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Cardiac complications are a leading cause of maternal death worldwide. Cardiac imaging with echocardiography is important for prompt diagnosis, but it is not available in many resource-limited settings. This is why we have developed Focused Cardiac Ultrasound (FoCUS) Solutions, a simplified protocol, used together with a hand-held cardiac ultrasound machine, to detect the presence of cardiac abnormalities in pregnant and postpartum women.

FoCUS Solutions is recommended for screening and triage to facilitate early diagnosis and to streamline the referral process. It is not intended to be used for confirmatory diagnosis and treatment purposes. For diagnosis, referral and treatment processes, we advise end users to follow the clinical guidance suggested by their local healthcare authorities.

This training resource is designed to be used by healthcare providers working in resource-limited settings around the world. The healthcare providers could be obstetricians, community medical officers, primary care providers or nurses.

We recommend that FoCUS Solutions be used alongside supervised in-person training in image acquisition in a ‘train-the-trainer’ format in the first instance. This training resource (animation video) is provided to enhance the learning experience and allow healthcare providers to train themselves and test their knowledge in their own time and at their own pace, after receiving the initial supervised training.

FoCUS Solutions can be used for screening pregnant women who present with suspected heart problems or pre-existing rheumatic heart disease and symptoms like severe anaemia, high blood pressure, palpitation or difficulty in breathing.

FoCUS Solutions is recommended for screening and triage to facilitate early diagnosis and to streamline the referral process. It is not intended to be used for confirmatory diagnosis and treatment purposes. For diagnosis, referral and treatment processes, we advise end users to follow the clinical guidance suggested by their local healthcare authorities.

We want to improve our resources and ensure that our training materials are widely accessible and relevant to those who use them. We would appreciate your feedback on our animation training resource using this short survey. 

  • Ministry of Health and Social Services, Namibia, 2022. Report on the confidential enquiry into maternal deaths, stillbirths and neonatal deaths (1 April 2018 to 31 March 2021). Windhoek.
  • Nair M, MaatHRI Writing Group. EClinicalMedicine 2021 Sep:39:101063. doi: 10.1016/j.eclinm.2021.101063 

Please add the following reference when using the FoCUS Solutions resources:

Alsharqi, M., V. A. Ismavel, L. Arnold, S. S. Choudhury, C. Solomi V, S. Rao, T. Nath, A. Rani, I. Goel, S. D. Kakoty, P. Mahanta, I. Roy, R. Deka, C. Opondo, C. Baigent, P. Leeson and M. Nair. Focused cardiac ultrasound to guide the diagnosis of heart failure in pregnant women in India. Journal American Society of Echocardiography.2022

Please contact Associate Professor Manisha Nair to learn more about FoCUS Solutions. If you have any suggestions about this training resource, please email us

This work was made possible by funding from the Medical Research Council (MRC), the Medical Research Foundation (MRF) and Ultromics Ltd UK. 

We thank all the MaatHRI collaborators and study participants. We also thank the collaborating hospitals in India who support this project:

  • Assam Medical College and Hospital, Dibrugarh
  • F.A.A Medical College and Hospital, Barpeta
  • Gauhati Medical College and Hospital, Guwahati
  • Jorhat Medical College and Hospital, Jorhat
  • Silchar Medical College and Hospital, Silchar
  • Makunda Christian Leprosy and General Hospital, Karimganj
  • Nazareth Hospital, Laitumkhrah, Shillong
  • Institute of Medical Sciences, Varanasi
  • Sewa Bhawan Hospital Society.

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