The Georgia Rural Health Innovation Center recognizes the value of creating community-centric models to improve availability and access to care, in particular, preserving local access to care. The Center has identified a unique opportunity to yield cutting-edge research data as part of its Maternal Mental Health Improvement Pilot Project.

The Centers for Disease Control and Prevention (CDC) reported that maternal deaths and mortality rates are progressively rising in the U.S., according to 2018-2020 data.¹ However, Georgia, which formerly topped the list as the state with the highest maternal mortality rate, dropped to the seventh highest with a rate of 33.9 maternal deaths per 100,000 live births for all women.¹

Credible sources, such as the American Academy of Pediatrics and the American College of Obstetrics and Gynecologists, inform us that fetal ultrasonography imaging is the most commonly used fetal imaging tool and is an accurate method of determining gestational age, fetal number, viability, and placental location.² Routine prenatal care, including fetal ultrasound, should be performed throughout pregnancy on all women to identify risk factors and initiate preventive care measures.³ Rural pregnant women are at increased risk of late or no initiation of prenatal care all due to their lack of access and resources.⁴ As a means to combat this significant health disparity, we at the Georgia Rural Health Innovation Center want to bring monthly prenatal, obstetrical, and postpartum services to rural Georgia counties that currently do not have any.⁵

To start, working with approved practice guidelines for the performance of obstetrical ultrasound, our pilot program aims to compare the hand-held ultrasound device with the traditional office-based imaging machine when performing obstetrical sonographic studies. Comprehensive data will be collected as directed by the physicians and partners to evaluate effectiveness and outcomes. Ultimately, the goal is for project results to expand obstetrical ultrasound access to rural counties across Georgia.

The Center has partnered with Dr. Joy Baker, a renowned OB/GYN physician with the WellStar Health System, to carry out the implementation and data analysis of this project. The project is comprised of four phases, listed as follows: Phase 1—Training; Phase 2—Recruitment; Phase 3—Acquisition of sonographic images; and Phase 4—Data Analysis. In each of these phases, the personally identifiable information (PII) of all patients will be kept confidential and removed from documentation and electronic files for sake of privacy. To briefly note the components of each phase,

Phase 1—Training—In this phase, staff from the Center will arrange and coordinate training for personnel at the WellStar office who will be utilizing the handheld ultrasound equipment. Staff in Dr. Baker’s OB/GYN office will host, participate, and complete training on the equipment to ensure the efficacy of the data collected.
Phase 2—Recruitment—In this phase, Dr. Baker’s staff will assist in the attainment of 10 women interested in participating in the project of undergoing 2 sets of ultrasounds, one with office-based stationary equipment and one with handheld equipment.
Phase 3—Acquisition of sonographic images—In this phase, the 10 participants will attend their prenatal appointments and have two sets of sonographic images taken of their fetus to be used for 1) their standard prenatal care and 2) data analysis for this project
Phase 4—Data Analysis—In this phase, physicians and sonographers will complete a comparative review of both sets of images looking for any differences in medical quality, image accuracy, and more.

Following the completion of data analysis for this project’s sonographic images, we are anticipating that the review will showcase that the handheld equipment is just as effective and of quality as the stationary equipment. With hopes of learning this information, we at the Center can share this information with our partner physicians and providers in the field of Maternal Health as a means to encourage the active use of handheld equipment in their offices providing prenatal care to pregnant women. In fact, it is our highest mission to influence these providers to expand their outreach of services by visiting the homes of women in rural towns of Georgia that lack maternal care. We aim to complete this project this spring and have a summary of results to share by summer 2023.

Sources:

[1] Centers for Disease Control and Prevention. (n.d.). Maternal deaths and mortality rates. Maternal deaths and mortality rates by state for 2018-2020. Retrieved April 4, 2023, from https://www.cdc.gov/nchs/maternal-mortality/MMR-2018-2021-State-Data.pdf

[2] American Academy of Pediatrics and the American College of Obstetricians and Gynecologists. (September 2017). Guidelines for Perinatal Care. Eighth Edition. Retrieved from https://www.acog.org/clinical-information/physician-faqs/-/media/3a22e153b67446a6b31fb051e469187c.ashx

[3] American Academy of Pediatrics and American College of Obstetricians and Gynecologists. (October 2012). Guidelines for Perinatal Care. Seventh Edition. Retrieved from https://www.healthpartnersplans.com/media/100339243/acog-guidelines-for-perinatal-care.pdf

[4] Centers for Medicare and Medicaid Services. Improving Access to Maternal Health Care in Rural Communities. (September 2019). Retrieved from https://www.cms.gov/About-CMS/Agency-Information/OMH/equity-initiatives/rural-health/09032019-Maternal-Health-Care-in-Rural-Communities.pdf

[5] Rural Health Information Hub. (August 2020). Maternal and Obstetric Care Challenges in Rural American from National Advisory Committee on Rural Health and Human Services. Retrieved from https://www.ruralhealthinfo.org/assets/3749-15835/maternal health-nacrhhs-082620.pdf