Assessing the impact of routine prenatal ultrasound on pregnancy and perinatal outcomes in low-resource settings: A systematic review protocol.

BACKGROUND

Obstetric ultrasound is integral to pregnancy care, yet access remains limited in low-resource settings, potentially contributing to preventable maternal and perinatal mortality.

OBJECTIVE

To systematically identify, critically appraise and synthesise evidence on the impact of routine prenatal ultrasound on pregnancy, maternal and perinatal outcomes in low-resource settings.

ELIGIBILITY CRITERIA: Pregnant women in low-income countries (World Bank GNI per capita ≤US$1135) or low-resource facilities in lower-middle-income countries. Eligible studies compare routine prenatal ultrasound against any setting where ultrasound is not systematically offered to all pregnant women, including no ultrasound access, selective ultrasound only, or ultrasound available but not routinely provided. All comparator types will be included in the primary pooled analysis, with comparator type explored as a pre-specified subgroup.

INFORMATION SOURCES: Seven databases (MEDLINE, Embase, CINAHL, Cochrane CENTRAL, Scopus, Maternity and Infant Care, Global Index Medicus) searched from January 1980 to 30 June 2026, with no language restriction.

RISK OF BIAS: The Scottish Intercollegiate Guidelines Network (SIGN) checklist for randomised trials; Newcastle-Ottawa Scale (NOS) for observational studies.

SYNTHESIS: Random-effects meta-analysis (DerSimonian-Laird); narrative synthesis following SWiM where pooling is not feasible.

CERTAINTY OF EVIDENCE: GRADE applied across five domains for co-primary outcomes (perinatal mortality; maternal mortality) and all secondary outcomes.

REGISTRATION: PROSPERO CRD42023474088.