeting the needs of pregnant women,” she said.

The cost of scans and access to Medicare rebates for antenatal imaging need review, coupled with targeted ultrasound education campaigns delivered to pregnant women about the benefits of ultrasound in early pregnancy, the survey found.

Clinicians report that more than four times as many women in remote areas do not consider antenatal ultrasound necessary.

Obstetricians recommend at least one ultrasound scan in the first trimester to estimate gestational age, reduce post-term deliveries, detect multiple pregnancies and fetal abnormalities. For women in major cities and large regional centres, this standard of care is readily accessible and resourced by skilled sonographers. This is not the case in rural areas.

“Rural clinicians face significant obstacles accessing training and opportunities to advance their clinical practice. Portable ultrasound machines and local training schemes are high priorities, alongside mentoring and accreditation of health professionals.

“Upskilling rural clinicians would help patients to access essential antenatal ultrasound services in their communities, ensuring they meet critical health priorities as well as reduce unnecessary travel,” Ms Bidner said.

The logistical challenges and limited workforce in remote regions could see clinicians being trained online and telehealth options explored for ultrasound education. Augmented reality simulated technologies with similar capabilities are also emerging as viable tools for distance education and support.

Rural pregnant women need improved access to ultrasound services

“Hopefully this report will inform future policies and practice regarding the delivery of antenatal ultrasound services and the training and continued professional development of healthcare clinicians in rural Australia,” Ms Bidner said.

National needs analysis survey examining accessibility to antenatal ultrasound and training in rural Australia is published in journal Ultrasound in Obstetrics and Gynecology

Amber Bidner is a registered nurse, nuclear medicine scientist and Research Project Manager for UniSA’s Healthy Newborn Project (HNP). In October 2022 she won the SA Women in Innovation Award in the Rural, Regional and Remote category.