Abstract
<title>Abstract</title> <p>Background Stillbirth remains a major global health problem, with most occurring in low- and middle-income countries (LMICs). Novel antenatal technologies, including Doppler ultrasound, maternal haemodynamic monitoring and artificial intelligence (AI)-enabled ultrasound, may improve antenatal risk detection. However, successful implementation in routine care depends on more than technical performance. We explored the perspectives of women, healthcare workers, and hospital managers on the implementation of novel antenatal technologies within routine pregnancy care services in Uganda. Methods This is a qualitative study, embedded within the multi-site iTECH study across four Ugandan referral hospitals. Data were collected through focus group discussions with women attending antenatal care and village health team members; semi-structured interviews with women who had experienced stillbirth or recent live birth and healthcare workers involved in antenatal care; and key informant interviews with hospital managers. Data were analysed using an inductive thematic approach, supported by NVivo 14, to identify emerging themes. Results Fifty-six participants were included: 27 women, 18 healthcare workers, and 11 community leaders. Three interrelated themes emerged: (1) acceptability of novel antenatal technologies, (2) integration into routine clinical practice, and (3) health system adoption. Participants viewed these technologies as potentially valuable for improving risk detection, particularly when accompanied by clear communication and person-centred care. However, effective integration depended on the ability of healthcare workers to interpret results, coordinate across teams, and incorporate findings into clinical workflows. Wider adoption was constrained by including workforce shortages, lack of standardised guidelines, infrastructure instability, and governance gaps. AI-enabled ultrasound was perceived as promising particularly where sonography capacity was limited, but its value was context-dependent, requiring validation, clinical integration, and health-system readiness. Conclusions Novel antenatal technologies have the potential to strengthen maternal and perinatal care in LMICs, but their impact depends on alignment across three interconnected levels: acceptability, integration into routine practice, and health system adoption. Embedding technologies within person-centred communication, coordinated workflows, and supportive health systems is essential to delivering meaningful clinical benefit.</p>