Referral Completion and Diagnostic Concordance of Obstetric Point-Of-Care Ultrasound Findings in Kenya

Background Obstetric point-of-care ultrasound (OPOCUS) can enhance early detection of high-risk conditions such as multiple gestation, abnormal placentation, and malpresentation, facilitating timely referral and intervention. While adoption across low- and middle-income countries (LMICs) is growing, limited evidence exists on referral completion and diagnostic concordance between frontline OPOCUS findings and assessments at referral facilities. This study evaluated these outcomes within Kenya’s primary healthcare system. Methods We conducted a prospective study of OPOCUS referral records from 115 Basic and Comprehensive Emergency Obstetric and Newborn Care (BEmONC and CEmONC) facilities across eight Kenyan counties over six months (February–July 2025). Referral completion was defined as confirmation of arrival at the receiving facility, while diagnostic concordance represented agreement between referring and receiving diagnoses. Results Of 565 recorded referrals, 471 (83%) were successfully traced and of these, 434 (92%) completed their referrals. Financial constraints accounted for most non-completions. Breech presentation (46%) and multiple gestations (24%) were the most common referral reasons. Overall diagnostic concordance was 75.3%, highest for multiple gestation (86.3%) and lowest for abnormal placental location (57%). There were significant statistical differences in concordance by obstetric parameters for both BEmONC (p = 0.043) and CEmONC facilities (p = 0.031). Marked county variation in referral completion was observed, with Turkana reporting the highest loss to follow-up (43%). Conclusion OPOCUS-supported referrals demonstrated strong completion and diagnostic agreement, underscoring its potential to strengthen maternal referral systems in resource-limited settings. Strengthened training and mentorship, documentation, and financial support mechanisms could further enhance accuracy and continuity of OPOCUS-driven referrals in LMICs.