Providers’ and pregnant women’s perspectives on obstetric point-of-care ultrasound use in peri-urban Karachi, Pakistan: a qualitative study

Abstract Background Ultrasound is essential for antenatal care (ANC), yet access remains limited in many low- and middle-income countries (LMICs) due to shortages of equipment and trained personnel. Point-of-care ultrasound (POCUS) offers a feasible solution for gestational dating, detection of high-risk conditions, and referral decision-making in these settings. Understanding the perspectives of both healthcare providers (HCPs) and pregnant women is important for successful integration of POCUS into routine antenatal care. This study aimed to explore the perceptions of obstetric POCUS use among HCPs and pregnant women at a peri-urban community in Karachi, Pakistan. Methods A qualitative study was conducted at a peri-urban site in Karachi, Pakistan to explore the perceptions of obstetric POCUS among HCPs and pregnant women. Purposive sampling was employed and in-depth interviews (IDIs) were conducted with pregnant women and HCPs from an ongoing POCUS cohort study until thematic saturation was achieved, yielding a total of nine participants (six pregnant women and three HCPs). Interviews were audio recorded, transcribed, translated, and analyzed using a thematic analysis framework. Results The five common themes identified were role of ultrasound, perceived utility of POCUS, limitations and areas of improvement, myths and misconceptions, and recommendations for future use. POCUS was perceived as a valuable and feasible tool for ANC due to its portability and ability to perform rapid assessment closer to communities. Women valued reduced travel times while HCPs highlighted its user-friendly design and short learning curve for basic obstetric assessment and referral decisions. However, concerns regarding technical difficulties and diagnostic limitations were also noted. Moreover, pregnant women and providers appraised POCUS from different vantage points: women’s confidence was largely driven by the reassurance of seeing the fetus directly, while providers held a more cautious view of what the device could diagnose. Findings were consistent with key constructs of the Technology Acceptance Model (TAM), as both women and providers recognized POCUS as a practical and beneficial addition to antenatal care. Both groups supported expanding POCUS use in community-based antenatal care. Conclusions Targeted interventions focusing on structured training and community education may support effective integration of POCUS into routine ANC and improve access to obstetric imaging in underserved communities, with the potential to improve maternal and neonatal outcomes.