Retrospective Multifacility Evaluation of the Rural Obstetric Ultrasound Program's Impact on Antenatal Care

Rural women in Nepal continue to face challenges accessing antenatal care (ANC). To address these challenges, the rural obstetric ultrasound program (ROUSG) was introduced to bring basic ultrasound services to rural health facilities, enabling earlier detection of complications and timely referral. This study assessed whether ROUSG improved ANC attendance, complication detection, and perinatal outcomes.

This retrospective comparative study was conducted at seven health facilities in Kailari Rural Municipality, Kailali District. ANC records of women aged 20-49 were compared across two 12-month periods: before and after ROUSG implementation. Data were analysed using descriptive and inferential statistical tests, with significance set at p ? 0.05.

After implementation of ROUSG, the distribution of delivery methods differed significantly (p = 0.032), with fewer vaginal deliveries and more assisted deliveries. A higher proportion of complications was identified, including malpresentation (1.1% vs. 1.9%), hypertension (1.1% vs. 2.3%), and abortion-related complications (1.6% vs. 2.1%). In contrast, early ANC attendance (first and second visits) and facility-based deliveries remained largely unchanged. Maternal mortality was zero in both periods, and neonatal mortality remained low at 0.3% (2 cases) in the pre-ROUSG group and 0.2% (1 case) in the post-ROUSG group.

The ROUSG program was associated with greater identification of pregnancy-related complications and changes in delivery management, but no increase in ANC attendance or facility deliveries. These findings suggest that while ultrasound strengthens diagnostic capacity, persistent barriers such as cultural norms, transportation challenges, and limited counselling must also be addressed to improve maternal care-seeking behaviours in rural Nepal.