A Commentary on the Operational Feasibility of Midwife-Led Point-of-Care Ultrasound for Antenatal Risk Assessment in Rural Oromia

Antenatal care in rural Ethiopia is constrained by a shortage of skilled personnel and diagnostic tools. Point-of-care ultrasound (POCUS) could enable early identification of obstetric risks, but its operational feasibility within midwifery practice at peripheral health posts is not well understood. This commentary critically examines the operational feasibility of a midwife-led POCUS programme for antenatal risk assessment in rural health posts of the Oromia Region, Ethiopia. It focuses on practical implementation considerations beyond clinical accuracy. The commentary synthesises field observations and relevant operational literature. It employs a feasibility framework analysing acceptability, demand, implementation, practicality, and adaptation within the primary healthcare system. Key insights: Key operational barriers include midwives’ initial apprehension, which typically shifts to acceptance after hands-on training. A critical requirement is a robust, simplified referral pathway, as a notable proportion of scans identify conditions requiring escalation. Sustained clinical mentorship, beyond initial training, was the most important factor for maintaining competency and programme integrity. Midwife-led POCUS at the health post level is operationally feasible but is not merely a technical intervention. Its success depends on addressing systemic enablers, particularly sustained supportive supervision and functional referral networks. Integrate POCUS training into pre-service midwifery curricula. Develop standardised, simplified scanning protocols for rural settings. Establish formal mentorship and quality assurance cycles. Strengthen communication and transport links between health posts and referral centres prior to scale-up. Point-of-care ultrasound, midwifery, antenatal care, operational feasibility, rural health services, Ethiopia This commentary provides a pragmatic, system-oriented analysis for policymakers and programme managers considering the integration of midwife-led POCUS into rural antenatal care services.