Feasibility and early clinical yield of handheld AI-assisted obstetric point-of-care ultrasound in routine antenatal care: a pilot study in Addis Ababa, Ethiopia

Background: The World Health Organization recommends at least one ultrasound examination before 24 weeks of gestation to improve gestational-age assessment and detection of multiple pregnancy and fetal anomalies. However, access to obstetric ultrasound at the primary-care level remains limited in many low-resource settings, including Ethiopia. This study evaluated the feasibility and early clinical yield of integrating AI-enabled handheld obstetric point-of-care ultrasound (POCUS) into routine antenatal care in four government health centers in Addis Ababa. Methods: We conducted a 4-week prospective pilot across four urban health centers (Abuare, Signal-Woreda 7, Kebena, and Janmeda). Pregnant women attending routine antenatal care (ANC) underwent focused obstetric POCUS using Butterfly handheld devices. Trained frontline providers, mainly junior GPs and midwives, performed scans using a standardized acquisition form, while clinical data were entered into REDCap and linked to archived image records on the Butterfly cloud platform. Primary outcomes were the feasibility of workflow integration, completeness of focused scan variables, the spectrum of focused obstetric findings, and referrals generated. Results: A total of 101 women were scanned. Mean maternal age was 28.3 years (SD 4.4); median gravidity was 2 (IQR 1–3), and median parity was 1 (IQR 0–2). Ultrasound-estimated gestational age was recorded in 100/101 women (median 30 weeks; IQR 16.8–33.0). Fetal cardiac activity was present in 92/99 (92.9%), absent in 4/99 (4.0%), and indeterminate in 3/99 (3.0%). Fetal presentation was cephalic in 65/101 (64.4%), breech in 5/101 (5.0%), transverse in 17/101 (16.8%), and indeterminate in 14/101 (13.9%). Placental location was low-lying in 1/100 (1.0%), and qualitative amniotic fluid was low in 1/100 (1.0%). Seven of 99 women (7.1%) were referred to a higher-level facility. A binary normal-scan indicator classified 93/101 scans (92.1%) as normal. Conclusions: Handheld focused obstetric POCUS was operationally feasible within routine urban ANC and identified a clinically relevant minority of women requiring referral or further review. Larger studies with standardized expert over-read, referral follow-up, and explicit image-quality metrics are needed before stronger claims about referral optimization or broader clinical impact can be made.