Open Access Highly Accessed Open Badges Research article

Impact of a standardized training program on midwives’ ability to assess fetal heart anatomy by ultrasound

Eric Hildebrand1*, Madeleine Abrandt Dahlgren2, Catarina Sved34, Tomas Gottvall1, Marie Blomberg1 and Birgitta Janerot-Sjoberg3567

Author Affiliations

1 Department of Obstetrics and Gynaecology, and Department of Clinical and Experimental Medicine, Linköping University, Linköping, Sweden

2 Department of Medicine and Health Sciences, Faculty of Health Sciences, Linköping University, Linköping, Sweden

3 Department of Clinical Physiology and Nuclear Medicine, University Hospital, Linköping, Sweden

4 Department of Medicine & Health, Division of Cardiovascular medicine, Faculty of Health Sciences, Linköping University, Linköping, Sweden

5 Department Biomedical Engineering, Linköping University, Linköping, Sweden

6 Department of Clinical Physiology, Karolinska University Hospital, Stockholm, Sweden

7 Department of Clinical Science, Division of Medical Imaging and Technology, Intervention and Technology, Karolinska Institutet, Stockholm, Sweden

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BMC Medical Imaging 2014, 14:20  doi:10.1186/1471-2342-14-20

Published: 2 June 2014



Studies of prenatal detection of congenital heart disease (CHD) in the UK, Italy, and Norway indicate that it should be possible to improve the prenatal detection rate of CHD in Sweden. These studies have shown that training programs, visualization of the outflow tracts and color-Doppler all can help to speed up and improve the detection rate and accuracy. We aimed to introduce a more accurate standardized fetal cardiac ultrasound screening protocol in Sweden.


A novel pedagogical model for training midwives in standardized cardiac imaging was developed, a model using a think-aloud analysis during a pre- and post-course test and a subsequent group reflection. The self-estimated difficulties and knowledge gaps of two experienced and two beginner midwives were identified. A two-day course with mixed lectures, demonstrations and hands-on sessions was followed by a feedback session three months later consisting of an interview and check-up. The long-term effects were tested two years later.


At the post-course test the self-assessed uncertainty was lower than at the pre-course test. The qualitative evaluation showed that the color Doppler images were difficult to interpret, but the training seems to have improved their ability to use the new technique. The ability to perform the method remained at the new level at follow-up both three months and two years later.


Our results indicate that by implementing new imaging modalities and providing hands-on training, uncertainty can be reduced and examination time decreased, but they also show that continuous on-site training with clinical and technical back-up is important.

Color Doppler; Congenital heart disease; Detection of congenital heart defects; Fetal heart scanning; Learning program; Prenatal cardiology; Second trimester screening; Standardized training program; Ultrasound screening