Reading: Part A - Answer booklet Instructions ‘TIME LIMIT: 15 MINUTES + Complete the following summary using the information in the four texts, A1-A4, provided on pages 2 and 3 of the Text booklet. + You do nat need to read each text from beginning to end to complete the task. You should scan the texts to find the formation you need. + Gaps may require 1, 2 or 3 words. You will not receive any marks if you write more than 3 words. + You should write your answers next tothe appropriate number in the right-hand column, + Please use correct spelling in your responses. Do not use abbreviations unless they appear in the texts. ‘Summary. ‘Answers Mate Obstetric ultrasound it | Medical ultrasound uses high frequency sound 2 ‘waves which are bounced off internal tissue to create =f echoes that can then be made into. (y,,.Medical | 3, ultrasound, also known as sonography is, sed in some countries, such as the US, to understand 4, several obstetric issues, for example, the position of the. @,,.. the possibility of gy. pregnancy and | 5. congenital Issues, and the | (5, of conception. Rates of maternal. ¢g,,,.due to complications in pregnancy, | 6. highest in Africa and |). according to the data, area... that demonstrates a marked difference | 7. between rich and poor. Correspondingly, nearly all of the __g,., babies who died before reaching (4g), of | 8 ‘age were born in low or middle income countries. The outcomes in (1)... af even worse. Itis thought that | 8. ‘the use of ultrasound could reduce these death rates, ‘thus helping to achieve two. (a, 10. " [Continued on next pags 12.‘Summary Answers One study found that implementing | yg), in rural setting in Africa was both (ya,__.and 46). After being trained by sonographers besed in yg), local health workers in Mozambique were divided into two «groups: those that conducted the scanning 7). and those that worked alone. The identification rates of the pregnancy issues detected by the two groups were -a{t8).. Soteening populations for risks can lead to better delivery outcomes as well as producing data to develop new ig, By improving obstetric care itis hoped thet the African maternal mortality ratio of -20),., P&F 100,000 live births can be reduced. ‘As ultrasound technology becomes more readily available, different concerns also arise. More life-like (21). ultrasound images of the foetus have led to a ‘market in which ultrasound is being used for |g)... purposes and, in some places, parents can obtain ultrasound images from ga), without any need for @ 4... Although there is an argument that these pictures could help jg, between parents and their unborn baby, this has not been established. Moreover, the practice is gq). by some medical associations because of the potential (gr, _ of ultrasound as well as the lack of medical involvement, which could lead to findings not being |g... 13. 14, 15. 16. 17. 18. 19. 20. 21. 22, 23, 24, 25. 26. 27. 28. END OF PART A THIS ANSWER BOOKLET WILL BE COLLECTED Markers use onlyReading: Part A - Text booklet Instructions TIME LIMIT: 15 MINUTES. + Complete the summary on pages 2 and 3 of Part A - Answer booklet using the information in the four texts (A1-Ad) below. + You do not need to read each text from beginning to end to complete the task. You should scan the texts to find the information you need. + Gaps may require 1, 2 or 3 words, Answer ALL questions. Marks are NOT deducted for incorrect answers. + You should write your answers next to the appropriate number in the right-hand column, + Please use correct spelling in your responses. Do not use abbreviations unless they appear in the texts. Obstetric ultrasound: Texts Obstetric Ultrasound ‘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 Miz, 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. ‘Abstract: Implementing an 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 rrisks, 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 Texts continue on the next pagea ‘The Role of Obstetric Ultrasound in Low Resource Settings Poor maternal and child health (MCE) 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 Azia. 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 (i) 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 6 targets. “Entertainment” Ultrasound Examinations It has been proposed that natural-appearing 3-D ultrasound images of the fetus could improve parent- fetal bonding. Given the recognised 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 biveffects 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. END OF PART A THIS TEXT BOOKLET WILL BE COLLECTED